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Cost-Effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in Patients With a History of Acute Coronary Syndrome: Analysis of Results of the IMPROVE-IT Trial.
- Source :
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Heart, lung & circulation [Heart Lung Circ] 2018 Jun; Vol. 27 (6), pp. 656-665. Date of Electronic Publication: 2017 Jun 15. - Publication Year :
- 2018
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Abstract
- 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.<br />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.<br />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.<br />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.<br /> (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.)
- Subjects :
- Acute Coronary Syndrome complications
Acute Coronary Syndrome diagnosis
Anticholesteremic Agents administration & dosage
Anticholesteremic Agents economics
Brain Ischemia epidemiology
Brain Ischemia etiology
Cost-Benefit Analysis
Dose-Response Relationship, Drug
Drug Therapy, Combination
Ezetimibe economics
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors economics
Male
Middle Aged
Myocardial Infarction epidemiology
Myocardial Infarction etiology
Prospective Studies
Quality-Adjusted Life Years
Saudi Arabia epidemiology
Simvastatin economics
Treatment Outcome
Acute Coronary Syndrome drug therapy
Brain Ischemia prevention & control
Ezetimibe administration & dosage
Forecasting
Myocardial Infarction prevention & control
Simvastatin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1444-2892
- Volume :
- 27
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Heart, lung & circulation
- Publication Type :
- Academic Journal
- Accession number :
- 28716519
- Full Text :
- https://doi.org/10.1016/j.hlc.2017.05.139