ArticleFrontiers in pharmacology2026
Cost-utility analysis of add-on ezetimibe to moderate-intensity statin versus moderate-intensity statin alone for secondary prevention in patients with acute coronary syndrome intolerant to high-intensity statin therapy in Thailand.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Although high-intensity statin therapy is recommended for the secondary prevention of acute coronary syndrome (ACS), a subset of patients is unable to tolerate such regimens due to statin-associated adverse effects. For these patients, adding ezetimibe to a maximally tolerated moderate-intensity statin is a guideline-recommended lipid-lowering strategy. This study aimed to evaluate the cost-utility of ezetimibe added to moderate-intensity statin therapy, compared with moderate-intensity statin therapy alone, for the secondary prevention of ACS in Thailand. Methods: A Markov model with four health states was developed. Incremental cost-effectiveness ratios (ICERs) were estimated to compare strategies from both societal and healthcare provider perspectives. Transition probabilities, utility values, and cost inputs were derived from the IMPROVE-IT trial and relevant literature, supplemented with Thailand-specific data. Costs (2024 Thai baht [THB]) and outcomes were discounted at an annual rate of 3%. One-way and probabilistic sensitivity analyses were conducted. The intervention was considered cost-effective if the ICER was below the Thai willingness-to-pay (WTP) threshold of 160,000 THB per QALY (4,533 USD/QALY). Results: Ezetimibe added to moderate-intensity statin therapy yielded an ICER of 155,312 THB/QALY (4,400.4 USD/QALY) from the societal perspective and 148,934 THB/QALY (4,219.7 USD/QALY) from the healthcare provider perspective; both were below the 160,000 THB/QALY threshold. In the one-way sensitivity analysis, the relative risk of death from myocardial infarction (MI) associated with ezetimibe was the most influential parameter (ICER change: -27.31% to +54.32%). Probabilistic sensitivity analysis indicated a 56.8% probability of cost-effectiveness at the predefined threshold. Conclusion: These findings suggest that adding ezetimibe to moderate-intensity statin therapy may be cost-effective compared with moderate-intensity statin monotherapy for the secondary prevention of ACS among patients in Thailand who are intolerant to high-intensity statins. However, because the base-case ICER was only marginally below the national threshold and probabilistic sensitivity analysis showed a 56.8% probability of cost-effectiveness, the results should be interpreted with appropriate caution.
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