Canadian Journal of Cardiology
Clinical Research| Volume 30, ISSUE 2, P237-243, February 2014

Use and Misuse of Ezetimibe: Analysis of Use and Cost in Saskatchewan, a Canadian Jurisdiction With Broad Access

Published:December 09, 2013DOI:



      Saskatchewan is the only Canadian province that lists ezetimibe for open formulary access even though it is a second-line agent for lowering cholesterol.


      A retrospective analysis of ezetimibe use in Saskatchewan between 2002 and 2011 was carried out using provincial health administrative databases. Overall use and costs of ezetimibe were described over time. Among new users of ezetimibe, the percentage who received the drug as first-line monotherapy was estimated. First-line monotherapy was defined as no statin dispensations in the 365 days before and the 60 days after the first ezetimibe dispensation. Potential predictors of first-line monotherapy were assessed using generalized linear mixed-effect models.


      In 2004, ezetimibe represented 2.5% of cholesterol-lowering dispensations. In 2011, its use increased to 8.8% of cholesterol-lowering dispensations and 13.2% of the total cost of cholesterol-lowering agents. Overall, ezetimibe was used as first-line monotherapy in 23% of all new users (4024 of 17,475 patients). Approximately half of all cases of first-line monotherapy were prescribed by 10.4% (112 of 1074) of prescribers in the cohort. Patients who had experienced previous acute coronary syndrome or who had undergone coronary revascularization procedures were significantly less likely to receive first-line monotherapy.


      A high proportion of ezetimibe's use is not in accordance with evidence-based recommendations. Suboptimal prescribing could partially explain current patterns of use; however, other factors such as medication nonadherence may have played an important role. Restricting ezetimibe use in the provincial formulary in addition to improving prescribers' awareness through academic detailing should be considered.



      La Saskatchewan est la seule province canadienne qui inscrit l’ézétimibe à la liste des médicaments à accès libre même s’il est un agent hypocholestérolémiant de deuxième intention.


      Une analyse rétrospective de l’utilisation de l’ézétimibe en Saskatchewan a été réalisée entre 2002 et 2011 en utilisant la base de données administratives provinciales sur la santé. Dans l’ensemble, l’utilisation et les coûts de l’ézétimibe ont été décrits avec le temps. Parmi les nouveaux utilisateurs de l’ézétimibe, le pourcentage de ceux qui prenaient le médicament en monothérapie de première intention a été évalué. La monothérapie de première intention a été définie comme la non-délivrance de statines au cours des 365 jours précédents et les 60 jours suivants la première délivrance d’ézétimibe. Les prédicteurs potentiels de la monothérapie de première intention ont été évalués en utilisant les modèles linéaires généralisés à effets mixtes.


      En 2004, l’ézétimibe représentait 2,5 % de la délivrance d’hypocholestérolémiants. En 2011, son utilisation a augmenté à 8,8 % de la délivrance des hypocholestérolémiants et à 13,2 % du coût total des agents hypocholestérolémiants. Dans l’ensemble, l’ézétimibe a été utilisé en monothérapie de première intention chez 23 % de tous les utilisateurs (4024/17 475). Approximativement la moitié de tous les cas de monothérapie de première intention ont reçu l’ordonnance de 10,4 % (112/1074) des personnes autorisées à prescrire des médicaments de la cohorte. Les sujets ayant auparavant eu un syndrome coronarien aigu ou subi des interventions de revascularisation coronarienne étaient considérablement moins susceptibles de recevoir la monothérapie de première intention.


      Une forte proportion de l’utilisation de l’ézétimibe n’est pas conforme aux recommandations fondées sur les données probantes. Une prescription sous-optimale pourrait partiellement expliquer les modèles actuels d’utilisation. Cependant, d’autres facteurs comme la non-observance de la médication peut avoir joué un rôle important. L’inscription de l’ézétimibe à la liste provinciale des médicaments à accès restreint et l’amélioration de la conscientisation des personnes autorisées à prescrire des médicaments par la formation continue en pharmacothérapie devraient être considérées.
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