Ezetimibe for elevated cholesterol and other blood lipid levels
Elevated blood lipid levels (such as elevated cholesterol levels) are widespread, especially among older people. They are a risk factor for various cardiovascular diseases caused by fat deposits in the blood vessels. One treatment option for high blood lipid levels is the drug ezetimibe, which is used either as a single therapy or in combination with other therapies. This report examines its efficacy, safety, cost-benefit ratio, and impact on the cost budget, as well as legal, social, ethical, and organizational aspects.
The literature review included a total of over 70 studies. In people with elevated cholesterol levels but no other cardiovascular disease, treatment with ezetimibe led to lower cholesterol levels than a placebo, but it was less effective than statin therapy alone. The best results were achieved with combination therapy of ezetimibe and statin, but this had more side effects. In cases of elevated cholesterol levels associated with cardiovascular disease, the results showed that combination therapy with statins and ezetimibe lowered cholesterol levels more effectively than statin therapy alone. Adverse events such as strokes were also less common. Ezetimibe also lowered cholesterol levels more significantly than a placebo in people with generally high blood lipid levels but no other cardiovascular disease. Statin monotherapy was even more effective and also had a positive effect on other groups of blood lipids (triglycerides). There was no measurable improvement with combination therapy of statins and ezetimibe. The cost-benefit ratio of combination therapy with ezetimibe and simvastatin was positive compared to statin monotherapy, but not compared to monotherapy with highly effective statins. The available data related exclusively to people with elevated cholesterol levels and cardiovascular disease. This reinforces the recommendation that ezetimibe should only be administered to people who cannot tolerate statins. The cost budget could be reduced by 2 to 6 million Swiss francs per year by using highly effective statins instead of ezetimibe.
The report concludes that ezetimibe lowers blood lipid levels in most cases. The cost-benefit ratio of ezetimibe is positive only in certain cases, and reduced use of ezetimibe can lead to cost reductions.
Federal Office of Public Health FOPH
Health Technology Assessment Section
Schwarzenburgstrasse 157
Switzerland - 3003 Bern