Impact of Ezetimibe on the Rate of Cardiovascular-Related Hospitalizations and Associated Costs Among Patients With a Recent Acute Coronary Syndrome: Results From the IMPROVE-IT Trial (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)
Open accessAbstract
Background—: Ezetimibe, when added to simvastatin therapy, reduces cardiovascular events after recent acute coronary syndrome. However, the impact of ezetimibe on cardiovascular-related hospitalizations and associated costs is unknown. Methods and Results—: We used patient-level data from the IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) to examine the impact of simvastatin–ezetimibe versus simvastatin–placebo on cardiovascular-related hospitalizations and related costs (excluding drug costs) over 7 years follow-up. Medicare Severity–Diagnosis Related Groups were assigned to all cardiovascular hospitalizations. Hospital costs were estimated using Medicare reimbursement rates for 2013. Associated physician costs were estimated as a percentage of hospital costs. The impact of treatment assignment on hospitalization rates and costs was estimated using Poisson and linear regression, respectively. There was a significantly lower cardiovascular hospitalization rate with ezetimibe compared with placebo (risk ratio, 0.95; 95% confidence interval, 0.90–0.99; P =0.031), mainly attributable to fewer hospitalizations for percutaneous coronary intervention, angina, and stroke. Consequently, cardiovascular-related hospitalization costs over 7 years were $453 per patient lower with ezetimibe (95% confidence interval, −$38 to −$869; P =0.030). Although all prespecified subgroups had lower cost with ezetimibe therapy, patients with diabetes mellitus, patients aged ≥75 years, and patients at higher predicted risk for recurrent ischemic events had even greater cost offsets. Conclusions—: Addition of ezetimibe to statin therapy in patients with a recent acute coronary syndrome leads to reductions in cardiovascular-related hospitalizations and associated costs, with the greatest cost offsets in high-risk patients. These cost reductions may completely offset the cost of the drug once ezetimibe becomes generic, and may lead to cost savings from the perspective of the healthcare system, if treatment with ezetimibe is targeted to high-risk patients. Clinical Trial Registration—: URL: https://www.clinicaltrials.gov . Unique Identifier: NCT00202878
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ASCEND found no significant impact on serious vascular events (HR 0.97, 95% CI 0.87-1.08) among 15,480 people randomized to omega-3 supplements versus placebo over a mean 7.4 years.
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- Authors
- Pokharel, Y., Chinnakondepalli, K., Vilain, K., Wang, K., Mark, D. B., Davies, G., Blazing, M. A., Giugliano, R. P., Braunwald, E., Cannon, C. P., Cohen, D. J., & Magnuson, E. A.
- Affiliations
- Brigham and Women's Hospital (US)
- From the Department of Cardiovascular Research, Saint Luke’s Mid America Heart Institute, Kansas City, MO (Y.P., K.C., K.V., K.W., D.J.C., E.A.M.); Department of Medicine, University of Missouri-Kansas City (Y.P., D.J.C.); Department of Medicine, Duke University School of Medicine, Durham, NC (D.B.M., M.A.B.); Merck and Co, Inc, North Wales, PA (G.D.); Department of Medicine, Brigham and Women’s Hospital, Boston, MA (R.P.G., E.B., C.P.C.).
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2017-05
- Volume
- 10
- Issue
- 5
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2615439792
- Cited by
- 11
- References
- 15
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 1
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- ezetimibe, simvastatin, acute coronary syndrome, cardiovascular hospitalization, health care costs, IMPROVE-IT trial, percutaneous coronary intervention, stroke, angina pectoris, diabetes mellitus, high-risk patients, cost offsets, statin therapy
- MeSH terms
- Ezetimibe, Ezetimibe, Simvastatin Drug Combination, Aged, Anticholesteremic Agents, Dose-Response Relationship, Drug, Double-Blind Method, Female, Follow-Up Studies, Forecasting, Hospitalization, Humans, Male, Middle Aged, Treatment Outcome, Hospital Costs, Acute Coronary Syndrome
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