Icosapent Ethyl (Vascepa) Cost-Effective in REDUCE-IT USA-Confirmed what we predicted and see in the trenches

Cost-Effectivess of Icosapent Ethyl in REDUCE-IT USA:Results From Patients Randomized in the United States"authored by William S. Weintraub MD et al,was just published in J.Am.Heart Assoc.2024;13:e032413.DOI:10.1161/JAHA.123.032413

There was incremental gain in quality-adjusted life-years with IPE compared with standard care using in-trial(3.28 versus 3.13) and lifetime (10.36 versus 9.83) horizons.

Using an IPE cost of $4.59 per day ,health care costs were lower with IPE compared with standard care for both in-trial ($29,420 versus $30,947) and lifetime ($216,243 versus $219,212) analysis.IPE versus standard care was a dominant strategy in trial and over the lifetime ,with 99.7% lifetime probability of an incremental cost-effectiveness ratio <$50,000 per quality-adjusted life-year gained

IPE is cost-effective at $11.48 per day for conventional willingness-to-pay thresholds.(The cost per quality-adjusted life-year gained was $36,208 in trial and $9,582 over the lifetime)

These results were not surprising to me as we published in the Journal of Medical Economics(Sephy Philip et al.2016.Vol19,No.10,1003-1010) over 7 1/2 years ago(7/14/2016),long before REDUCE-IT(1/3/2019) was published that prescription IPE would be cost-effective.

We published that EPA-plus-statin therapy compared with statin monotherapy resulted in cost savings(total 5-year costs $29,393 versus $30,587 per person,respectively) and improved utilities(average 3.627 versus 5.575,respectively).Furthermore,our model actually probably underestimated the cost-effectiveness as it allowed only a single event per patient.

One can appreciate this benefit in cost-effectiveness by just looking at the total CVD event rate reduction from IPE.The impact of total CVD event reduction in REDUCE-IT is substantial: for every 1,000 patients treated with IPE for 5 years,approximately 159 total primary endpoints could be prevented,including 12 CVD deaths,42 MI';s,14 strokes,76 coronary revascularizations and 16 episodes of hospitalization for unstable angina(Bhatt DL et al.JACC.2019;73(22):2791-2802)

Millions of Americans can benefit from IPE.Nathan D. Wong,PhD,MPH et al published in Am.J.Cardiol.2020;134:62-68 from NHANES data ,using FDA eligibility criteria,an estimated 4.6 million persons would be eligible for IPE,with 60,544 preventable primary CVD outcomes annually from REDUCE-IT USA event rates !!!