Abstract 243: A Novel Cost Effectiveness Model of Eicosapentaenoic Acid (EPA) for Secondary Prevention in the United States

Abstract

Background: Cardiovascular disease (CVD) is responsible for one in every four deaths in the United States as well as direct and indirect costs exceeding $100 billion. Each year in the US, 210,000 heart attacks and 185,000 strokes occur among patients who have previously experienced one. Given the substantial burden of CVD, a novel model was developed to explore the cost-effectiveness of a prescription EPA only omega-3 intervention among secondary prevention populations in the US. Methods: The framework and initial clinical data source for model input was the published Japanese EPA Lipid Intervention Study (JELIS) secondary prevention strata, which included major coronary and stroke endpoints. Two US-focused base case scenarios were developed based on published data: a standard and an aggressive scenario, with the aggressive scenario assuming a highly effective intervention. Costs and utilities were derived from published studies in the US, or the wholesale acquisition cost (WAC), in the case of prescription costs. The initial utility value assigned to this secondary prevention population was 0.78, with unique decrements for each event. Expert opinion was used when clinical assumptions were required for unreported data points. The model takes the perspective of a US, commercial, third-party payer. Costs are presented in 2014 US$. The model extends for 5 years and applies a discount rate of 3% to costs and benefits. Sensitivity analyses are presented to understand the influence of various parameters on outcomes. Results: Under the base case assumptions for the standard US scenario, EPA plus statins compared to statins alone was associated with cost savings (average 5-year costs $29,393 vs. $30,587 per person for EPA plus statins vs statins monotherapy, respectively) and improved utilities (average 3.61 vs. 3.56 respectively), denoting that the strategy of combining EPA with statin therapy exceeds accepted thresholds for cost-effectiveness when compared to statin monotherapy. The aggressive scenario was even more favorable for the combined strategy; being more cost-effective than statin monotherapy, with five-year savings ($29,707 vs. $38,793) and more utilities accrued (3.61 vs 3.50). The results of this model were found to be robust during sensitivity analyses exploring alternative scenarios, with consistent findings of cost-effectiveness or cost savings in the standard and aggressive US scenarios. Conclusions: This novel model suggests that combining EPA with statin therapy for secondary prevention of cardiovascular disease in the United States may be cost-saving and appears to be a more compelling intervention than statin monotherapy. The framework of this model provides a starting point for development of microsimulation models as more data become available.