Theoretical Cost-Effectiveness of PCSK9 Inhibitors in Stroke Due to Intracranial Atherosclerosis

Given the high costs of treatment, are proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) cost-effective for patients with stroke due to intracranial atherosclerosis?This economic evaluation of 367 patients with recent strokes attributed to intracranial atherosclerotic stenosis used theoretical estimates of PCSK9i treatment effect and found that the probability of cost-effectiveness for reducing recurrent stroke at 5 years was 58.6% for alirocumab, 53.8% for evolocumab, and 36.7% for inclisiran.These findings suggest that within this theoretical framework, alirocumab and evolocumab were cost-effective for preventing recurrent stroke at current direct-to-consumer annual prices of $6600 and $7200, respectively.

Corresponding Author: James E. Siegler, MD, Department of Neurology, University of Chicago, 5841 S Maryland Ave, MC 2030, S243, Chicago, IL 60637 (siegler.james@gmail.com).

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