Ezetimibe: use, costs, and adverse events in Australia

Hollingworth, Samantha A., Ostino, Remo, David, Michael C., Martin, Jennifer H. and Tett, Susan E. (2017) Ezetimibe: use, costs, and adverse events in Australia. Cardiovascular Therapeutics, 35 1: 40-46. doi:10.1111/1755-5922.12236


Author Hollingworth, Samantha A.
Ostino, Remo
David, Michael C.
Martin, Jennifer H.
Tett, Susan E.
Title Ezetimibe: use, costs, and adverse events in Australia
Journal name Cardiovascular Therapeutics   Check publisher's open access policy
ISSN 1755-5922
1755-5914
Publication date 2017-02-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/1755-5922.12236
Open Access Status Not yet assessed
Volume 35
Issue 1
Start page 40
End page 46
Total pages 7
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Subject 3004 Pharmacology
2705 Cardiology and Cardiovascular Medicine
2736 Pharmacology (medical)
Abstract Aim: To analyze the subsidized use and reported adverse events of ezetimibe, used to lower cholesterol, in Australia over the 11 years following its inclusion on the Pharmaceutical Benefits Scheme (PBS) in 2004. Methods: Pharmacoepidemiological analysis of dispensed prescriptions from Medicare Australia. Adverse event data were obtained from the Therapeutic Goods Administration. Use was measured by the defined daily dose (DDD) per 1000 population per day for each calendar year. Adverse events were counted by organ class system. Results: Total ezetimibe use rose to 8.46 DDD/1000 population/d in the 11 years to 2015. Ezetimibe as a sole active ingredient was the most commonly dispensed formulation followed by the two combination products containing ezetimibe and 40 mg or 80 mg simvastatin. The average yearly increase in utilization was 19% with a 24% annual increase in costs to government (2006-2015) to $169.0 million in 2015. There were substantial differences in ezetimibe use between states, with no relationship to deaths from ischaemic heart disease (IHD) in each jurisdiction. The major reported adverse events were musculoskeletal and connective tissue disorders and gastrointestinal disorders. Conclusions: Ezetimibe use has increased rapidly in Australia since receiving public subsidy. Although the indications for subsidy are very restricted, there appears to have been widespread use, not explained by differential geographical IHD death rates. Latest guidelines still question the value of ezetimibe, so further discussion about whether the public spending on this medication for any potential improvement in population health outcomes is justified.
Formatted abstract
Aim: To analyze the subsidized use and reported adverse events of ezetimibe, used to lower cholesterol, in Australia over the 11 years following its inclusion on the Pharmaceutical Benefits Scheme (PBS) in 2004.

Methods: Pharmacoepidemiological analysis of dispensed prescriptions from Medicare Australia. Adverse event data were obtained from the Therapeutic Goods Administration. Use was measured by the defined daily dose (DDD) per 1000 population per day for each calendar year. Adverse events were counted by organ class system.

Results: Total ezetimibe use rose to 8.46 DDD/1000 population/d in the 11 years to 2015. Ezetimibe as a sole active ingredient was the most commonly dispensed formulation followed by the two combination products containing ezetimibe and 40 mg or 80 mg simvastatin. The average yearly increase in utilization was 19% with a 24% annual increase in costs to government (2006-2015) to $169.0 million in 2015. There were substantial differences in ezetimibe use between states, with no relationship to deaths from ischaemic heart disease (IHD) in each jurisdiction. The major reported adverse events were musculoskeletal and connective tissue disorders and gastrointestinal disorders.

Conclusions: Ezetimibe use has increased rapidly in Australia since receiving public subsidy. Although the indications for subsidy are very restricted, there appears to have been widespread use, not explained by differential geographical IHD death rates. Latest guidelines still question the value of ezetimibe, so further discussion about whether the public spending on this medication for any potential improvement in population health outcomes is justified.
Keyword Anticholesteremic agents
Australia
Drug-related side effects and adverse reactions
Ezetimibe
Pharmacoepidemiology
Pharmacovigilance
Simvastatin drug combination
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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