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Introduction: The purpose of this analysis is to evaluate the cost effectiveness of ezetemibe coadministration compared to a shift to higher doses of simvastatin or to a more potent statin., Materials and Methods: The calculations are based on a Markov model in which a patient who does not attain the desired cholesterol outcome with simvastatin treatment is treated either with ezetemibe coadministration, or with increased simvastatin doses, or with a more potent statin. Calculations are conducted for a total of 72 different patient types followed over the remainder of their lives., Results: Ezetemibe coadministration evaluated over the entire lifetime will be somewhat more expensive than simvastatin titration but must, however, be seen in relation to improved survival and increased quality of life. For the typical patient, treatment will be associated with costs of between DKK 50,000 and 100,000 per gained year of life, which cannot be deemed too expensive in relation to other interventions provided by the Health Authorities. For some patient types who receive treatment with a potent statin (atorvastatin), savings will also be possible here as well as an increase in life expectancy and quality of life., Conclusion: The results of the study indicate that ezetemibe coadministration is cost effective. The results are sustainable even with quite significant changes of the estimates used and taking into account uncertainties in the material and methods.

Introduction: In deciding whether a pharmaceutical drug should be granted reimbursement, economic considerations play a considerable role. However, the fact that the very decision on reimbursement - whether individual, conditional or general--influences the cost-effectiveness of the drug considered as a medical intervention is often overlooked., Material and Methods: In the computation of cost-effectiveness not only purely medical effects should be taken into consideration but also the risk that a patient in need of treatment is not treated--possibly as a consequence of the procedure involved in applying for individual reimbursement--as well as the risk of wasting resources on treatment that is not medically justified. The method is illustrated by a concrete example based on the data from treatment of coronary heart disease patients with statins in the period 1994-1998 where reimbursement was given on an individual basis and after 1998 when conditional reimbursement was introduced., Results: The individually-based regime turns out to have been very cost-ineffective, given that it prevented medically appropriate treatment of a large number of patients. A simple calculation along the principles outlined here would have shown this resource-loss., Discussion: Including the reimbursement regime in the assessment of cost-effectiveness seems to be a useful tool for preventing the loss of patients who could have been treated at a lower cost with the medical intervention considered than with other interventions currently used in the health care sector.