A new meta-analysis pooled data from 63,328 patients with atherosclerotic cardiovascular disease (ASCVD) to compare three PCSK9 inhibitors (alirocumab, evolocumab, and inclisiran) against standard care, which included statins with or without ezetimibe. The analysis combined results from multiple randomized trials to give a clearer picture of how these newer cholesterol-lowering drugs perform.
All three drugs significantly reduced LDL cholesterol levels compared with standard care. Both alirocumab and evolocumab also lowered the risk of non-fatal heart attacks. However, none of the drugs showed a statistically significant difference in stroke outcomes. The study did not report any increased risk of serious adverse events for any of the three drugs.
The analysis also looked at cost-effectiveness. Alirocumab cost about $12,791 per quality-adjusted life year (QALY), evolocumab about $11,646 per QALY, and inclisiran about $31,730 per QALY. In a scenario where inclisiran's price was reduced by 72.1%, its cost-effectiveness improved to $9,686 per QALY, with a 96.6% probability of being cost-effective at a willingness-to-pay threshold of $13,410 per QALY.
This is a meta-analysis, meaning it combines existing studies, so the results are only as reliable as those studies. Also, the cost-effectiveness findings for inclisiran depend heavily on a specific price reduction scenario. For patients, this suggests that PCSK9 inhibitors are effective at lowering cholesterol and preventing heart attacks, but they may not reduce stroke risk. Anyone considering these drugs should discuss their individual risks and costs with their doctor.
