<p>Cost-Effectiveness Analysis of Ezetimibe as the Add-on Treatment to Moderate-Dose Rosuvastatin versus High-Dose Rosuvastatin in the Secondary Prevention of Cardiovascular Diseases in China: A Markov Model Analysis</p>

Abstract

Background: For patients with inadequate control of cholesterol using moderate-dose statins in the secondary prevention of cardiovascular diseases (CVD), either doubling the dose of statins or adding ezetimibe should be considered. The cost-effectiveness of them is unknown in the Chinese context. The aim of this study is to compare the cost and effectiveness of the two regimens, and estimate the incremental cost-effectiveness ratio (ICER).Methods: A Markov model of five health statuses were used to estimate long-term costs and quality-adjusted life-years (QALYs) of the two treatment regimens from the healthcare perspective. The effectiveness data used to calculate the transition probability was based on a previously published randomized trial. The utility data was gathered from literature and the costs were gathered from the electronic medical record system of West China Hospital in Chinese Yuan (CNY) in 2017 price. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted. Results: The ICER for ezetimibe plus moderate-dose rosuvastatin was 47,102.99 CNY per QALY for 20 years simulation, which did not reach the threshold of per capita gross domestic product (GDP) of 59,660 CNY per QALY in 2017 in China. Non-CVD-related mortality and CVD-related mortality contributed most to the ICER. Conclusion: Adding ezetimibe to the moderate-dose statin in secondary prevention for CVD is cost-effective, compared with the high-dose statin in the Chinese context whose lowdensity lipoprotein cholesterol (LDL-c) was not inadequately controlled by moderate-dose statin alone.

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

“…Authors from studies not reporting cost year were contacted by e-mail in an effort to complete the missing data. In addition, results from Permpanich et al [31] and Yang et al [32] could not be adapted due to the lack of data on purchasing power parities. Korman and Wisloff [33] reported cost results in Euros but the study was based in Norway, and Lin et al [34] reported costs in international dollars but the study was set in five low-and medium-income countries (LMIC), and both studies were excluded from cost adjustment.…”

“…The general characteristics of the included articles organised by treatment strategies are summarised in Table 1. Of the selected studies, ten evaluated ezetimibe [12,13,32,33,35,36,[42][43][44][45], 15 PCSK9 inhibitors [12, 26, 28-30, 33, 37-39, 43-48], five n-3 PUFAs [31,40,[49][50][51], and seven the polypill [27,34,41,[52][53][54][55]. Four out of the 15 studies focusing on PCSK9 inhibitors also reported the ICERs of ezetimibe versus statins, but considering ezetimibe as a comparator [12,33,43,44], and those results have also been included and reported in this review.…”

“…Of note, the study by Dressel et al [28] used ezetimibe as a comparator, but did not report the ICER for ezetimibe. Only five out of 32 studies [31,32,34,45,53] were set in LMICs, and only seven [31,32,34,45,46,49,53] were based in non-Western countries. Most of the studies analysed lifetime horizons (28 studies) [12, 13, 25-29, 31-40, 42-52, 55], and the majority used Markov models (29 studies) [12, 13, 26, 28-33, 35-52, 54, 55].…”

“…Among the ten studies evaluating the cost-effectiveness of ezetimibe versus standard therapy, five were set in the US [12,13,[42][43][44] and the rest in Finland [36], the UK [35], Norway [33], Thailand [45] and China [32]. All the studies analysed the addition of ezetimibe 10 mg/day to statin therapy.…”

The Impact of Changes in Population LDL-C Levels on LDL-C Control in Patients After PCI&nbsp;in China: A Retrospective Cohort Study

“…[19] In countries with low per capita gross domestic product, a 97% reduction would be considered costeffective. [20] The results of some studies are cost-effective when ezetimibe is added to ongoing statin therapy and the costs and bene ts of maintaining current doses of statin therapy [21]. However, in a 5-10 year follow-up model, ezetimibe combined with statin therapy is not a cost-effective alternative, but when the follow-up period is extended to a lifetime, combination therapy becomes a cost-effective treatment.…”