title: Projected cost-effectiveness of ezetimibe/simvastatin compared with doubling the statin dose in the United Kingdom: findings from the INFORCE study.
abstract: OBJECTIVE
  To evaluate the incremental cost-effectiveness ratio (ICER) of switching to ezetimibe/simvastatin (Eze/Simva) compared with doubling the submaximal statin doses, in patients with acute coronary syndrome (ACS) events in the INFORCE study.
  
  
  METHODS
  Lifetime treatment costs and benefits were computed using a Markov model. Model inputs included each patient's cardiovascular risk factor profile and actual lipid values at baseline and 12 weeks (endpoint). Cardiovascular event and drug costs were discounted at 3.5%. Age-specific utilities were based on UK literature values and non-coronary heart disease mortality rates on the Office of National Statistics data. In the INFORCE study, 384 patients taking statins at stable doses for ≥6 weeks before hospital admission were stratified by statin dose/potency (low, medium, and high) and then randomized to doubling the statin dose or switching to Eze/Simva 10/40mg for 12 weeks.
  
  
  RESULTS
  The Eze/Simva group (n=195) had a higher mean baseline total cholesterol than the double-statin group (n=189). Analyses were adjusted for baseline characteristics. In the INFORCE study, Eze/Simva reduced low-density lipoprotein cholesterol (LDL-C) by ∼30% (vs. 4% with doubling statin doses) and significantly enhanced LDL-C goal attainment. In the cost-effectiveness analysis, Eze/Simva conferred 0.218 incremental discounted quality-adjusted life year (QALY) at a discounted incremental cost of £2524, for an ICER of £11,571/QALY (95% confidence interval=£8181-£18,600/QALY). The ICER was £13,552/QALY, £11,930/QALY, and £10,148/QALY in the low-, medium-, and high-potency strata, respectively.
  
  
  CONCLUSIONS
  Switching to Eze/Simva 10/40 mg is projected to be a cost-effective treatment (vs. double-statin) in UK patients with ACS.
authors.affiliation: Royal United Hospital, Bath, and Honorary Reader in Medicine, University of Bath, Bath, UK.
authors.forename: John
authors.initials: J
authors.lastname: Reckless
authors.forename: Glenn
authors.initials: G
authors.lastname: Davies
authors.forename: Kaan
authors.initials: K
authors.lastname: Tunceli
authors.forename: X Henry
authors.initials: XH
authors.lastname: Hu
authors.forename: Philippe
authors.initials: P
authors.lastname: Brudi
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics*; D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics; D001384:Azetidines / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics*; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D016032:Randomized Controlled Trials as Topic; D019821:Simvastatin / Q000008:administration & dosage / Q000191:economics*; D006113:United Kingdom
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe