{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:12:41Z","timestamp":1779257561919,"version":"3.51.4"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although high-intensity statin therapy is recommended for the secondary prevention of acute coronary syndrome (ACS), a subset of patients is unable to tolerate such regimens due to statin-associated adverse effects. For these patients, adding ezetimibe to a maximally tolerated moderate-intensity statin is a guideline-recommended lipid-lowering strategy. This study aimed to evaluate the cost-utility of ezetimibe added to moderate-intensity statin therapy, compared with moderate-intensity statin therapy alone, for the secondary prevention of ACS in Thailand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov model with four health states was developed. Incremental cost-effectiveness ratios (ICERs) were estimated to compare strategies from both societal and healthcare provider perspectives. Transition probabilities, utility values, and cost inputs were derived from the IMPROVE-IT trial and relevant literature, supplemented with Thailand-specific data. Costs (2024 Thai baht [THB]) and outcomes were discounted at an annual rate of 3%. One-way and probabilistic sensitivity analyses were conducted. The intervention was considered cost-effective if the ICER was below the Thai willingness-to-pay (WTP) threshold of 160,000 THB per QALY (4,533 USD\/QALY).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ezetimibe added to moderate-intensity statin therapy yielded an ICER of 155,312 THB\/QALY (4,400.4 USD\/QALY) from the societal perspective and 148,934 THB\/QALY (4,219.7 USD\/QALY) from the healthcare provider perspective; both were below the 160,000 THB\/QALY threshold. In the one-way sensitivity analysis, the relative risk of death from myocardial infarction (MI) associated with ezetimibe was the most influential parameter (ICER change: \u221227.31% to +54.32%). Probabilistic sensitivity analysis indicated a 56.8% probability of cost-effectiveness at the predefined threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that adding ezetimibe to moderate-intensity statin therapy may be cost-effective compared with moderate-intensity statin monotherapy for the secondary prevention of ACS among patients in Thailand who are intolerant to high-intensity statins. However, because the base-case ICER was only marginally below the national threshold and probabilistic sensitivity analysis showed a 56.8% probability of cost-effectiveness, the results should be interpreted with appropriate caution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1813614","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:47:38Z","timestamp":1779256058000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-utility analysis of add-on ezetimibe to moderate-intensity statin versus moderate-intensity statin alone for secondary prevention in patients with acute coronary syndrome intolerant to high-intensity statin therapy in Thailand"],"prefix":"10.3389","volume":"17","author":[{"given":"Nattiwat","family":"Promchit","sequence":"first","affiliation":[{"name":"Master\u2019s Degree Program in Clinical Pharmacy, Faculty of Pharmacy, Chiang Mai University","place":["Chiang Mai, Thailand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surarong","family":"Chinwong","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University","place":["Chiang Mai, Thailand"]},{"name":"Research Center for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Multidisciplinary Research Institute (MDRI), Chiang Mai University","place":["Chiang Mai, Thailand"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Unchalee","family":"Permsuwan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University","place":["Chiang Mai, Thailand"]},{"name":"Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University","place":["Chiang Mai, Thailand"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e017693","DOI":"10.1161\/JAHA.120.017693","article-title":"Temporal trends, predictors, and outcomes of acute ischemic stroke in acute myocardial infarction in the United States","volume":"10","author":"Aggarwal","year":"2021","journal-title":"J. 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