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Cost-effectiveness of ezetimibe coadministration in statin-treated patients not at cholesterol goal: application to Germany, Spain and Norway.
Pharmacoeconomics. 2004;22 Suppl 3:49-61
Publication Type
John R Cook
Don Yin
Evo Alemao
Glenn Davies
Karl J Krobot
Enrico Veltri
Leslie Lipka
Xavier Badia
Author Affiliation
Merck & Co., Inc., Whitehouse Station, New Jersey, USA.
Pharmacoeconomics. 2004;22 Suppl 3:49-61
Publication Type
Anticholesteremic Agents - administration & dosage - economics - therapeutic use
Azetidines - administration & dosage - economics - therapeutic use
Comparative Study
Coronary Disease - prevention & control
Cost-Benefit Analysis
Decision Support Techniques
Dose-Response Relationship, Drug
Drug Costs
Drug Therapy, Combination
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage - economics - therapeutic use
Hypercholesterolemia - drug therapy - economics
Lipids - blood
Middle Aged
Risk factors
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. CONCLUSION: Compared with statin titration, ezetimibe coadministration is projected to be cost effective in the populations and countries studied.
PubMed ID
15669153 View in PubMed
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