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December 2017

Cost-effectiveness of PCSK9 Inhibitors: Proof in the Modeling

Author Affiliations
  • 1Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Editor, JAMA Cardiology
  • 3Department of Medicine, Stanford University, Stanford, California
  • 4Deputy Editor, JAMA Cardiology
JAMA Cardiol. 2017;2(12):1298-1299. doi:10.1001/jamacardio.2017.3656

In recent weeks, JAMA and JAMA Cardiology have published 3 separate cost-effectiveness analyses of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor drug evolocumab,1-3 each of which addresses the value proposition of this innovative but expensive therapy for reducing low-density lipoprotein cholesterol levels. These 3 analyses are timely in the wake of the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial,4 which demonstrated that the addition of evolocumab to baseline statin therapy resulted in significant reductions, compared with placebo, in cardiovascular events in high-risk secondary prevention patients. In 2 instances, the reports represent updates of analyses that predated the FOURIER results.1,3 Following the first update by Kazi et al,1 the editors undertook extensive discussion and decided to publish the next 2 analyses,2,3 although cognizant of the risks of appearing to disseminate repetitive findings. In addition to the value of publishing confirmatory results, we determined that these 3 analyses, when viewed collectively, would provide our readers with insights into the nuances of interpreting and understanding cost-effectiveness studies.