SIGNALLING DEMAND: PCSK9 INHIBITORS FOR STATIN INTOLERANT INDIVIDUALS
PCSK9 inhibitors are a class of LDL cholesterol-lowering therapy that aim to reduce an individual's risk of experiencing a cardiovascular event. The National Institute for Health and Care Excellence and the Institute for Clinical and Economic Review have in recent years issued recommendations stating that PCSK9 inhibitors are not cost-effective at their listed price in the UK and US, respectively. The purpose of this paper was to establish a demand curve for PCSK9 inhibitor therapy in a stratified sample of the Scottish population, assuming that the individuals were statin intolerant.
The Scottish CVD Policy Model, a previously published decision analytic model, was used to simulate PCSK9 inhibitor therapy in all CVD-free individuals included in the Scottish Health Survey 2011. The incremental costs and QALYs associated with PCSK9 inhibitor therapy treatment compared to no treatment were recorded. The net monetary benefit of treatment, with intervention costs subtracted, was calculated for each individual at a range of willingness-to-pay thresholds. Reverse cost-effectiveness analysis was employed to establish the annual treatment cost at which each individual in the dataset would be cost-effective to treat. A demand curve was then produced for this population.
The results from the analysis, with a willingness-to-pay threshold of £25,000/QALY, are displayed in the figure below. At an annual treatment cost of £133, PCSK9 inhibitor therapy should be made available to 50% of the population. At an annual treatment cost of £901, a PCSK9 inhibitor therapy should be made available to 5% of the population. At the currently listed price for PCSK9 inhibitor therapy in the UK, not one individual in the dataset would be deemed cost-effective to treat.
At their current price, PCSK9 inhibitors are unlikely to be regarded as a cost-effective means of averting primary cardiovascular events in any subgroup of statin intolerant individuals in Scotland. Using the methodology applied in this paper, a payer can signal their demand curve for PCSK9 inhibitors. A rational monopolist manufacturer acting in a perfect market will respond to such a demand curve and price their intervention such that marginal revenue is equal to the marginal cost of production.