LDL, PCSK9 and the billion-dollar clinical trial

It will take more than $1 billion dollars for Amgen to determine whether their PCSK9 inhibitor (Repatha) is worth the money (list price = $14,523 per year). PCSK9 inhibitors have been hailed as a way to help people at risk of cardiac events lower their LDL levels. In a clinical trial with ~27,000 patients, Repatha worked, lowering LDL levels. Great, but Amgen’s stock dropped 6% when the results were released. Why? While LDL decreased, the reduction in cardiac events was mild. The math: 50 patients would have to be treated for 3 years to prevent 1 heart attack/stroke/death. BTW, 50 people at $14,523 per year for 3 years = ~$2.2 million to prevent 1 heart attack/stroke/death. May the odds be ever in your favor.