Background
Simvastatin plus ezetimibe reduced the risk of cardiovascular events in the IMProved
Reduction of Outcomes: Vytorin Efficacy International (IMPROVE-IT) study. The aim
of this study is to investigate the cost-effectiveness of adding ezetimibe to simvastatin
treatment for patients with ACS based on the recently completed IMPROVE-IT trial.
Methods
We constructed a Markov state-transition model to evaluate the costs, quality-adjusted
life-years (QALYs), and incremental cost-effectiveness (ICER) associated with co-therapy
compared with simvastatin alone from a health care perspective. We ran separate base-case
analyses assuming a trial-length and longer term follow-up. One-way sensitivity analyses
were used to explore uncertainty in model parameters.
Results
In the trial-length model, the ICERs compared with simvastatin alone were $114,400
per QALY for the combination therapy. In 5- and 10-year time horizons, the ICERs remained
above the cost-effectiveness threshold of $50,000 per QALY. In the lifetime horizon
model, The ICER was $45,046 per QALY for combination treatment compared with simvastatin
alone. The combination therapy is cost-effective at an 80% decrease in the current
branded simvastatin and ezetimibe cost. Probabilistic sensitivity analysis suggested
simvastatin and ezetimibe co-therapy would be a cost-effective alternative to simvastatin
monotherapy 60.7% of the time.
Conclusions
In our trial-length, 5-year, and 10-year models, the co-therapy was not a cost-effective
alternative; however, as follow-up was extended to lifetime, the co-therapy became
a cost-effective treatment compared with the simvastatin monotherapy in patients with
histories of ACS.
Keywords
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Article info
Publication history
Published online: June 15, 2017
Accepted:
May 25,
2017
Received in revised form:
May 11,
2017
Received:
October 11,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
