New blood cholesterol lowering guidelines were recently released by the American Heart Association and the American College of Cardiology which include recommendations for ezitimbe and PCSK9-Inhibitors, like alirocumab.(1) These agents that can be added to statin therapy for both primary and  secondary prevention of acute cardiovascular disease in patients unable reduce LDL-C to target goals.  The ODYSSEY Outcomes (2) (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial was the first trial powered to evaluate the effect of alirocumab on cardiovascular events in high risk patients, showing a 15% reduction in a composite outcome of nonfatal myocardial infarction (MI), ischemic stroke, hospitalization for unstable angina, and coronary heart disease death, as well as a 15% reduction in all-cause mortality.  The cost-effectiveness of alirocumab and ezetimbe were also evalauated, showing that compared to a statin alone, the addition of ezetimibe cost $81 000 and the addition of alirocumab cost $308,000 per quality adjusted lines year (QALY).(3)  The authors concluded that the price of alirocumab would need to decrease from its original cost of $14 560 to $1974 annually to be cost-effective relative to ezetimibe.  While Regeneron Pharmaceuticals, maker of alirocumab, released a statement saying they disagreed with this analysis, they did lower their price from ~$14,000 a year to $7000 a year  

1) 2018 Guideline on the Management of Blood Cholesterol

2)  Szarek M, White HD, Schwartz GG, ODYSSEY OUTCOMES Committees and Investigators.  Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events in the ODYSSEY OUTCOMES Trial. J Am Coll Cardiol. 2018 Oct 27

3) Kazi DS, Penko J, Coxson PG, Guzman D, Wei PC, Bibbins-Domingo K. Cost-Effectiveness of Alirocumab: A Just-in-Time Analysis Based on the ODYSSEY Outcomes Trial. Ann Intern Med. 2019 Jan 1.

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