Many patients with acute coronary syndrome cannot take the strongest statin drugs because of side effects. This situation leaves them with fewer options for preventing future heart problems. A new analysis looks at whether adding ezetimibe to a moderate-intensity statin helps these people without costing too much. The study focused on patients in Thailand who are already intolerant to high-intensity statin therapy. It compared this combination approach against using a moderate-intensity statin alone. The researchers calculated how much extra money it costs to gain one extra year of healthy life. They found the cost was about 4,400 US dollars per quality-adjusted life year from a societal view. From a healthcare provider perspective, the cost was slightly lower at about 4,220 US dollars per quality-adjusted life year. A quality-adjusted life year measures both how long you live and how well you feel. The analysis showed a 56.8 percent chance that this strategy is considered cost-effective by local standards. The base-case cost was only marginally below the national threshold for value. Probabilistic sensitivity analysis confirmed this 56.8 percent probability of cost-effectiveness. The study did not report specific safety data or adverse events. Results should be interpreted with appropriate caution because the evidence is limited. This finding suggests that adding ezetimibe might be a smart choice for secondary prevention in this specific group.
Guideline on cost-effectiveness of add-on ezetimibe for statin-intolerant acute coronary syndrome patients in ThailandAdd-on ezetimibe may be cost-effective for statin-intolerant patients in Thailand
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Key Takeaway
Consider add-on ezetimibe for statin-intolerant ACS patients in Thailand; cost-effectiveness probability is 56.8%.
This publication is a cost-utility analysis included within a guideline. It assesses the economic value of adding ezetimibe to moderate-intensity statin therapy for secondary prevention of acute coronary syndrome among patients in Thailand who cannot tolerate high-intensity statins. The study setting is Thailand, and the sample size was not reported. Follow-up duration was not reported. Safety data, including adverse events and tolerability, were not reported.
The primary outcome measured was the incremental cost-effectiveness ratio. From a societal perspective, the ICER was 155,312 THB per QALY, equivalent to 4,400.4 USD per QALY. From a healthcare provider perspective, the ICER was 148,934 THB per QALY, equivalent to 4,219.7 USD per QALY. The probability of cost-effectiveness was 56.8%.
The authors note that the base-case ICER was only marginally below the national threshold. Probabilistic sensitivity analysis showed a 56.8% probability of cost-effectiveness. Funding or conflicts of interest were not reported. The practice relevance suggests that add-on ezetimibe may be cost-effective compared with moderate-intensity statin monotherapy for this specific population.
What this means for you:
Add-on ezetimibe may be cost-effective for statin-intolerant patients with acute coronary syndrome in Thailand. More on Coronary Artery Disease
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View Original Abstract ↓
BackgroundAlthough high-intensity statin therapy is recommended for the secondary prevention of acute coronary syndrome (ACS), a subset of patients is unable to tolerate such regimens due to statin-associated adverse effects. For these patients, adding ezetimibe to a maximally tolerated moderate-intensity statin is a guideline-recommended lipid-lowering strategy. This study aimed to evaluate the cost-utility of ezetimibe added to moderate-intensity statin therapy, compared with moderate-intensity statin therapy alone, for the secondary prevention of ACS in Thailand.MethodsA Markov model with four health states was developed. Incremental cost-effectiveness ratios (ICERs) were estimated to compare strategies from both societal and healthcare provider perspectives. Transition probabilities, utility values, and cost inputs were derived from the IMPROVE-IT trial and relevant literature, supplemented with Thailand-specific data. Costs (2024 Thai baht [THB]) and outcomes were discounted at an annual rate of 3%. One-way and probabilistic sensitivity analyses were conducted. The intervention was considered cost-effective if the ICER was below the Thai willingness-to-pay (WTP) threshold of 160,000 THB per QALY (4,533 USD/QALY).ResultsEzetimibe added to moderate-intensity statin therapy yielded an ICER of 155,312 THB/QALY (4,400.4 USD/QALY) from the societal perspective and 148,934 THB/QALY (4,219.7 USD/QALY) from the healthcare provider perspective; both were below the 160,000 THB/QALY threshold. In the one-way sensitivity analysis, the relative risk of death from myocardial infarction (MI) associated with ezetimibe was the most influential parameter (ICER change: −27.31% to +54.32%). Probabilistic sensitivity analysis indicated a 56.8% probability of cost-effectiveness at the predefined threshold.ConclusionThese findings suggest that adding ezetimibe to moderate-intensity statin therapy may be cost-effective compared with moderate-intensity statin monotherapy for the secondary prevention of ACS among patients in Thailand who are intolerant to high-intensity statins. However, because the base-case ICER was only marginally below the national threshold and probabilistic sensitivity analysis showed a 56.8% probability of cost-effectiveness, the results should be interpreted with appropriate caution.
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