Abstract 3728: LDL Lowering Effect of Ezetimibe 5 and 10 mg in Clinical Practice: A Potential Billion Dollar Savings
Background: ATP III recommends an LDL <100 mg/dL in pts with established vascular disease; an LDL target of less than 70 mg/dL may be considered in those at very high risk. While statins are the cornerstone of LDL-lowering therapy, some pts fail to achieve their goal LDL levels despite statin therapy, while others develop side effects which require their discontinuation. Thus other LDL-lowering agents, including niacin, resins and ezitimibe are prescribed. Annual sales for ezetimibe as monotherapy or in combination with simvastatin as Vytorin are over 3 billion dollars. During ezetimibe’s development, various doses were evaluated (.625 mg to 40 mg); 5 mg signifcantly lowered LDL (15–20%). Despite this, ezetimibe is available only as 10 mg tablets. 2 yrs ago, our institution mandated that all new ezetimibe prescriptions start at 5 mg, prescribed as a 10 mg split in half. Mandated conversion of existing 10 mg perscriptions to 5 mg was not instituted.
Methods: The impact of the 2 ezetimibe dosing strategies on LDL and achievement of ATP III goals in all pts prescribed 5 or 10 was evaluated. The most recent LDL prior to initiation of ezetimibe was compared with the 1st LDL recorded after a minimum of 4 wks of therapy.
Results: 258 pts were prescribed ezetimibe; 74 received 5 mg and 184 10 mg. Of those 258 pts, 211 pts had an evaluable baseline and post treatment LDL, 55 in the 5 mg and 156 in the 10 mg group. Reasons for being nonevaluable included multiple medication changes during the “treatment” period (e.g. statin dose changed when ezetimibe started) and the absence of an LDL assessment after initiation of ezetimibe.
Conclusion: Ezetimibe 5 mg is comparable to 10 mg with respect to achievement of LDL levels and ATP III LDL goals. Widespread adoption of this low-dose strategy could result in a cost-savings of more than a billion dollars annually. At the federal price of $1.24 per 10 mg ezetimibe tablet, implementing this strategy in our own institution will result in annual savings of almost $40,000.