RNA therapeutics
Early health-technology assessment finds both olpasiran and pelacarsen highly cost-effective for secondary CHD prevention in Bulgaria (Clinicoecon Outcomes Res 2026)
Original title: Early Health Technology Assessment (HTA) of Olpasiran and Pelacarsen for Secondary Prevention of Coronary Heart Disease (CHD)
This early health technology assessment built a Markov state-transition model, using OCEAN(a)-Outcomes and Lp(a) HORIZON trial data plus Mendelian randomisation evidence, to simulate a cohort of 597 patients with prior coronary heart disease, familial hypercholesterolaemia and elevated Lp(a). Olpasiran 150 mg every three months added to standard of care saved 3.29 QALYs undiscounted (0.23 QALYs with 3.5% annual discounting) compared with standard of care alone, while pelacarsen 80 mg monthly saved 8.63 QALYs undiscounted (0.58 discounted). Against Bulgaria's GDP-per-capita cost-effectiveness threshold, olpasiran was highly cost-effective at an annual price of 10,424.78 BGN and pelacarsen at 6,105.99 BGN. This is an early, model-based economic case for both RNA-targeted Lp(a)-lowering agents ahead of their pivotal outcomes trials reading out, specific to one country's pricing and thresholds.
Original abstract
Purpose: In recent studies elevated lipoprotein(a) (Lp(a)) levels have been identified as an independent and causal risk factor for atherosclerosis and coronary heart disease. This study aims to perform a comparative early health technology assessment (HTA) of olpasiran and pelacarsen for secondary prevention of coronary heart disease (CHD) in patients with atherosclerotic cardiovascular disease, familial hypercholesterolemia, and elevated Lp(a).
Patients And Methods: We developed a Markov state transition model to simulate the progression of a cohort of 597 patients with history of coronary heart disease (CHD) as myocardial infarction, coronary artery disease or peripheral artery disease, familial hypercholesterolaemia in the treatment arms of OCEAN(a)-Outcomes trial (NCT05581303) [16] and Lp(a) HORIZON trial (NCT04023552). Baseline risks of CHD, costs and utilities were obtained from published sources. Clinical trial data were used to derive reductions in lipoprotein(a). Mendelian randomization study data were used to estimate clinical benefits. Annual discounting was 3.5%.
Results: The treating strategy comprising olpasiran 150 mg every 3 months in addition to standard of care saved 3.29 QALYs, compared with standard of-care alone. With 3.5% annual discounting, there were 0.23 QALYs saved. The treating strategy comprising pelacarsen 80 mg every month in addition to standard of care saved 8.63 QALYs, compared with standard of-care alone (undiscounted). With 3.5% annual discounting, there were 0.58 QALYs saved.
Conclusion: We found that olpasiran was highly cost-effective at the annual price of 10,424.78 BGN, compared with standard-of-care alone. Pelacarsen was highly cost-effective at the annual price of 6105.99 BGN. The threshold applied is that of gross domestic product (GDP) per capita as indicated by the National Council on prices and reimbursement of medicinal products in Bulgaria.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.