Cost Effectiveness of Adding Ezetimibe to Atorvastatin Therapy in Patients Not at Cholesterol Treatment Goal in Canada

Abstract

Our analysis suggests that adding ezetimibe to atorvastatin for patients not achieving treatment goals with their current atorvastatin dose produces greater clinical benefits than treatment with a fixed-dose atorvastatin or atorvastatin titration at an increased overall cost. The cost-effectiveness ratios provide strong evidence for the adoption of ezetimibe within the Canadian healthcare system.

Cost-effectiveness of raising HDL cholesterol by adding prolonged-release nicotinic acid to statin therapy in the secondary prevention setting: a French perspective

“…Applying treatment effects and costs obtained from the VIDAL Dictionary (2005) (18) resulted in an ICER of €39,937 for ezetimibe added to statin monotherapy compared with statin alone. Thus, in the second‐line setting, the ICER for PR nicotinic acid as add‐on therapy in dyslipidaemic patients with CHD and persistently low HDL‐C levels compares favourably with that of ezetimibe add‐on therapy in patients with persistently elevated LDL‐C levels, which is consistent with previously reported data in other European countries and North America (29,30).…”

Economic evaluation of ezetimibe combined with simvastatin for the treatment of primary hypercholesterolaemia

“…Moreover, E/S was cost-effective at £30,000/QALY and the ICERs were below the £20,000/ QALY compared with branded atorvastatin [20]. The current evaluation assumed that E/S-related LDL-C decreases reduce CVD risk consistent with published evidence [7,[18][19][20]. The present analysis and other published data demonstrate that E/S has a greater probability for achieving goal LDL-C levels compared with statin monotherapy and decreases the risk of CVD events [7,16].…”

“…The impact of any treatment modification within the model is reflected in a probabilistic change in the patient's lipid profile with consequently altered CVD risk and health state over time [4,18]. Accordingly, the present model assumed that ezetimibe-associated lipid level decreases are associated with a CVD risk reduction.…”

“…Several studies have reported on the cost-effectiveness of statin and E/S therapy in country-specific healthcare settings [10,[16][17][18][19][20][21]. Given the lack of information on cost-effectiveness on E/S-induced lipid modification within the Dutch healthcare system, the present analysis was initiated using clinical data from the Dutch EASEGO study [11] and statistical data from the Dutch Guideline on Cardiovascular Risk Management 2006 and the Dutch Healthcare Performance Report 2008 [22].…”

Projected Cost-Effectiveness of Ezetimibe/Simvastatin Compared with Doubling the Statin Dose in the United Kingdom: Findings from the INFORCE Study

“…A previous study suggested that adding ezetimibe to a statin was cost-effective (vs. statin monotherapy) [67]. In this study, the cost-effectiveness of treating patients with Eze/statins (vs. statin monotherapy with doubling of the statin dose) improved as a function of increasing CHD risk [67], given that ICER values decreased with increasing statin dose potency, which is in turn commonly construed as a surrogate for increased cardiovascular risk. On the other hand, a recent study in the United Kingdom using a Markov model projected that, in a hypothetical population of 1000 men aged 55 years with cardiovascular disease, adding Eze to a statin conferred 134 additional QALYs and averted 43 nonfatal MIs, 7 nonfatal strokes, and 26 cardiovascular deaths over the population's total lifespan, compared with doubling the statin dose; these data were consistent with an ICER value of £27,475/QALY compared with statin monotherapy up-titrated by 1 dose [68].…”