Background

Improved survival after a cardiovascular event has led to an expanding patient population at very high risk of recurrent events. Reduction in low-density lipoprotein cholesterol, and thus implicitly non–high-density lipoprotein cholesterol, to guideline-recommended goals is a key tenet of secondary prevention. Yet, standard-of-care treatment with statin (with or without ezetimibe) often leaves a high risk of preventable cardiovascular events. Inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), highly efficacious lipid-lowering treatments that confer reduction in cardiovascular events and death, clearly have a role in the personalized management of these very-high-risk patients. Given budget constraints, however, their integration into the health care pathway merits health economic considerations. Consequently, it is important to identify challenges at the crossroads of the clinical and economic dimensions.

Findings and conclusion

Health economic analyses involve application of modeling scenarios integrating multiple parameters to ultimately yield values for quality-adjusted life-years and cost-effectiveness ratios. To date, these analyses have led to widely variable estimates of these benchmarks for PCSK9 inhibitors, causing confusion among stakeholders in the health care pathway. Clearly, a consensual approach to the conduct and reporting of health economic analyses involving all players, including noneconomists such as clinicians and patient advocates, is essential to bridge the gap between the clinical needs of patients and financial access to PCSK9 inhibition.

中文翻译：

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PCSK9抑制，动脉粥样硬化性心血管疾病和卫生经济学：十字路口的挑战。

背景

心血管事件后存活率的提高导致复发事件风险很高的患者人数不断增加。降低低密度脂蛋白胆固醇，从而隐含地非高密度脂蛋白胆固醇，以达到指南推荐的目标，是二级预防的主要宗旨。然而，使用他汀类药物（有或没有依泽替米贝）的标准护理治疗通常会导致可预防的心血管事件的高风险。前蛋白转化酶枯草杆菌蛋白酶/ kexin 9型抑制剂（PCSK9）是一种有效的降脂疗法，可减少心血管事件和死亡，显然在这些高危患者的个性化治疗中发挥了作用。但是，鉴于预算限制，将它们纳入卫生保健途径值得考虑卫生经济因素。所以，

结论与结论

卫生经济分析涉及建模方案的应用，该方案方案集成了多个参数，以最终产生质量调整后的寿命年和成本效益比的值。迄今为止，这些分析已导致对PCSK9抑制剂的这些基准进行了广泛的估计，从而在卫生保健途径的利益相关者之间造成了混乱。显然，采取共识性方法进行和报告涉及所有参与者的健康经济分析，包括非经济学家，例如临床医生和患者权益倡导者，对于弥合患者的临床需求与财务上获得PCSK9抑制作用之间的差距至关重要。