Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study

Rev Esp Cardiol (Engl Ed). 2017 Jan;70(1):42-49. doi: 10.1016/j.rec.2016.05.009. Epub 2016 Jul 26.
[Article in English, Spanish]

Abstract

Introduction and objectives: To estimate the health benefits and cost-effectiveness of a polypill intervention (aspirin 100 mg, atorvastatin 20 mg, ramipril 10 mg) compared with multiple monotherapy for secondary prevention of cardiovascular events in adults with a history of myocardial infarction from the perspective of the Spanish National Health System.

Methods: An adapted version of a recently published Markov model developed and validated in Microsoft Excel was used to compare the cost-effectiveness of the polypill with that of its combined monocomponents over a 10-year time horizon. The population included in the model had a mean age of 64.7 years; most were male and had a history of myocardial infarction. The input parameters were obtained from a systematic literature review examining efficacy, adherence, utilities, and costs. The results of the model are expressed in events avoided, incremental costs, incremental life years, incremental quality-adjusted life years, and the incremental cost-effectiveness ratio.

Results: Over a 10-year period, use of the cardiovascular polypill instead of its monocomponents simultaneously would avoid 46 nonfatal and 11 fatal cardiovascular events per 1000 patients treated. The polypill would also be a more effective and cheaper strategy. Probabilistic analysis of the base case found a 90.9% probability that the polypill would be a cost-effective strategy compared with multiple monotherapy at a willingness-to-pay of 30 000 euros per quality-adjusted life year.

Conclusions: The polypill would be a cost-effective strategy for the Spanish National Health System with potential clinical benefits.

Keywords: Adherence; Adherencia; Cost-effectiveness; Coste-efectividad; Policomprimido; Polypill; Prevención secundaria cardiovascular; Secondary cardiovascular prevention.

MeSH terms

  • Adult
  • Angiotensin-Converting Enzyme Inhibitors / economics
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Aspirin / economics
  • Aspirin / therapeutic use*
  • Atorvastatin / economics
  • Atorvastatin / therapeutic use*
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Drug Costs / trends*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / economics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Incidence
  • Male
  • Markov Chains
  • Medication Adherence
  • Middle Aged
  • Platelet Aggregation Inhibitors / economics
  • Platelet Aggregation Inhibitors / therapeutic use
  • Quality-Adjusted Life Years
  • Ramipril / economics
  • Ramipril / therapeutic use*
  • Retrospective Studies
  • Secondary Prevention / methods*
  • Spain / epidemiology

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Atorvastatin
  • Ramipril
  • Aspirin