Authors (including presenting author) :
Chen MS
Affiliation :
Pharmacy Department, Tuen Mun Hospital
Introduction :
This study explores alternatives to the contraindication of the 40mg daily dosage of rosuvastatin in Chinese patients. With the reclassification of lipid-lowering agents in Drug Formulary and growing demand for therapy, the cost-effectiveness of combining ezetimibe with statins versus doubling statin doses remains underexplored in the local context.
Objectives :
1. To analyze and compare the mean or median percentage changes in lipid parameters including LDL-C, TC, TG and HDL-C across intervention arms.
2. To assess and compare the proportion of patients achieving an LDL-C goal of less than 1.8 mmol/L across intervention arms.
3. To investigate and compare the proportion of patients failing to achieve a positive outcome in LDL-C reduction across intervention arms.
4. To examine and compare the safety profile of interventions within each arm, assessing incidences of muscle-related side effects, documented abnormalities in liver function, medication intolerance, and any significant elevations in ALT and CPK levels within respective specified sampling period
5. To compare the cost-effectiveness of different intervention pairs by evaluating the mean or median cost-effectiveness ratio
Methodology :
A retrospective, observational, cross-sectional study, involving 176 Chinese patients, assessed four intervention pairs: adding ezetimibe to rosuvastatin (10mg or 20mg) or atorvastatin (20mg or 40mg), versus doubling the individual statin dose. Primary outcome centered on the mean percentage change in LDL-C, analyzed using Independent Samples t-Test and presented as mean (standard deviation). Incremental cost-effectiveness ratio (ICER) for each pair were computed, contributing to the determination of cost-effectiveness results.
Result & Outcome :
Ezetimibe addition consistently demonstrated superior LDL-C reduction in P1R10/EvsR20 [30.50 (18.15) vs 17.43 (22.19), P = .04, d = 0.65], P2R20/EvsR40 [36.14 (17.19) vs 21.1 (13.44), P = .002, d = 0.97], P3A20/EvsA40 [38.01 (13.42) vs 26.61 (16.30), P = .002, d = 0.76] and P4A40/EvsA80 [34.79 (7.80) vs 16.46 (23.75), P = .002, d = 1.04] compared to intensified therapy. Despite some lacking statistical significance and only showing superiority or equivalence in arbitrary value comparisons, add-on therapy exhibited overall favourable outcomes in LDL-C goal attainment of less than 1.8 mmol/L, median percentage changes in total cholesterol and triglyceride levels, rates of unsuccessful LDL-C reduction, and medication safety profiles across all pairs. However, add-on therapy incurred a greater cost per additional 1% reduction in LDL-C in each pair, as indicated by positive ICERs.
