Cost-effectiveness of ezetimibe coadministration in statin-treated patients not at cholesterol goal: application to Germany, Spain and Norway.
BACKGROUND
Despite the growing use of statins, many hypercholesterolaemic patients fail to reach their lipid goal and remain at elevated risk of coronary heart disease (CHD). Alternative treatment strategies, such as ezetimibe coadministration and statin titration, can help patients achieve greater lipid control, and thereby lower their CHD risk. But is it cost effective to more aggressively lower cholesterol levels across a broad range of current statin users?


METHODS
Using a decision-analytic model based on epidemiological and clinical trials data, we project the lifetime benefit and cost of alternative lipid-lowering treatment strategies for CHD and non-CHD diabetic patients in Germany, Spain and Norway.


RESULTS
It is projected that from 40% to 76% of these patients who have failed to reach their lipid goal with their current statin treatment will be able to reach their goal with ezetimibe coadministration; this represents a gain of up to an additional absolute 14% who will be able to reach their goal compared with a 'titrate to goal' strategy where patients are titrated in order to reach their lipid goal (up to the maximum approved dose). For CHD patients, the estimated incremental cost-effectiveness ratio for ezetimibe coadministration is under Euro 18 000 per life-year gained (Euro/LYG) and 26 000 Euro/LYG compared with strategies based on the observed titration rates and the aggressive 'titrate to goal' strategy, respectively; for non-CHD diabetic patients, these ratios are under 26 000 Euro/LYG and 48 000 Euro/LYG for ezetimibe coadministration compared with the two titration strategies.


CONCLUSIONS
Compared with statin titration, ezetimibe coadministration is projected to be cost effective in the populations and countries studied.
Cook
John R
JR
Merck & Co., Inc., Whitehouse Station, New Jersey, USA. john_cook@merck.com
Yin
Don
D
Alemao
Evo
E
Davies
Glenn
G
Krobot
Karl J
KJ
Veltri
Enrico
E
Lipka
Leslie
L
Badia
Xavier
X
D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D001384:Azetidines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003327:Coronary Disease / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D005858:Germany; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009664:Norway; D012307:Risk Factors; D013030:Spain
D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D000069438:Ezetimibe