title: 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.
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 1,000 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 pound 3,693,000, the lifetime discounted cost per QALY gained would be pound 27,475 (95% CI, pound 27,331- pound 27,620) and would rise to pound 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.
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom. r.m.ara@sheffield.ac.uk
authors.forename: Roberta
authors.initials: R
authors.lastname: Ara
authors.forename: Abdullah
authors.initials: A
authors.lastname: Pandor
authors.forename: Indra
authors.initials: I
authors.lastname: Tumur
authors.forename: Suzy
authors.initials: S
authors.lastname: Paisley
authors.forename: Alejandra
authors.initials: A
authors.lastname: Duenas
authors.forename: Robert
authors.initials: R
authors.lastname: Williams
authors.forename: Anna
authors.initials: A
authors.lastname: Wilkinson
authors.forename: Paul
authors.initials: P
authors.lastname: Durrington
authors.forename: Jim
authors.initials: J
authors.lastname: Chilcott
mesh_terms: D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D001384:Azetidines / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012737:Sex Factors; D006113:United Kingdom
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D000069438:Ezetimibe