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

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 low-density lipoprotein cholesterol (LDL-c) was not inadequately controlled by moderate-dose statin alone.

Keywords:

• ezetimibe
• rosuvastatin
• lipid-lowering treatment
• cost-effectiveness analysis
• Markov model
• secondary prevention of cardiovascular diseases

Acknowledgment

An abstract of this paper was presented as a poster presentation in ISPOR 2019 (PDG20).

Author Contributions

HT, MH and SL conceived the study. NL and YZ collected the data. HY performed the model and statistical analysis. MH guaranteed the quality of the statistical procedure. HY and SL interpreted the results. HY, ZX and SL drafted the manuscript.

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Funding

This study was supported by the Cholesterol Fund by China Cardiovascular Foundation and China Heart House, the International Visiting Program for Excellent Young Scholars of Sichuan University, Sichuan Science and Technology Program (No. 2019YFH0150), the National Natural Science Foundation of China (No. 81400811 and 21534008) and 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZYGD18022). The funders played no role in the planning, design, conduction, analysis and publication of the study.

Disclosure

The authors report no conflicts of interest in this work.