High cost but effective therapies should be value based. The vascular risk foundation presents a cost calculator (update 18.08.2019) which is value based and allows to calculate individual prices per patient that are cost-efficient when using PCSK9-inhibitors.
Variables that influence cost-efficiency calculations are the current price of the drug, the medical effect of the drug, the associated relative risk reduction in a patient with a certain amount of risk and a certain amount of a modifiable risk factor.
Cost-efficiency relies further on the effect of the therapy on quality of life. In our calculator we present 3 ways for input amounts, first, Swiss Medical Board Statin report, second, values for a statistical life publicated by Schlander et al and the relation between direct and indirect costs provided by the European Union, and finally an FDA approach regarding value of life, loss of QALY due to myocardial infarction and value of non-fatal events.
The concept of QALY relies on the validity of quality of life measures. This posteriori vue of an event is usually associated by a loss of quality of life of 20%. The FDA calcualted 29%. Ex ante, for a given patient, avoidance of a disabilitating stroke, may be viewed as a loss of life quality after the event has occured, and despite post-infarction rehabilitation, as a loss of quality of e.g. 70%. Therefore, ex ante, when treating a patient, ex ante estimates of the wish of a patient are important.