College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of National Defence, Canada.
Can J Cardiol. 2014 Feb;30(2):237-43. doi: 10.1016/j.cjca.2013.11.031. Epub 2013 Dec 8.
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.
萨斯喀彻温省是加拿大唯一将依折麦布列入开放式处方目录的省份，尽管它是降低胆固醇的二线药物。
利用省级卫生行政数据库，对萨斯喀彻温省 2002 年至 2011 年期间依折麦布的使用情况进行了回顾性分析。描述了依折麦布的总体使用情况和成本。在依折麦布的新使用者中，估计了接受该药作为一线单药治疗的比例。一线单药治疗定义为在首次依折麦布配药前的 365 天和 60 天内没有开具他汀类药物。使用广义线性混合效应模型评估了一线单药治疗的潜在预测因素。
2004 年，依折麦布占降胆固醇药物处方的 2.5%。2011 年，其使用量增加到降胆固醇药物处方的 8.8%和降胆固醇药物总成本的 13.2%。总体而言，新使用者中有 23%（17475 名患者中的 4024 名）将依折麦布作为一线单药治疗。在该队列中，大约一半的一线单药治疗病例是由 10.4%（112 名医生中的 1074 名）的处方医生开具的。曾经历过急性冠状动脉综合征或接受过冠状动脉血运重建手术的患者接受一线单药治疗的可能性显著降低。
依折麦布的使用很大一部分不符合循证建议。处方的不理想可能部分解释了当前的使用模式；然而，其他因素，如药物不依从，可能也发挥了重要作用。除了通过学术详述提高处方医生的认识外，还应考虑在省级处方目录中限制依折麦布的使用。
