Evidence map›Paper›PMID 24895451›Full record

Observational studyCirculation. Cardiovascular quality and outcomes2014

Impact of drug policy on regional trends in ezetimibe use.

Lingyun Lu, Harlan M Krumholz, Jack V Tu, Joseph S Ross, Dennis T Ko, Cynthia A Jackevicius

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Cardiovascular quality and outcomes, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Lingyun LuFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Harlan M KrumholzFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Jack V TuFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Joseph S RossFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Dennis T KoFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.).
Cynthia A JackeviciusFrom the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (L.L., C.A.J.); Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA (L.L., C.A.J.); Department of Medicine, Section of Cardiovascular Medicine (H.M.K.) and Center for Outcomes Research and Evaluation, Yale New Haven Hospital (H.M.K., J.S.R.), Yale University School of Medicine, New Haven, CT; Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (H.M.K., J.S.R.); Robert Wood Johnson Clinical Scholars Program, New Haven, CT (H.M.K., J.S.R.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (J.V.T., D.T.K., C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine (J.V.T., D.T.K., C.A.J.) and Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); and University Health Network, Toronto, Ontario, Canada (C.A.J.). cjackevicius@westernu.edu.

Funding

Center for Cardiovascular Outcomes Research at Yale UniversityU01HL105270 · NHLBI · YALE UNIVERSITY · PI CURTIS, JEPTHA PELHAM, KRUMHOLZ, HARLAN MARC · 2010 to 2013
$5.8M
Impact of Publicity Reporting Hospital Outcome Measures for Older AdultsK08AG032886 · NIA · YALE UNIVERSITY · PI ROSS, JOSEPH SOLOMON · 2008 to 2012
$738k
CIHRNHLBI NIH HHS U01 HL105270NIA NIH HHS K08 AG032886
6 · The paper itself

Abstract

backgroundEzetimibe use has steadily increased in Canada during the past decade even in the absence of evidence demonstrating a beneficial effect on clinical outcomes. Among the 4 most populated provinces in Canada, there is a gradient in the restrictiveness of ezetimibe in public-funded formularies (most to least strict: British Columbia, Alberta, Quebec, and Ontario). The effect of formulary policy on the use of ezetimibe over time is unknown. METHODS AND

resultsWe conducted a population-level cohort study using Intercontinental Marketing Services Health Canada's data from June 2003 to December 2012 to examine ezetimibe use in these 4 provinces to better understand the association between use and formulary restrictiveness. We found regional variations in the patterns of ezetimibe use. From June 2003 to December 2012, British Columbia (most restrictive) had the lowest monthly increasing rate from $261 to $21 926 ($190/100 000 population/mo), whereas Ontario (least restrictive) had the most rapid monthly increase from $223 to $74 030 ($ 647/100 000 population/mo), and Quebec from $130 to $59 690 ($522/100 000 population/mo) and Alberta from $356 to $ 37 604 ($327/100 000 population/mo) were intermediate (P<0.001).

conclusionsEzetimibe use remains common, increasing during the past decade. Use steadily increased in provinces with the most lenient formularies. In contrast, use was lower, plateauing since 2008 in British Columbia and Alberta, which have more restrictive formularies. The gradient in ezetimibe use was related to variability in restrictiveness of the provincial formularies, illustrating the potential of a policy response gradient that may be used to more effectively manage medication use.

Indexed as

Health PolicyPrescription DrugsAnticholesteremic AgentsAzetidinesCanadaDrug CostsDyslipidemiasEzetimibeFollow-Up StudiesHumansRetrospective StudiesAnticholesteremic AgentsAzetidinesEzetimibePrescription Drugsdrug utilizationezetimibehealth policy

Identifiers

PMID24895451
PMCPMC4222175

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.