Use of Ezetimibe in Australia

Use of Ezetimibe in Australia

Background: Ezetimibe reduces absorption of dietary and biliary cholesterol by inhibiting its transport across the intestinal wall. Ezetimibe receives public subsidy in Australia from the Pharmaceutical Benefits Scheme (PBS) for very restricted indications (authorisation required).

Objectives: To analyse the subsidised utilisation of ezetimibe in Australia.

Methods: Utilisation of the five ezetimibe products (individual and combined with simvastatin) between 2004 and
2012 were extracted using PBS item reports, downloaded from Medicare Australia website. The defined daily dose (DDD) for ezetimibe is 10 mg. DDD were calculated per 1000 inhabitants of Australia per day (DDD/1000/day) for each calendar year.

Results: Ezetimibe as a sole active ingredient was the most commonly dispensed formulation (0.25 up to 4.19 DDD/1000/day, from 2004 to 2012), followed by the two combination products containing ezetimibe and higher doses: 40 mg (0.21 up to 1.50 DDD/1000/day from 2006 to 2012); and 80 mg (0.16 up to 1.39 DDD/1000/day from 2006 to 2012) of simvastatin. The two
combination products with ezetimibe and lower doses (10 mg and 20 mg) simvastatin, subsidised since 2009, were not widely dispensed (together 0.32 DDD/1000/day in 2012). The average yearly increase in utilisation between 2006 and 2012 was 25% and the increase in costs to government was 32%.

Conclusions: Ezetimibe use has increased rapidly in Australia since receiving public subsidy. Although the indications for subsidy are very restricted there appears to have been quite widespread use, with total use of ezetimibe in all forms at 7.40 DDD/1000/day by 2012. Latest guidelines still question the value of ezetimibe use so further investigation is needed in Australia about whether the public spending on this medication is justifiable for the potential improvement in population health outcomes.

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