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Friday, April 25, 2008

Journal : Use of Ezetimibe in the United States and Canada

Cynthia A. Jackevicius, Pharm.D., M.Sc., Jack V. Tu, M.D., Ph.D., Joseph S. Ross, M.D., M.H.S., Dennis T. Ko, M.D., and Harlan M. Krumholz, M.D., S.M.


Background Ezetimibe lowers low-density lipoprotein cholesterol, but current lipid-lowering guidelines in the United States and Canada do not recommend it as a first option for either primary or secondary prevention. We sought to describe the adoption of ezetimibe relative to that of other lipid-lowering agents and compare its use in the two countries.

Methods We conducted a population-level, cohort study using data from January 2002 to December 2006, provided by IMS Health, to describe prescribing practices and expenditures for lipid-lowering agents and ezetimibe in the United States and Canada.

Results From 2002 to 2006, the monthly number of prescriptions for lipid-lowering agents rose from 3719 to 7401 per 100,000 population in Canada and from 3927 to 6827 per 100,000 population in the United States. Of these prescriptions, the proportion for ezetimibe rose from 0.2% in 2003 to 3.4% in 2006 in Canada and from 0.1% in 2002 to 15.2% in 2006 in the United States. Statin use was relatively constant between 2002 and 2006 in Canada, whereas the proportion of statin prescriptions decreased from 86.5 to 80.8% in the United States. In 2006, the ratio of prescriptions for statins to those for ezetimibe was 26:1 in Canada and 5:1 in the United States. In 2006, expenditures for ezetimibe per 100,000 population were higher in the United States than in Canada by a factor of more than 4.

Conclusions Distinct patterns of use of ezetimibe emerged in the United States and Canada from 2002 to 2006, a difference that markedly altered the approach to the treatment of hyperlipidemia in the United States. The U.S. pattern increased overall costs, but the effect on clinical outcomes is uncertain.

Source Information

From the University Health Network (C.A.J.), the Department of Health Policy, Management and Evaluation, Faculty of Medicine (C.A.J., J.V.T.), and the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto; and the Institute for Clinical Evaluative Sciences (J.V.T., D.T.K.) — all in Toronto; the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (C.A.J.); Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, New York (J.S.R.); and the Department of Internal Medicine, Section of Cardiovascular Medicine, and the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine (H.M.K.); the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital (H.M.K.); and the School of Public Health, Section of Health Policy and Administration, Yale University (H.M.K.) — all in New Haven, CT.

This article (10.1056/NEJMsa0801461) was published at on March 30, 2008.

Address reprint requests to Dr. Jackevicius at the Western University of Health Sciences, College of Pharmacy, 309 E. Second St., Pomona CA, 91766, or at

Full Text of this Article

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