Ezetimibe for the treatment of hypercholesterolaemia: a systematic review and economic evaluation

Ara, Roberta; Tumur, Indra; Pandor, Abdullah; Duenas, Alejandra; Williams, Robert; Wilkinson, Anna; Paisley, Suzy; Chilcott, Jim

doi:10.3310/hta12210

Cited by 44 publications

(53 citation statements)

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“…Furthermore, ezetimibe is a comparatively new hypocholesterolemic agent that suppresses the absorption of biliary and dietary cholesterol in the intestine (46). In contrast, we revealed that the combination of green tea extract powder and eriodictyol improved hypercholesterolemia, decreased the expression levels of hepatic cholesterol synthase enzymes, including HMGCR and HMGCS, and increased the expression level of LDLR in mice fed with a HF/HS diet.…”

Section: Discussionmentioning

confidence: 55%

The Combination of Green Tea Extract and Eriodictyol Inhibited High-Fat/High-Sucrose Diet-Induced Cholesterol Upregulation Is Accompanied by Suppression of Cholesterol Synthesis Enzymes

Yamashita

Kumazoe

Nakamura

et al. 2016

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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Summary Western diets induce obesity associated with an increased risk of hypercholesterolaemia. Indeed, obesity-induced hypercholesterolaemia is correlated with increased coronary cardiovascular disease (CVD) risk. Male C57BL/6J mice were fed a normal diet, highfat and high-sucrose diet (HF/HS), HF/HS with green tea extract powder diet (HF/HS1GT), HF/HS with eriodictyol diet (HF/HS1Eri), or HF/HS with green tea extract powder and eriodictyol diet (HF/HS1GT1Eri) for 8 wk. Body weight was lower in the HF/HS1GT1Eri group than in the HF/HS group (28.3%, p,0.01). The HF/HS diet elicited an upregulation of total cholesterol levels (263%, p,0.001), and low-density lipoprotein (LDL) levels (289%, p,0.001) were significantly suppressed by the GT1Eri diet. Conversely, no change (p.0.05) was observed in the HF/HS1GT and HF/HS1Eri groups. The HF/HS diet-induced hepatic mRNA increase in 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) was ameliorated (273%) by the oral administration of green tea extract and eriodictyol. Moreover, the GT1Eri diet suppressed HF/HS diet-induced upregulation of 3-hydroxy-3-methylglutaryl-coenzyme A synthase (HMGCS) (275%, p,0.05). Furthermore, the LDL receptor (LDLR) levels were higher in the HF/HS1GT1Eri group (150%, p,0.05) than in the HF/ HS group. These results suggest that a combination of green tea and eriodictyol decreases cholesterol levels, particularly LDL levels, accompanied by the suppression of HMGCR and HMGCS levels and upregulation of LDLR levels in the liver.

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Section: Discussionmentioning

confidence: 55%

The Combination of Green Tea Extract and Eriodictyol Inhibited High-Fat/High-Sucrose Diet-Induced Cholesterol Upregulation Is Accompanied by Suppression of Cholesterol Synthesis Enzymes

Yamashita

Kumazoe

Nakamura

et al. 2016

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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“…The model is based on modified and updated versions of models used and described in previous health technology assessments in the area of CVD risk. 338,339 The model consists of a number of discrete and mutually exclusive health states, each of which is associated with the presence or absence of a particular CVD-related health condition or with death. Events, such as a stroke, establish the state to which an individual patient in the cohort is assigned at any moment in time.…”

Section: The State Transition Cohort Simulation Modelmentioning

confidence: 99%

“…The model used the probabilities from the study by Ara et al, 338 one of the studies on which the model itself was based. The probabilities were obtained by Ara et al 338 using a two-stage regression analysis.…”

Section: Transitions and Secondary Eventsmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…In terms of reporting, all direct searches, including search strategies should be reported but equally important, in order that the whole process of information acquisition is transparent, is an audit of how all evidence cited in support of a model came to be part of the modelling process. The appendices of two published costeffectiveness models provide examples of how this can be presented [55,56].…”

Section: Discussionmentioning

confidence: 99%

Identification of Evidence for Key Parameters in Decision-Analytic Models of Cost Effectiveness: A Description of Sources and a Recommended Minimum Search Requirement

Paisley

2016

PharmacoEconomics

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The paper proposes recommendations for a minimum level of searching for data for key parameters in decision-analytic models of cost-effectiveness and describes sources of evidence relevant to each parameter type. Key parameters are defined as treatment effects, adverse effects, costs, resource use, health state utility values (HSUVs) and baseline risk of events. The recommended minimum requirement for treatment effects is comprehensive searching according to available methodological guidance. For other parameter types the minimum is the searching of one bibliographic database plus, where appropriate, specialist sources and non-research based and non-standard format sources. The recommendations draw on the search methods literature and on existing analyses of how evidence is used to support decision-analytic models. They take account of the range of research and non-research based sources of evidence used in cost-effectiveness models and of the need for efficient searching. Consideration is given to what constitutes best evidence for the different parameter types in terms of design and scientific quality and to making transparent the judgments that underpin the selection of evidence from the options available. Methodological issues are discussed including the differences between decision-analytic models of cost-effectiveness and systematic reviews when searching and selecting evidence and comprehensive versus sufficient searching. Areas are highlighted where further methodological research is required. Key points for decision makers Procedural guidance on how to search for evidence for key model parameters does not exist resulting in inconsistent search practice and a lack of transparency  A minimum search requirement across all key model parameters is proposed Identification of evidence for key model parameters 2  Important considerations are taken into account including the diverse range of evidence used in models and the need for efficient searching

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Ezetimibe for the treatment of hypercholesterolaemia: a systematic review and economic evaluation

Cited by 44 publications

References 4 publications

The Combination of Green Tea Extract and Eriodictyol Inhibited High-Fat/High-Sucrose Diet-Induced Cholesterol Upregulation Is Accompanied by Suppression of Cholesterol Synthesis Enzymes

The Combination of Green Tea Extract and Eriodictyol Inhibited High-Fat/High-Sucrose Diet-Induced Cholesterol Upregulation Is Accompanied by Suppression of Cholesterol Synthesis Enzymes

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Identification of Evidence for Key Parameters in Decision-Analytic Models of Cost Effectiveness: A Description of Sources and a Recommended Minimum Search Requirement

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