Abstract
Background
Saskatchewan is the only Canadian province that lists ezetimibe for open formulary
access even though it is a second-line agent for lowering cholesterol.
Methods
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.
Results
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.
Conclusions
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.
Résumé
Introduction
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.
Méthodes
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.
Résultats
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.
Conclusions
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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Article info
Publication history
Published online: December 09, 2013
Accepted:
November 27,
2013
Received:
October 9,
2013
Footnotes
See page 242 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
