{
  "abstract": "Background and Importance Statin intolerance represents a significant challenge in cardiovascular risk management, limiting use of first-line lipid-lowering therapies. Ezetimibe is widely used as the standard non-statin option, while bempedoic acid has recently emerged as a novel therapy with proven efficacy in statin-intolerant patients. Evidence on their comparative economic value is limited. Understanding the cost-effectiveness of these options is critical for resource allocation and decision making in hospital pharmacy and payer settings.Aim and Objectives This study aimed to evaluate the cost-effectiveness of bempedoic acid compared with ezetimibe in statin-intolerant patients using a lifetime Markov model from a payer perspective.Material and Methods A Markov model with six health states (no cardiovascular disease, non-fatal myocardial infarction, non-fatal stroke, post-myocardial infarction, post-stroke, death) was developed to simulate outcomes over a lifetime horizon. Patients entered the model at age 65. Transition probabilities were derived from risk equations and life tables. Treatment effects, utility values, and cost parameters were obtained through a structured review of published literature, including randomised controlled trials, meta-analyses, and standard cost databases. Costs included drug acquisition, medical management, and post-event care, adjusted to 2025 values. Both costs and outcomes were discounted at 3% annually. Results were expressed as total costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic sensitivity analysis and price-reduction scenarios were performed.Results Ezetimibe generated 10.31 discounted QALYs at a lifetime cost of 166,513 units, while bempedoic acid yielded 11.01 discounted QALYs at 389,310 units. Compared with ezetimibe, bempedoic acid produced an incremental gain of 0.70 QALYs at an additional cost of 222,797 units, resulting in an ICER of 318,282 per QALY. This exceeded the accepted cost-effectiveness threshold. Sensitivity analyses confirmed robustness, with drug acquisition cost as the most influential parameter. Scenario analysis showed that bempedoic acid would become cost-effective only if its price decreased by ~45%, equal to a 28.5% reduction in lifetime costs.Conclusion and Relevance Bempedoic acid provides incremental health benefits compared with ezetimibe in statin-intolerant patients but is not cost-effective at current prices. Substantial price reductions would be required for it to represent value for money. These findings provide evidence to guide hospital pharmacy practice and payer decision making in evaluating lipid-lowering therapies.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Vimut-Theptarin Hospital, Pharmacy, Bangkok, Thailand"
      ],
      "name": "A Sermhattakit"
    }
  ],
  "title": "1ISG-004 Cost-effectiveness of bempedoic acid versus ezetimibe in statin-intolerant patients: a payer perspective",
  "uid": "932c877a-073a-51cf-8f67-3fea75c1d073"
}