Should we continue to subsidise therapeutics with uncertain efficacy? Health economic implications for icosapent ethyl

In 2019, the results of the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) were published,1 which showed that in patients with elevated triglyceride levels receiving statin therapy, the addition of icosapent ethyl [an ethyl ester of the omega-3 fatty acid eicosapentaenoic acid (EPA)] led to a 25% relative reduction in the risk of major adverse cardiovascular events [hazard ratio (HR): 0.75 (95% CI: 0.68–0.83)] compared with a mineral oil comparator. In order to inform payers looking to subsidise the cost of icosapent ethyl, Ademi et al.2 published a cost-effectiveness analysis based on this 25% risk reduction and showed that icosapent ethyl in combination with statin therapy is likely cost-effective in a secondary preventive setting [assuming a willingness-to-pay threshold of AU$50 000 per quality adjusted life year (QALY) gained].

However, recent evidence (reviewed below) suggests this may be an overestimate of the efficacy of icosapent ethyl. With an aging population and the associated expectation of increased healthcare spending, there is an ever-increasing need to invest limited healthcare resources in the most efficient way. It is thus of considerable importance to assess the health economic implications of uncertain efficacy of icosapent ethyl; in this viewpoint, we discuss these implications in response to aspects of recent trials of omega-3 fatty acids.