Icosapent Ethyl May Be Cost Effective in Patients With Hypertriglyceridemia

William S. Weintraub, MD

The use of icosapent ethyl was projected to be cost-effective compared with standard care in high-risk patients with hypertriglyceridemia, according to a new in-trial cost-effectiveness analysis of the REDUCE-IT trial.

“The findings suggest that treatment with IPE may be cost-effective among patients with high cardiovascular risk whose triglyceride levels remain high despite statin therapy,” said study author William S. Weintraub, MD, Medstar Healthcare Delivery Research Network.

Although findings from the REDUCE-iT trial highlighted the efficacy and safety of icosapent ethyl in reducing cardiovascular events in high-risk patients, investigators had not observed whether these benefits provided good value for patients.

Thus, the team of investigators aimed to estimate “the incremental in-trial and lifetime health gains, health care costs, and cost-effectiveness of adding IPE, 4 g/d, to statin therapy.”

In REDUCE-IT, patients were randomized in a double-blinded manner to icosapent ethyl or placebo between November 2011 - May 2018. A total of 8179 patients with hypertriglyceridemia despite stable stain therapy were recruited.

Cost of medications was sourced from the SSR Health net cost (SSR cost). The SSR cost for icosapent ethyl was $4.16 per day, with an annual cost of $1518, while the Redbook wholesale acquisition cost (WAC) for icosapent ethyl was $9.28 per day, at an annual cost of $3387.

Investigators additionally determined quality-adjusted life-years (QALYs) by multiplying survival, measured in life-years, by utility. Statistical analysis was conducted from March 2018 - October 2021.

Assessments of the distribution of incremental costs and QALYs occurred in 5000 bootstrapped samples, with cost-effectiveness of icosapent ethyl expressed as the incremental cost-effectiveness ratio (ICER) in cost per life-year or QALY gained for icosapent ethyl, in comparison to standard care.

The study considered icosapent ethyl to be highly cost-effective if the ICER was less than $50,000 per QALY gained and intermediate between $50,000 - $150,000 per QALY gained.

A total of 4089 patients were randomly assigned to receive icosapent ethyl (71.6% men; median age, 64.0 years), while 4090 patients were randomized to receive standard care (70.8%; median age, 64.0 years).

Through the use of the SSR cost, the cost of icosapent ethyl was $18,786 and the cost of standard care was $17,273 at a mean difference of $1513 (95% CI, $155 - $2870). With the use of WAC, the cost of icosapent ethyl was $24,544 and the cost of standard care was $17,273 at a mean difference of $7271 (95% CI, $5911 - $8630).

Further, treatment with icosapent ethyl yielded 3.34 QALYs versus 3.27 QALYs in standard care (mean difference, 0.07; 95% CI, 0.01 - 0.12). This continued over a lifetime projection with 10.59 QALYs for icosapent ethyl versus 10.25 QALYs in standard of care (mean difference, 0.24; 95% CI, 0.15 - 0.33).

Data show the ICER point estimate was $22,311 per QALY gained using SSR cost and $107,218 per QALY gained using WAC.

The SSR cost found icosapent ethyl to be cost saving at $195,276 compared with standard care ($197,064) at a mean difference of -$1788 (95% CI, -$9735 to $6159). On the other hand, with the use of WAC, icosapent ethyl’s cost was $202,830 and the cost of standard care was $197,064, at a mean difference of $5766 (95% CI, $1094 - $10,438).

Compared to standard care, icosapent ethyl had a higher probability of costing less and more effective as such:

• 58.4% lifetime probability of costing less and being more effective using SSR cost
• 89.4% probability of costing <$50,000 per QALY gained when using SSR cost
• 72.5% probability of costing <$50,000 per QALY gained when using WAC

The study, “Cost-effectiveness of Icosapent Ethyl for High-risk Patients With Hypertriglyceridemia Despite Statin Treatment,” was published in JAMA Network Open.