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

Figure 1

Transition diagram. Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease.

Figure 2

Tornado diagram. Notes: Parameters: u_CHD: utility value of CHD; u_stroke: utility value of stroke; p1: transition rate of CHD recurrence in combination group; p2: transition rate of stroke recurrence in combination group; p3: transition rate of CVD-related mortality in combination group; p4: transition rate of non-CVD-related mortality in combination group; ph1: transition rate of CHD recurrence in high-dose group; ph2: transition rate of stroke recurrence in high-dose group; ph3: transition rate of CVD-related mortality in high-dose group; ph4: transition rate of non-CVD-related mortality in high-dose group; ph5: transition rate of adverse events with CHD in high-dose group; ph6: transition rate of adverse events with stroke in high-dose group; c_CHD: cost of CHD rehospitalization; c_CHD1: cost of inpatient lipid-lowering drug for CHD in combination group; c_CHD2: cost of outpatient lipid-lowering drug for CHD in combination group; c_CHD3: cost of inpatient lipid-lowering drug for CHD in high-dose group; c_CHD4: cost of outpatient lipid-lowering drug for high-dose group; c_stroke: cost of stroke rehospitalization; c_stroke1: cost of inpatient lipid-lowering drug for stroke in combination group; c_stroke2: cost of outpatient lipid-lowering drug for stroke in combination group; c_stroke3: cost of inpatient lipid-lowering drug for stroke in high-dose group; c_stroke 4: cost of outpatient lipid-lowering drug for stroke in high-dose group; c_mp1: cost of hospitalization due to the adverse events; c_mp2: average daily cost of hospitalization due to adverse events; disc: discount rate of cost; time: time horizon. Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life years.

Figure 3

Scatter plot of Monte Carlo simulation. Abbreviations: QALY, quality-adjusted life years; WTP, willing-to-pay.

Figure 4

Cost-effective acceptability curve. Abbreviation: QALY, quality-adjusted life years.