Opinion
Video
Clinical Value of Nonstatin Therapies
Author(s):
Panelists discuss how evidence from a value-based care perspective demonstrates long-term health benefits, including reduced recurrent events and hospitalizations, as well as cost savings associated with intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies beyond statins in patients who are very high-risk post-atherosclerotic cardiovascular disease (ASCVD), while also addressing key challenges health care providers face in selecting nonstatin therapies and strategies to overcome them.
Evidence on Long-Term Health Outcomes and Cost Savings:
From a value-based care perspective, evidence suggests that intensive LDL-C–lowering therapies beyond statins, such as PCSK9 inhibitors, ezetimibe, and bempedoic acid, provide significant benefits for patients who are very high-risk post-ASCVD. These therapies have been shown to further reduce LDL-C levels, leading to a reduction in recurrent cardiovascular events, hospitalizations, and overall mortality. For example, studies have demonstrated that adding PCSK9 inhibitors or ezetimibe to statin therapy in high-risk patients can reduce major adverse cardiovascular events and improve long-term outcomes. Additionally, while these therapies may have higher initial costs, they can potentially lead to cost savings over time by reducing hospital admissions and the need for long-term care due to complications from recurrent events.
Key Challenges in Selecting Nonstatin Therapies: Health care providers face several challenges when selecting nonstatin LDL-C–lowering therapies for post-ASCVD patients:
Cost and access: Many of the nonstatin therapies, such as PCSK9 inhibitors, are expensive, and insurance coverage may be limited, making them less accessible for some patients.
Patient adherence: Long-term adherence to intensive LDL-C–lowering therapies can be difficult due to adverse effects, complex regimens, or the perception that the therapy is not necessary if the patient feels well.
Clinical experience and education: Providers may not be fully familiar with the newer nonstatin therapies, and a lack of awareness or experience with these treatments may influence prescribing decisions.
Risk of adverse effects: While nonstatin therapies are generally well tolerated, some patients may experience adverse effects, and providers must balance the benefits with potential risks.
Overcoming These Challenges:
- Cost management: To address cost concerns, providers can work closely with patients and insurance companies to explore reimbursement options, such as patient assistance programs, and consider generic alternatives such as ezetimibe.
- Patient education and engagement: Physicians can improve patient adherence by educating patients about the importance of LDL-C reduction in preventing future cardiovascular events, addressing concerns about adverse effects, and offering personalized care plans.
- Professional development: Continuing education for health care providers on the latest therapies and their clinical benefits will help ensure that providers are informed and comfortable prescribing these treatments.
- Monitoring and support: Ongoing monitoring and support, such as regular follow-ups and adjustment of therapies as needed, can help optimize patient outcomes and minimize adverse effects.
Conclusion
In summary, while nonstatin LDL-C–lowering therapies offer promising benefits for patients who are very high-risk post-ASCVD in terms of reducing recurrent events and hospitalizations, challenges such as cost, patient adherence, and provider education must be addressed to ensure these therapies are effectively utilized.
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