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Vol. 71. Issue 12.
Pages 1090 (December 2018)
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Vol. 71. Issue 12.
Pages 1090 (December 2018)
Letter to the Editor
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Cost-effectiveness of Evolocumab. Response
Coste-efectividad del evolocumab. Respuesta
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Antonio Olry de Labry Limaa,b,c,
Corresponding author
, Antonio Matas Hocesd, Emilio Jesús Alegre del Reye, Vicente Gimeno Ballesterf
a Escuela Andaluza de Salud Pública (EASP), Granada, Spain
b Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada, Universidad de Granada, Spain
c CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
d Centro Andaluz de Documentación e Información del Medicamento (CADIME), Granada, Spain
e Servicio de Farmacia, Hospital Universitario Puerto Real, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
f Servicio de Farmacia, Hospital Universitario Miguel Servet, Zaragoza, Spain
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To the Editor,

We appreciate the authors’ comments contained in their letter, which enabled the correction of an error in the cost of evolocumab at 10 years reported in the article previously published online (the correct average costs of evolocumab and standard treatment are 47 297.16 and 1622.63 euros respectively). We will now elaborate on some of the comments made on the study.1 First, we believe that to facilitate understanding it is important to consider the results of the key variables in absolute values. Thus, while it remains true that there is a relative reduction of 15% and 20% in the primary and secondary variables, respectively, this difference can be expressed as a 1.5% reduction in both variables compared with the total population. For every 100 patients treated, there were 1.5 fewer patients with an event in the intervention group than in the control group.

We agree that it is difficult to collect data on cost, and hope that the IMPACT-HTA project, whose aims include the creation of a repository of direct and indirect costs, will facilitate future economic assessments.2

Ideally, we would have access to information on evolocumab treatment outcomes in a population with the same conditions of use established in Spain (≥ 100mg/dL), but, as mentioned in the discussion, the efficacy was not superior in patients with higher levels of low-density lipoprotein cholesterol. It would also be interesting to use a time scale longer than 10 years, but only 26 months of evidence was available. Projecting the effects over time does not improve the evidence, as costs increase simultaneously. No benefit was reached in cardiovascular mortality (hazard ratio=1.05; P=.62); to explain this finding, it would also be pertinent to know the cardiovascular variables not described.

Finally, the lack of an effectiveness threshold makes it difficult–although not impossible–to draw conclusions, which are obviously open to debate.3 To conclude that evolocumab is not cost-effective for the Spanish National Health System would be in line with the findings that it has not been demonstrated to be cost-effective in other counties such as the United Kingdom, Austria, and Finland, as well as the United States.4

References
[1]
A. Olry de Labry Lima, V. Gimeno-Ballester, J.F. Sierra-Sánchez, A. Matas Hoces, J. González-Outón, E.J. Alegre del Rey.
Cost-effectiveness and budget impact of treatment with evolocumab versus statins and ezetimibe for hypercholesterolemia in Spain.
Rev Esp Cardiol., 71 (2018), pp. 1027-1035
[2]
Servicio de Información Comunitario sobre Investigación y Desarrollo (CORDIS). Improved methods and actionable tools for enhancing health technology assessment. Available at: https://cordis.europa.eu/project/rcn/213045_es.html. Accessed 30 Apr 2018.
[3]
C. Campillo-Artero, V. Ortún.
Cost-effectiveness analysis: why and how.
Rev Esp Cardiol., 69 (2016), pp. 370-373
[4]
KaziDS, A.E. Moran, P.G. Coxson, et al.
Cost-effectiveness of PCSK9 inhibitor therapy in patients with heterozygous familial hypercholesterolemia or atherosclerotic cardiovascular disease.
JAMA., 316 (2016), pp. 743-753
Copyright © 2018. Sociedad Española de Cardiología
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