{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T22:17:27Z","timestamp":1775600247933,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,11,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The FOURIER (Further Cardiovascular Outcomes Research With PCSK9i [Proprotein Convertase Subtilisin\u2010Kexin Type 9 Inhibitors] in Subjects With Elevated Risk) trial found a reduction in cardiovascular events in patients with atherosclerotic cardiovascular disease (\n              <jats:styled-content style=\"fixed-case\">ASCVD<\/jats:styled-content>\n              ). Our objective was to estimate the eligibility, clinical outcomes, and budget impact of adopting\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i in a large healthcare system.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Ontario, Canada, residents alive in 2011, aged 40 to 85\u00a0years, were eligible for inclusion.\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i eligibility was determined on the basis of\n              <jats:styled-content style=\"fixed-case\">FOURIER<\/jats:styled-content>\n              trial definition. Hazard ratios observed in the\n              <jats:styled-content style=\"fixed-case\">FOURIER<\/jats:styled-content>\n              trial were applied to assess the number of events that could be avoided. Budget impact was calculated as the difference between projected costs of treatment adoption and events avoided if\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i were used. Of the 2.4\u00a0million included individuals, 5.3% had a history of\n              <jats:styled-content style=\"fixed-case\">ASCVD<\/jats:styled-content>\n              . We estimated that 2.7% of the general population and 51.9% of the patients with ASCVD would be eligible for\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i. Adoption of\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i in all eligible patients with ASCVD was projected to reduce primary events rates by 1.8% after 3\u00a0years. Despite cost reduction of $44\u00a0million in events,\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i adoption would have a net budget impact of $1.5\u00a0billion over 3\u00a0years. Potential benefits of\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i varied widely across subgroups, with the largest absolute risk reduction estimated to be 4.3% at 3\u00a0years in peripheral artery disease. In this subgroup of 5601 patients, the budget impact of treatment adoption was $116\u00a0million.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We estimated that \u22481 in 2 patients with ASCVD would be eligible for\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i. The budget impact of adopting\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i for all patients with ASCVD is substantial. Selective adoption to high\u2010risk patients will lessen the overall budgetary impact of\n              <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>\n              9i treatment.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.010007","type":"journal-article","created":{"date-parts":[[2018,12,16]],"date-time":"2018-12-16T20:51:35Z","timestamp":1544993495000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Eligibility, Clinical Outcomes, and Budget Impact of PCSK9 Inhibitor Adoption: The CANHEART PCSK9 Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Dennis T.","family":"Ko","sequence":"first","affiliation":[{"name":"Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"University of Toronto Ontario 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