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
Received 6 May 2019
Accepted for publication 2 January 2020
Published 14 January 2020 Volume 2020:14 Pages 157—165
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Cristiana Tanase
Han Yang, 1, 2 Nan Li, 3 Youlian Zhou, 1, 4 Zhilan Xiao, 4 Haoming Tian, 1 Ming Hu, 2 Sheyu Li 1
1Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of China; 2West China School of Pharmacy, Sichuan University, Chengdu 610041, People’s Republic of China; 3Department of Informatics, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of China; 4West China School of Medicine, Sichuan University, Chengdu 610041, People’s Republic of China
Correspondence: Sheyu Li
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu 610041, Sichuan, People’s Republic of China
West China School of Pharmacy, Sichuan University, 17 Renmin South Road (3rd Section), Chengdu 610041, People’s Republic of China
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]