Abstract 13035: Impact of Ezetimibe on Hospitalization-Related Costs Among Patients With a Recent Acute Coronary Syndrome: Results From the IMPROVE-IT Trial

Abstract

Impact of Ezetimibe on Hospitalization Costs among Patients with a Recent Acute Coronary Syndrome: Results from the IMPROVE-IT Trial Objectives: The IMPROVE-IT Trial demonstrated that in patients with a recent acute coronary syndrome, the combination of ezetimibe 10 mg and simvastatin 40 mg (E+S) significantly reduced the rate of major cardiovascular events relative to simvastatin 40 mg (S) alone. We used patient-level resource data to compare costs associated with hospitalizations (hosps) between E+S and S over the course of the trial (median follow-up 6 years; mean 5.4 years). Methods: Details regarding hosps for all patients (n=18,144) were collected prospectively. MS-DRGs were assigned to all cardiovascular (CV) hosps, to which average 2013 Medicare reimbursement rates were applied. Physician costs associated with hosps were estimated as a % of hospital costs. Hosp rates/costs per patient were compared using Poisson regression/bootstrapping. Results: Over the follow-up period, there were 8612 and 9105 CV hosps for E+S and S, respectively (p=0.03). Treatment with E+S led to a $459/patient reduction in hospitalization-related costs (95% CI -$885 to -$42; p=0.02). Lower costs associated with coronary revascularization accounted for the majority ($392/patient) of the lower hosp costs for E+S. Forty percent of hosps for an adjudicated MI (1106/2769) involved a revascularization procedure and hosp costs for revascularization procedures in the setting of an MI were $314/patient lower with E+S. Lower costs associated with hosp for angina, stroke, and acute MI not requiring revascularization also contributed to the lower costs with E+S vs. S. Conclusions: Over a mean 5.4 year follow-up period, E+S was associated with lower rates of CV hospitalization and associated hospitalization costs compared with S. The extent to which these lower hospitalization costs offset the higher drug costs is expected to be more favorable when ezetimibe becomes generic in 2016.