[Cost effectiveness in the Danish health care of ezetemibe co-administration compared to simvastatin].
BACKGROUND
The purpose of this analysis is to evaluate the cost effectiveness of ezetemibe coadministration compared to a shift to higher doses of simvastatin or to a more potent statin.


METHODS
The calculations are based on a Markov model in which a patient who does not attain the desired cholesterol outcome with simvastatin treatment is treated either with ezetemibe coadministration, or with increased simvastatin doses, or with a more potent statin. Calculations are conducted for a total of 72 different patient types followed over the remainder of their lives.


RESULTS
Ezetemibe coadministration evaluated over the entire lifetime will be somewhat more expensive than simvastatin titration but must, however, be seen in relation to improved survival and increased quality of life. For the typical patient, treatment will be associated with costs of between DKK 50,000 and 100,000 per gained year of life, which cannot be deemed too expensive in relation to other interventions provided by the Health Authorities. For some patient types who receive treatment with a potent statin (atorvastatin), savings will also be possible here as well as an increase in life expectancy and quality of life.


CONCLUSIONS
The results of the study indicate that ezetemibe coadministration is cost effective. The results are sustainable even with quite significant changes of the estimates used and taking into account uncertainties in the material and methods.
Keiding
Hans
H
Københavns Universitet, Økonomisk Institut, København K. hans.keiding@pop.oko.ku.dk
Hildebrandt
Per
P
Alemao
Evo
E
Davies
Glenn M
GM
D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000191:economics; D001384:Azetidines / Q000008:administration & dosage* / Q000191:economics; D002318:Cardiovascular Diseases / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D003657:Decision Making; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage* / Q000191:economics; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe