Elsevier

Clinical Therapeutics

Volume 30, Issue 8, August 2008, Pages 1508-1523
Clinical Therapeutics

Estimating the health benefits and costs associated with ezetimibe coadministered with statin therapy compared with higher dose statin monotherapy in patients with established cardiovascular disease: Results of a Markov model for UK costs using data registries

https://doi.org/10.1016/j.clinthera.2008.08.002Get rights and content

Abstract

Background: Ezetimibe has been reported to improve lipid control in patients with established cardiovascular disease (CVD).

Objective: The aim of this study was to estimate the potential long-term impact on health status of prescribing ezetimibe in combination with statin therapy in patients with established CVD and evaluate its cost-effectiveness in a health economic model.

Methods: A Markov model was used to compare ezetimibe and statin combination therapy with statin monotherapy. A published relationship linking changes in low-density lipoprotein cholesterol and cardiovascular events was used to estimate the cardiovascular events avoided through lipid-lowering therapies. The model was populated using results of extensive literature searches and a meta-analysis of clinical evidence. An adjustment was applied to model second-line lipid-lowering benefits. Conservative assumptions were used to extend the patient pathway beyond the clinical evidence. The analysis took the perspective of the UK Department of Health; therefore, only direct costs were included. Costs were calculated as year-2006 British pounds.

Results: For a cohort of 1000 hypothetical male patients aged 55 years, ezetimibe coadministered with current statin therapy was estimated to prevent a mean of 43 nonfatal myocardial infarctions, 7 nonfatal strokes, and 26 cardiovascular deaths over a lifetime, compared with doubling the current statin dose. The events avoided would provide a mean of 134 additional quality-adjusted life-years (QALYs). With a mean incremental cost of £3,693,000, the lifetime discounted cost per QALY gained would be £27,475 (95% CI, £27,331–£27,620) and would rise to £32,000 for men aged 75 years.

Conclusions: The results suggest that, in some instances, ezetimibe coadministration may be cost-effective compared with statin monotherapy, but there are several limitations with this model. The economic effects of ezetimibe must be revisited when long-term effectiveness and safety data become available.

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      The results of the decision model should not be seen as contradictory to the findings of previous European studies that the combination of ezetimibe and statin is a cost-effective therapy compared with statin monotherapy. The review of those studies suggests that statin plus ezetimibe had better clinical outcomes with cost savings [46,47,48]. For example, Ara et al. reported that the ezetimibe and statin combination was cost-effective compared with statin monotherapy among the United Kingdom’s population [46].

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