Economic aspects of the fixed combinations of lipid lowering medicines in group risks patients

Relevance.  Cardio-vascular diseases (CVD) are the one of the main reasons of mortality and disability. Hypercholesterinemia is a factor of CVD progression, and thus it should be corrected. Combination of statin + ezetemib is an effective option of a medical technology for this purpose. Pharmacoeconomic analysis of rosuvastatin and ezetemib fixed combination (FC) has been performed in this work in comparison with free combination (FrC) of these drugs.

Materials and methods. Modelling of FC vs FrC in groups of CVD risk has been performed on 1–5 years horizon based on the local epidemiologic published data with aim of economic analysis. Efficacy of FC and FrC, direct medical costs, including cost of drugs, hospitalizations etc. were taken into account also. ICER has been calculated and compared with willingness to pay.

Results. FC usage instead FrC can prevent 2960–3055 deaths and 8880–9164 admissions to hospital caused CVD. FC decrease of ambulance cost as well as others direct medical expenditures in compare with FrC treatment on 9,3 bln RUR per 5 years. ICER has been calculated and has negative (dominant) result.

Conclusion. FC usage is an economic dominant technology in compare with FrC for hypercholesterolemia control.

1. Federal'naya sluzhba gosudarstvennoj statistiki (Rosstat). (In Russ.). http://rosstat.gov.ru (дата обращения: 23.12.2022).

2. https://ec.europa.eu/eurostat/documents/4187653/10321616/HeartDay3.png.

3. Erina AM, Usol tsev DA, Boyarinova MA, et al. Appointment of lipid-lowering therapy in the Russian population: comparison of SCORE and SCORE2 (according to the ESSE-RF study). Russian Journal of Cardiology. 2022;27(5):5006. (In Russ.). doi: 10.15829/1560-4071-2022-5006. EDN HBBGKQ.

4. Boytsov SA, Drapkina OM, Shlyakhto EV, et al. Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Ten years later. Cardiovascular Therapy and Prevention. 2021;20(5):3007. (In Russ.). doi: 10.15829/1728-8800-2021-3007

5. Balanova YuA, Kontsevaya AV, Imaeva AE, et al. Economic losses due to low coverage of lipid-lowering therapy in patients with cardiovascular diseases in the Russian Federation. Rational Pharmacotherapy in Cardiology. 2018;14(5):716–24. (In Russ.). doi: 10.20996/1819-6446-2018-14-5-716-724

6. Zhang H, Plutzky J, Skentzos S, et al. Discontinuation of statins in routine care settings: a cohort study. Ann. Intern. Med. 2013 Apr 2;158(7):526–34. doi: 10.7326/0003-4819-158-7-201304020-00004

7. Reston JT, Buelt A, Donahue MP, Neubauer B, Vagichev E, McShea K. Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease: A Systematic Review for the 2020 U. S. Department of Veterans Affairs and U. S. Department of Defense Guidelines for Management of Dyslipidemia. Ann. Intern. Med. 2020 Nov 17;173(10):806–12. doi: 10.7326/M20-4680

8. Alekseeva IA, Ezhov MV. Features of using of a fixed combination of rosuvastatin and ezetimibe for effective hypolipidemic therapy. Meditsinskiy sovet = Medical Council. 2020;(14):26–32. (In Russ.) doi: 10.21518/2079-701X-2020-14-26-32

9. Ezhov MV, Bliznyuk SA, Alekseeva IA, Vygodin VA. Prevalence of hypercholesterolemia and statins intake in the outpatient practice in the Russian Federation (ICEBERG study). Atherosclerosis & Dislipidemias. 2017;4:5–17. (In Russ.).

10. Khunti K, Danese MD, Kutikova L, et al. Association of a Combined Measure of Adherence and Treatment Intensity With Cardiovascular Outcomes in Patients With Atherosclerosis or Other Cardiovascular Risk Factors Treated With Statins and/or Ezetimibe. JAMA Netw. Open. 2018 Dec 7;1(8):e185554. doi: 10.1001/jamanetworkopen.2018.5554

11. Rea F, Savaré L, Corrao G, Mancia G. Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe. Adv. Ther. 2021 Oct;38(10):5270–85. doi: 10.1007/s12325-021-01892-7

12. Decree of the Government of the Russian Federation of 12/29/2022 No. 2497 "On the Program of state guarantees of free provision of medical care to citizens for 2023 and for the planning period of 2024 and 2025". Updated interpretation of clinical and statistical groups of diseases, taking into account the peculiarities of medical care, defined by Order No. 344n FFOMS]. http://www.consultant.ru/document/cons_doc_LAW_436688/d3d22ba7bb85c58fca4ba9b30c8ccb358505bf86/.

13. Pharmacoeconomics and pharmacoepidemiology — practice of the right decisions / ed. V. B. Gerasimov, A. L. Khokhlov, O. I. Karpov. — Moscow, 2005. (In Russ.).

14. WHO. Making choices in health: WHO guide to cost-effectiveness analysis / Tan-Torres Edejer T, Baltussen R, Adam T et al., editors. Geneva: WHO; 2003.