TORONTO–Canada's ban on direct-to-consumer drug advertising probably saved Canadians with high cholesterol and their drug plans $150 million in 2006 alone.

A new study comparing U.S. and Canada sales patterns of a controversial cholesterol lowering drug show the dramatic savings.

Canadian sales of the drug Ezetrol – the generic name is ezetimibe – were four times lower than those rung up south of the border, where the drugs' manufacturers spent $200 million (U.S). advertising the drug to consumers in 2007.

Sales of ezetimibe, which is sold solo in the U.S. as Zetia or combined with a statin drug as Vytorin, are expected to drop after Sunday's release of trial results showing the drug failed to slow atherosclerosis, the clogging of the arteries with fatty deposits.

"It basically shows that the approach in Canada to this whole drug was much more appropriate and evidence-based compared to the U.S. approach where basically it's been marketed very aggressively," says Dr. Jack Tu, one of the authors of the study comparing usage trends in the two countries.

"It's sort of a textbook example of the potential downsides if you have direct-to-consumer advertising where the manufacturer potentially can promote new and expensive drugs that don't have a huge amount of evidence behind them and get them to be first-line therapy as opposed to older, cheaper medications with a lot more evidence," Tu says.

Canada's ban on direct-to-consumer drug advertising is currently being challenged in the courts by CanWest Global Communications.

The study was conducted by researchers from Western University of Health Sciences, in Pomona, Calif., the Institute for Clinical Evaluative Sciences (ICES) in Toronto, and Yale University. Tu, a senior scientist at ICES, is also a cardiologist and epidemiologist at Sunnybrook Health Sciences Centre.

It will be published in a future issue of the New England Journal of Medicine, but was released Sunday to coincide with the presentation of the findings of the Enhance trial at the American College of Cardiology meeting in Chicago. That long-awaited trial tested whether Vytorin (ezetimibe plus simvastatin) was better at slowing atherosclerosis than simvastatin alone.

Ezetimibe was brought to the U.S. market in October, 2002, and in Canada in May, 2003. Vytorin hit the U.S. market in July, 2004, but was never licensed for sale in Canada.

The manufacturers, Merck and Co. and Schering-Plough Corp., aggressively pushed the drugs in the U.S. with TV commercials. Only the U.S. and New Zealand allow direct-to-consumer advertising.

Here, Health Canada allows pharmaceutical companies to advertise only either the name of a drug or a health condition with a reminder that people who suffer from it should talk to a doctor about potential treatments.

Meanwhile, worldwide sales of ezetimibe alone or in combination took off, recently crossing the $5 billion (U.S.) threshold – despite no evidence it was better at slowing the clogging of the arteries.

The drug captured 15 per cent of the U.S. market for cholesterol lowering drugs by 2006, whereas in Canada it made up only 3.4 per cent of such sales.

"No one should be surprised by this," says Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba. Schafer did not take part in the study.

"There's lots of evidence that if you advertise directly to consumers and ... induce the patients to mention a particular drug to their doctors, their doctors are likely to prescribe it regardless of the medical evidence for that drug.

"We knew that beforehand and this is a powerful illustration of what will happen in Canada if and when the government of Canada lifts its restriction on direct-to-consumer advertising within Canada."

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The Canadian Press