Abstract DP158: Cost-effectiveness of theoretical benefit of PCSK9 inhibitor use in patients with stroke due to severe intracranial atherosclerosis: A post hoc analysis of the SAMMPRIS trial

Introduction: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) can reduce low density lipoprotein (LDL) levels by approximately 60% when added to maximally tolerated statins, which leads to a decrease in atherosclerotic events. For patients with intracranial atherosclerosis >70%, who are at high risk of recurrent stroke, these agents may significantly lessen recurrent stroke events. Methods: With individual patient data from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study, we utilized prior estimates of the LDL-lowering effect on reduction of recurrent stroke rates to estimate cost-effectiveness of PCSK9i. Using a base-case assumption of 32% relative risk reduction for recurrent stroke in this population, and cost parameters drawn from current US healthcare expenditures (with a willingness-to-pay [WTP] threshold of