Cost Effectiveness of Adding Ezetimibe to Atorvastatin Therapy in Patients Not at Cholesterol Treatment Goal in Canada

Michele Kohli, Cheryl Attard, Annette Lam, Daniel Huse, John Cook, Chantal Bourgault, Evo Alemao, Donald Yin and Michael Marentette ()

PharmacoEconomics, 2006, vol. 24, issue 8, 815-830

Abstract: Introduction: This analysis compared the cost effectiveness of adding ezetimibe to atorvastatin therapy versus atorvastatin titration or adding cholestyramine (a resin) for patients at high risk of a coronary artery disease (CAD) event who did not reach target cholesterol levels on their current atorvastatin dosage. The primary analysis focused on 65-year-old patients with low-density lipoprotein cholesterol (LDL-C) levels of 3.1 or 3.6 mmol/L with a treatment goal of >2.5 mmol/L, classified as very high risk according to the 2000 Canadian Guidelines for Management and Treatment of Hyperlipidaemia. Methods: A previously developed Markov model was utilised to capture the cost and clinical consequences of lipid-lowering therapy in primary and secondary prevention of CAD. Comparisons between treatment strategies were made using ICERs (cost per QALY) from a Canadian Ministry of Health perspective. The effects of lipid-lowering therapies were based on clinical trial data. The risks of CAD events were estimated using Framingham Heart Study risk equations. Treatment costs and the costs of acute and long-term care for CAD events were included in the analysis. Costs ($Can, 2002 values) and outcomes were discounted at 5% per annum. Results: Ezetimibe added to atorvastatin therapy compared with treatment with the most common fixed atorvastatin daily dosage (10mg) or with common atorvastatin titration strategies (up to 20mg daily; up to 40mg daily) resulted in cost per QALY estimates ranging from $Can25 344 to $Can44 332. The addition of ezetimibe to atorvastatin therapy was less costly and more effective than the addition of cholestyramine (dominant). Conclusion: Our analysis suggests that adding ezetimibe to atorvastatin for patients not achieving treatment goals with their current atorvastatin dose produces greater clinical benefits than treatment with a fixed-dose atorvastatin or atorvastatin titration at an increased overall cost. The cost-effectiveness ratios provide strong evidence for the adoption of ezetimibe within the Canadian healthcare system. Copyright Adis Data Information BV 2006

Date: 2006
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DOI: 10.2165/00019053-200624080-00007

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