CVD: Cost-Effectiveness Data and Treatment Selection

Implications of cost-effectiveness analysis data on treatment selection to reduce the risk of cardiovascular events.


Deepak L. Bhatt, MD, MPH: Maybe I could just turn to Dr Navar and ask, how do you use all this cost-effectiveness information, such as what was just presented, in terms of actual decision-making with your patients? Do you actually factor it in?

Ann Marie Navar, MD, PhD: The reality of how we take care of patients in clinic is that a lot of it is driven by what the costs are to the individual patient, which is driven by what the payers are doing in terms of coverage, which is driven by the cost effectiveness. Oftentimes, when I’m trying to explain why a medication is so expensive, I say, “We’re going to start with ezetimibe because PCSK9 inhibitors are very expensive. Let’s see how low we can get your LDL [low-density lipoprotein] cholesterol with this lower-cost therapy first.”

Rather than talk about the specifics of the cost effectiveness, I think generalities around the cost of therapies and the potential value of therapies actually resonate with patients. People want to know if a therapy is going to be worth it or not.

It can be helpful when we’re talking generally about therapies, and maybe it’s been really helpful when they incorporated that into the guidelines to help us justify the use of ezetimibe after statins instead of PCSK9 inhibitors, even though that wasn’t what was tested in the trial. It has also been incredibly helpful in that because icosapent ethyl is cost saving, when I prescribe it to patients it’s often approved by the payers. The co-pays are fairly low. A lot of that is because the payer interpretation of the cost-effectiveness data has led to favorable coverage and cost sharing for the patients.

Deepak L. Bhatt, MD, MPH: Maybe I can turn to Dr Budoff. Regarding cost-effectiveness analyses in general, but specifically related to the ones we’re talking about here—PCSK9 inhibitors, icosapent ethyl—do they influence anything you do?

Matthew J. Budoff, MD: I think so. The clinician understands enough. They obviously do not understand in the detail that some of the experts would, but they understand enough that cost savings or being highly cost effective is something we need to strive for. We’re being pushed by many different groups and our own practices to be more cost effective in how we practice. If we can be cost saving, that has a huge implication for patients and the health care system in general.

This type of data is very impactful to the clinician to help them understand that this is something that’s going to actually lead to saving money rather than further increasing our cost burden for the health care system.

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