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Cost-effectiveness of Ezetimibe plus statin lipid-lowering therapy: A systematic review and meta-analysis of cost-utility studies

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  • Akhil Sasidharan
  • Bhavani Shankara Bagepally
  • S Sajith Kumar
  • Kayala Venkata Jagadeesh
  • Meenakumari Natarajan

Abstract

In addition to statin therapy, Ezetimibe, a non-statin lipid-modifying agent, is increasingly used to reduce low-density lipoprotein cholesterol and atherosclerotic cardiovascular disease risk. Literature suggests the clinical effectiveness of Ezetimibe plus statin (EPS) therapy; however, primary evidence on its economic effectiveness is inconsistent. Hence, we pooled incremental net benefit to synthesise the cost-effectiveness of EPS therapy. We identified economic evaluation studies reporting outcomes of EPS therapy compared with other lipid-lowering therapeutic agents or placebo by searching PubMed, Embase, Scopus, and Tufts Cost-Effective Analysis registry. Using random-effects meta-analysis, we pooled Incremental Net Benefit (INB) in the US $ with a 95% confidence interval (CI). We used the modified economic evaluations bias checklist and GRADE quality assessment for quality appraisal. The pooled INB from twenty-one eligible studies showed that EPS therapy was significantly cost-effective compared to other lipid-lowering therapeutic agents or placebo. The pooled INB (95% CI) was $4,274 (621 to 7,927), but there was considerable heterogeneity (I2 = 84.21). On subgroup analysis EPS therapy is significantly cost-effective in high-income countries [$4,356 (621 to 8,092)], for primary prevention [$4,814 (2,523 to 7,106)], and for payers’ perspective [$3,255 (571 to 5,939)], and from lifetime horizon [$4,571 (746 to 8,395)]. EPS therapy is cost-effective compared to other lipid-lowering therapeutic agents or placebo in high-income countries and for primary prevention. However, there is a dearth of evidence from lower-middle-income countries and the societal perspective.

Suggested Citation

  • Akhil Sasidharan & Bhavani Shankara Bagepally & S Sajith Kumar & Kayala Venkata Jagadeesh & Meenakumari Natarajan, 2022. "Cost-effectiveness of Ezetimibe plus statin lipid-lowering therapy: A systematic review and meta-analysis of cost-utility studies," PLOS ONE, Public Library of Science, vol. 17(6), pages 1-17, June.
  • Handle: RePEc:plo:pone00:0264563
    DOI: 10.1371/journal.pone.0264563
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    References listed on IDEAS

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    1. Michele Kohli & Cheryl Attard & Annette Lam & Daniel Huse & John Cook & Chantal Bourgault & Evo Alemao & Donald Yin & Michael Marentette, 2006. "Cost Effectiveness of Adding Ezetimibe to Atorvastatin Therapy in Patients Not at Cholesterol Treatment Goal in Canada," PharmacoEconomics, Springer, vol. 24(8), pages 815-830, August.
    2. Clara Marquina & Ella Zomer & Sandra Vargas-Torres & Sophia Zoungas & Richard Ofori-Asenso & Danny Liew & Zanfina Ademi, 2020. "Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness," PharmacoEconomics, Springer, vol. 38(10), pages 1095-1113, October.
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