Cost-Effectiveness Analysis of Fixed-Dose Combination Rosuvastatin and Ezetimibe vs. Simvastatin Plus Ezetimibe for the Treatment of Hypercholesterolemia in Patients at High Risk and Very High Risk of Cardiovascular Disease in Algeria
Author(s)
Redouane NEDJAR, MD1, Rihab Al-Homsi, Pharm.D2, YACINE HAMMAS, Pharm.D3, Ahmad Aburmilah, M.Sc2, Jalal Kamel Atieh, BSc Pharm2.
1Cardiology department at Blida University Hospital, Algiers, Algeria, 2Hikma Pharmaceuticals, Amman, Jordan, 3Hikma Pharmaceuticals, Algiers, Algeria.
1Cardiology department at Blida University Hospital, Algiers, Algeria, 2Hikma Pharmaceuticals, Amman, Jordan, 3Hikma Pharmaceuticals, Algiers, Algeria.
OBJECTIVES: To evaluate the cost-effectiveness of fixed-dose combination (FDC) rosuvastatin and ezetimibe (ROS/EZE) versus simvastatin (SIM) plus ezetimibe (EZE), for treating hypercholesterolemia in patients at high risk (HR) and very high risk (VHR) of cardiovascular disease (CVD) not adequately controlled with the maximum tolerated dose of statin in Algeria.
METHODS: A cost-effectiveness analysis was conducted over 1 year from Algerian payers’ perspective using a decision tree model. Only direct drug acquisition costs were considered. Effectiveness was measured as the number of CVD events averted per 100 patients annually. The expected clinical benefits of LDL-C lowering therapies were estimated using the algorithm from 2019 ESC/EAS dyslipidemia management guidelines and the results of 2 large meta-analyses. % LDL-C reduction for both treatment arms was sourced from GRAVITY trial. Baseline LDL-C reflected the reported lipid profiles in Middle East & North Africa and pooled data from meta-analyses. Primary and secondary prevention of CVD were included. Relative CVD risk reduction and baseline CVD event rates were estimated from meta-analysis for guideline recommended therapies. Monthly drug prices were ROS/EZE 10/10 mg (2,814.79 DZD), ROS/EZE 20/10 mg (3,170.58 DZD), SIM 40 mg (1,980.00 DZD), and EZE 10 mg (2,899.80 DZD). FDC SIM/EZE was unavailable in Algerian market. One-way sensitivity analysis (OWSA) was performed.
RESULTS: Compared to SIM 40 plus EZE 10, FDC ROS/EZE 10/10 and 20/10 averted additional 1.2 and 1.5 CVD events per 100 patients annually with annual cost savings of DZD 24,780.12 and DZD 20,510.64, respectively. FDC ROS/EZE 10/10 and 20/10 were dominant options, the ICERs were -DZD 20,934.18 and -DZD 13,542.86 per 1 CVD event averted annually, respectively. OWSA confirmed the dominance across all scenarios.
CONCLUSIONS: FDC ROS/EZE is a dominant option for treating hypercholesterolemia in patients at HR and VHR of CVD in Algeria, providing economic cost savings with additional LDL-C lowering benefits and improved adherence.
METHODS: A cost-effectiveness analysis was conducted over 1 year from Algerian payers’ perspective using a decision tree model. Only direct drug acquisition costs were considered. Effectiveness was measured as the number of CVD events averted per 100 patients annually. The expected clinical benefits of LDL-C lowering therapies were estimated using the algorithm from 2019 ESC/EAS dyslipidemia management guidelines and the results of 2 large meta-analyses. % LDL-C reduction for both treatment arms was sourced from GRAVITY trial. Baseline LDL-C reflected the reported lipid profiles in Middle East & North Africa and pooled data from meta-analyses. Primary and secondary prevention of CVD were included. Relative CVD risk reduction and baseline CVD event rates were estimated from meta-analysis for guideline recommended therapies. Monthly drug prices were ROS/EZE 10/10 mg (2,814.79 DZD), ROS/EZE 20/10 mg (3,170.58 DZD), SIM 40 mg (1,980.00 DZD), and EZE 10 mg (2,899.80 DZD). FDC SIM/EZE was unavailable in Algerian market. One-way sensitivity analysis (OWSA) was performed.
RESULTS: Compared to SIM 40 plus EZE 10, FDC ROS/EZE 10/10 and 20/10 averted additional 1.2 and 1.5 CVD events per 100 patients annually with annual cost savings of DZD 24,780.12 and DZD 20,510.64, respectively. FDC ROS/EZE 10/10 and 20/10 were dominant options, the ICERs were -DZD 20,934.18 and -DZD 13,542.86 per 1 CVD event averted annually, respectively. OWSA confirmed the dominance across all scenarios.
CONCLUSIONS: FDC ROS/EZE is a dominant option for treating hypercholesterolemia in patients at HR and VHR of CVD in Algeria, providing economic cost savings with additional LDL-C lowering benefits and improved adherence.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE198
Topic
Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)