The sustainability of hypercholesterolemia treatment: New drugs have made such therapy more expensive.

Abstract

Purpose: Hypercholesterolemia represents a major risk factor in the onset and progression of cardiovascular diseases. While statins have long been the cornerstone of low-density lipoprotein cholesterol (LDL-C) reduction, the occurrence of adverse events associated with their use has prompted the development and adoption of alternative lipid-lowering agents. These include ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran.

Methods: This study aims to assess and compare the consumption patterns and associated costs of lipid-lowering medications during the first half of 2023 and 2024. The objective is to evaluate the economic implications of emerging therapies in the management of dyslipidemia and the extent of adherence to clinical guidelines. Data were collected from both private community pharmacies and public healthcare facilities, including hospital and district pharmacies. Drug utilization was analyzed using the Anatomical Therapeutic Chemical (ATC) classification system and expressed in defined daily doses (DDD).

Results: Findings indicate a declining trend in the use of traditional statin monotherapy, accompanied by an increase in the uptake of newer and combination therapies. Statin use declined significantly, from 42% in the first half of 2023 to 30% in the corresponding period of 2024. The use of combination therapy involving statins and ezetimibe remained stable at 17% across both timeframes. In contrast, PCSK9 inhibitors showed a notable rise in use, increasing from 33% to 40% between the two periods. The utilization of bempedoic acid, whether as monotherapy or combined with ezetimibe, remained marginal, consistently below 2%.

Conclusion: The therapeutic landscape for dyslipidemia has evolved substantially in recent years with the introduction of multiple novel agents. Among these, bempedoic acid, characterized by a more favorable cost profile, may serve as a valuable adjunct to statins and ezetimibe, potentially enhancing therapeutic outcomes and minimizing adverse effects-thus delaying or avoiding the need for more costly injectable treatments such as evolocumab, alirocumab, and inclisiran. Ongoing monitoring of prescribing trends and expenditure is crucial to ensuring the sustainability of healthcare systems, facilitating the adoption of innovative and effective treatments while preventing unnecessary resource allocation.