{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:34:47Z","timestamp":1790087687105,"version":"4.0.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"13","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2012582"],"award-info":[{"award-number":["2012582"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2012582"],"award-info":[{"award-number":["2012582"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Heart Foundation Postdoctoral Fellowship","award":["108269-2024"],"award-info":[{"award-number":["108269-2024"]}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Approximately 1 in 11 people are intolerant to statins. There have been no studies evaluating the cost-effectiveness of early intervention for primary prevention of cardiovascular disease (CVD) with three non-statin drugs [ezetimibe, proprotein convertase subtilisin\u2013kexin type 9 inhibitors (PCSK9i; inclisiran and evolocumab), and bempedoic acid]. We aimed to evaluate the cost-effectiveness of these therapies when initiated at age 40 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We used a published microsimulation model populated with 108 statin-intolerant individuals. The model simulated the ageing of individuals from 40 to 85 years. We calculated the incremental cost-effectiveness ratio when non-statin lipid-lowering strategies were initiated at age 40 years compared to no intervention until a cardiovascular event. Incremental cost-effectiveness ratios were compared to Australian and UK cost-effectiveness thresholds of 28 000 AUD and 25 000 GBP per quality adjusted life year gained, respectively. We adopted each countries national healthcare system perspective (2022 AUD\/GBP) and discounted health economic results by 5% annually for Australia and 3.5% annually for the UK. At current prices in Australia, ezetimibe was cost-effective in 34\/108 (31.4%) individuals simulated; bempedoic acid in 17\/108 (15.7%); bempedoic acid and ezetimibe in combination in 14\/108 (13.0%); while inclisiran and evolocumab were not cost-effective in any individuals. Corresponding numbers for the UK were 98\/108 (90.7%); 5\/108 (4.6%); 11\/108 (10.2%); 0\/108 (0.0%); and 0\/108 (0.0%). Cost-effectiveness of bempedoic acid was predominantly among individuals with an LDL-C of at least 4.0\u2005mmol\/L and systolic blood pressure of at least 140\u2005mmHg in Australia and 5.0\u2005mmol\/L and 160\u2005mmHg in the UK, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Ezetimibe and bempedoic acid, both alone and in combination, are cost-effective for long-term primary prevention of CVD in a range of people with statin intolerance, depending on their baseline risk of CVD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf114","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T08:52:20Z","timestamp":1740473540000},"page":"1259-1270","source":"Crossref","is-referenced-by-count":11,"title":["Rethinking cardiovascular prevention: cost-effective cholesterol lowering for statin-intolerant patients in Australia and the UK"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3231-5758","authenticated-orcid":false,"given":"Jedidiah I","family":"Morton","sequence":"first","affiliation":[{"name":"Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University , 381 Royal Parade, Parkville, VIC 3052, Australia"},{"name":"Diabetes and Population Health, Baker Heart and Diabetes Institute , 75 Commercial Rd, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Liew","sequence":"additional","affiliation":[{"name":"Adelaide Medical School, University of Adelaide , Adelaide ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald F","family":"Watts","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Western Australia , Perth ,","place":["Australia"]},{"name":"Departments of Internal Medicine and Cardiology, Royal Perth Hospital, Perth ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Zoungas","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University , 553 St Kilda Rd, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Victorian Heart Institute, Monash University ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5285-409X","authenticated-orcid":false,"given":"Padraig","family":"Dixon","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0625-3522","authenticated-orcid":false,"given":"Zanfina","family":"Ademi","sequence":"additional","affiliation":[{"name":"Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University , 381 Royal Parade, Parkville, VIC 3052, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University , 553 St Kilda Rd, Melbourne, VIC 3004, Australia"},{"name":"Central Clinical School, Monash University , 99 Commercial Rd, Melbourne, VIC 3004, Australia"},{"name":"School of Pharmacy, University of Eastern Finland , P.O. Box 1627, FI-70211 Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"2025092119523304600_zwaf114-B1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025092119523304600_zwaf114-B2","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1001\/jama.2019.14120","article-title":"Association of genetic variants related to combined exposure to lower low-density lipoproteins and lower systolic blood pressure with lifetime risk of cardiovascular disease","volume":"322","author":"Ference","year":"2019","journal-title":"JAMA"},{"key":"2025092119523304600_zwaf114-B3","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1093\/eurheartj\/ehx144","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. 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