This NICE technology appraisal guidance on ezetimibe for primary (heterozygous-familial and non-familial) hypercholesterolaemia should be read in conjunction with the NICE technology appraisal guidance on the initiation of statin therapy (Technology Appraisal 94) and in the context of the relevant NICE clinical guidelines.

The full guidance1 was published in the NICE technology appraisal guidance in November 2007. The guidance was developed using NICE’s multiple technology appraisal process. Further information is available in the Guide to the methods of technology appraisal.2

The main points of the guidance are:

• Ezetimibe monotherapy is recommended as an option for treatment for adults who would otherwise be initiated on statin therapy but for whom this is not possible because of contraindications to initial statin therapy.

• Ezetimibe monotherapy is recommended as an option for treatment for adults who are intolerant to statin therapy.

• Ezetimibe, coadministered with initial statin therapy, is recommended as an option for treatment for adults who have been initiated on statin therapy when (a) serum total or low-density lipoprotein (LDL) cholesterol concentration is not appropriately controlled either after appropriate dose titration of initial statin therapy or because dose titration is limited by intolerance to the initial statin therapy, and (b) consideration is being given to changing from the initial statin therapy to an alternative statin.

DEVELOPMENT OF THE GUIDANCE

The Appraisal Committee considered the different mode of action of ezetimibe from that of statins, and the potential for the addition of ezetimibe to statin therapy to achieve greater reductions in cholesterol than with statin therapy alone. The limitations of current treatment options in lowering cholesterol concentrations to desirable levels among people with primary hypercholesterolaemia were also discussed. Additionally the Appraisal Committee recognised …