The Lifetime Worth of Icosapent Ethyl: A Cost Effective Analysis of REDUCE-IT

Cost-effective analysis of the Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial(REDUCE-IT) revealed more incremental quality-adjusted life-years (QALYs) during the trial and adjusted during the lifetime, according to a recent study published in JAMA Network.1

The REDUCE-IT trial enrolled patients with hypertriglyceridemia and high-risk patients and history of cardiovascular disease or diabetes along with at least one other risk factor and already on statins and randomized among 4 gm/day of icosapent ethyl (IPE) and placebo. The trial enrolled 8179 patients(4089 in IPE, 4090 in placebo arm) with a median follow up of 4.9 years, revealing a reduction in the primary composite endpoint of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina in the IPE arm (HR:0.75, CI: 0.68-0.83, p<0.0001) and number needed to treat of 21.2

The cost-effectiveness of IPE has been questioned; authors performed cost-effectiveness analysis from patient-based data, revealing IPE group with more QALYs during the trial (3.34 vs. 3.27) and lifetime projections (10.59 vs. 10.35) than placebo arm.

Interestingly, total health care cost was higher in the IPE arm during the period of trial than standard of care. Nevertheless, However, IPE arm had higher (3.34) QALY than standard of care (3.27) and this effect continued over lifetime projections as well(10.59 for IPE vs 10.25). IPE was found to be cost effective ($195,276) than standard of care ($197,064) at a mean difference of -$1788 (95% CI: -$9735-$6159) using SSR cost during lifetime. However, when comparing the wholesale acquisition cost (WAC), IPE was costly ($202,830) than standard of care ($197,064) with mean difference of $5766 (95% CI, $1094-$10,438) over lifetime.1

Overall, IPE was cheaper and cost-effective revealing, a 58.4% lifetime probability of costing less and 89.4% and 72.5% probability of costing less than $50,000 per QALY using SSR and WAC cost respectively.

This is a unique study shedding light on the cost effectiveness of IPE over lifetime in high-risk patients which will be helpful in primary and secondary prevention of cardiovascular diseases.

Lead principal investigator of REDUCE-IT trial, Dr. Deepak L. Bhatt,  Executive Director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical Schoool says, “This analysis from REDUCE-IT finds that icosapent ethyl is highly cost-effective. Coupled with the large reductions in cardiovascular events, these data provide a strong rationale to icosapent ethyl in all eligible patients.”