COST-EFFECTIVENESS OF EZETIMIBE PLUS MODERATE-INTENSITY STATIN VERSUS HIGH-INTENSITY STATIN MONOTHERAPY FOR PRIMARY PREVENTION OF ASCVD IN TAIWAN
Author(s)
Hsuan-Yu Su, MS1, Zong-Wei Chen, BS1, Shihchen Kuo, RPh, PhD2, Huang-tz Ou, PhD1.
1National Cheng Kung University, Tainan, Taiwan, 2University of Michigan Medical School, Ann Arbor, MI, USA.
1National Cheng Kung University, Tainan, Taiwan, 2University of Michigan Medical School, Ann Arbor, MI, USA.
OBJECTIVES: Ezetimibe plus a moderate-intensity statin (E-MS) has emerged as an alternative to high-intensity statin monotherapy (HS), but its economic value for primary prevention of atherosclerotic cardiovascular disease (ASCVD) remains uncertain, particularly from real-world evidence. We assessed the cost-effectiveness of E-MS versus HS among adults receiving lipid-lowering therapy for ASCVD primary prevention from Taiwan’s healthcare sector perspective.
METHODS: We developed a Markov model with five health states consisting of no-ASCVD, post-myocardial infarction, post-stroke, cardiovascular death, and non-cardiovascular death to project costs and quality-adjusted life-years (QALYs) over 10 years. Transition probabilities and health-state costs were estimated from a target trial emulation study using Taiwan’s National Health Insurance Research Database (2012-2023), enhancing the real-world applicability of results. Health-state utilities were obtained from published literature. Costs (in 2024 U.S. dollars) and QALYs were discounted at 3% annually. Sensitivity and subgroup analyses were performed to assess parameter uncertainty and heterogeneity of treatment effects.
RESULTS: E-MS dominated HS, yielding lower total healthcare costs ($12,713 versus $13,277; incremental cost, −$564) and accruing greater QALYs (7.95 versus 7.91; incremental QALYs, 0.04), indicating that E-MS versus HS delivers better health outcomes at lower costs for primary prevention of ASCVD. Results were most sensitive to annual healthcare costs in the no-ASCVD state and the probability of non-cardiovascular death, suggesting baseline healthcare utilization/cost and competing mortality risks as key drivers of economic outcomes. The economic advantage of E-MS was more pronounced among patients with diabetes, highlighting potential benefits in higher-risk subgroups.
CONCLUSIONS: These findings underscore the potential of E-MS as a value-based lipid-lowering strategy for ASCVD primary prevention, particularly in populations with elevated cardiovascular risks (e.g., patients with diabetes). Incorporating real-world evidence strengthens the relevance of these results for clinical practice and health policy. Further confirmation of study findings over longer time horizons and under alternative model assumptions is warranted.
METHODS: We developed a Markov model with five health states consisting of no-ASCVD, post-myocardial infarction, post-stroke, cardiovascular death, and non-cardiovascular death to project costs and quality-adjusted life-years (QALYs) over 10 years. Transition probabilities and health-state costs were estimated from a target trial emulation study using Taiwan’s National Health Insurance Research Database (2012-2023), enhancing the real-world applicability of results. Health-state utilities were obtained from published literature. Costs (in 2024 U.S. dollars) and QALYs were discounted at 3% annually. Sensitivity and subgroup analyses were performed to assess parameter uncertainty and heterogeneity of treatment effects.
RESULTS: E-MS dominated HS, yielding lower total healthcare costs ($12,713 versus $13,277; incremental cost, −$564) and accruing greater QALYs (7.95 versus 7.91; incremental QALYs, 0.04), indicating that E-MS versus HS delivers better health outcomes at lower costs for primary prevention of ASCVD. Results were most sensitive to annual healthcare costs in the no-ASCVD state and the probability of non-cardiovascular death, suggesting baseline healthcare utilization/cost and competing mortality risks as key drivers of economic outcomes. The economic advantage of E-MS was more pronounced among patients with diabetes, highlighting potential benefits in higher-risk subgroups.
CONCLUSIONS: These findings underscore the potential of E-MS as a value-based lipid-lowering strategy for ASCVD primary prevention, particularly in populations with elevated cardiovascular risks (e.g., patients with diabetes). Incorporating real-world evidence strengthens the relevance of these results for clinical practice and health policy. Further confirmation of study findings over longer time horizons and under alternative model assumptions is warranted.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE619
Topic
Clinical Outcomes, Economic Evaluation, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)