Projected Cost-Effectiveness of Ezetimibe/Simvastatin Compared with Doubling the Statin Dose in the United Kingdom: Findings from the INFORCE Study

Objective: To evaluate the incremental cost-effectiveness ratio (ICER) of switching to ezetimibe/simvastatin (Eze/Simva) compared with doubling the submaximal statin doses, in patients with acute coronary syndrome (ACS) events in the INFORCE study. Methods: Lifetime treatment costs and benefits were computed using a Markov model. Model inputs included each patient's cardiovascular risk factor profile and actual lipid values at baseline and 12 weeks (endpoint). Cardiovascular event and drug costs were discounted at 3.5%. Age-specific utilities were based on UK literature values and non-coronary heart disease mortality rates on the Office of National Statistics data. In the INFORCE study, 384 patients taking statins at stable doses for >= 6 weeks before hospital admission were stratified by statin dose/potency (low, medium, and high) and then randomized to doubling the statin dose or switching to Eze/Simva 10/40 mg for 12 weeks. Results: The Eze/Simva group (n = 195) had a higher mean baseline total cholesterol than the double-statin group (n = 189). Analyses were adjusted for baseline characteristics. In the INFORCE study, Eze/Simva reduced low-density lipoprotein cholesterol (LDL-C) by similar to 30% (vs. 4% with doubling statin doses) and significantly enhanced LDL-C goal attainment. In the cost-effectiveness analysis, Eze/Simva conferred 0.218 incremental discounted quality-adjusted life year (QALY) at a discounted incremental cost of 2524 pound, for an ICER of 11,571 pound/QALY (95% confidence interval = 8181- pound 18,600 pound/QALY). The ICER was 13,552 pound/QALY, 11,930 pound/QALY, and 10,148 pound/QALY in the low-, medium-, and high-potency strata, respectively. Conclusions: Switching to Eze/Simva 10/40 mg is projected to be a cost-effective treatment (vs. double-statin) in UK patients with ACS.