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. 2015 May 9;5(5):e007111.
doi: 10.1136/bmjopen-2014-007111.

Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK

Virginia Becerra  1 , Alfredo Gracia  1 , Kamal Desai  2 , Seye Abogunrin  2 , Sarah Brand  3 , Ruth Chapman  2 , Fernando García Alonso  1 , Valentín Fuster  4 , Ginés Sanz  5
Affiliations

Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK

Virginia Becerra et al. BMJ Open. .

Abstract

Objective: To evaluate the public health and economic benefits of adherence to a fixed-dose combination polypill for the secondary prevention of cardiovascular (CV) events in adults with a history of myocardial infarction (MI) in the UK.

Design: Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs.

Setting: General practice in the UK.

Participants: Patients with a mean age of 64.7 years, most of whom are men with a recent or non-recent diagnosis of MI and for whom secondary preventive medication is indicated and well tolerated.

Intervention: Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy.

Primary and secondary outcome measures: CV events prevented per 1000 patients; cost per life-year gained; and cost per quality-adjusted life-year (QALY) gained.

Results: The model estimates that for each 10% increase in adherence, an additional 6.7% fatal and non-fatal CV events can be prevented. In the base case, over 10 years, the polypill would improve adherence by ∼20% and thereby prevent 47 of 323 (15%) fatal and non-fatal CV events per 1000 patients compared with multiple monotherapy, with an incremental cost-effectiveness ratio (ICER) of £8200 per QALY gained. Probabilistic sensitivity analyses for the base-case assumptions showed an 81.5% chance of the polypill being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained compared with multiple monotherapy. In scenario analyses that varied structural assumptions, ICERs ranged between cost saving and £21,430 per QALY gained.

Conclusions: Assuming that some 450,000 adults are at risk of MI, a 10 percentage point uptake of the polypill could prevent 3260 CV events and 590 CV deaths over a decade.The polypill appears to be a cost-effective strategy to prevent fatal and non-fatal CV events in the UK.

Keywords: CARDIOLOGY; PREVENTIVE MEDICINE.

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Figures

Figure 1
Figure 1
Markov model of secondary prevention of cardiovascular events in patients surviving a first myocardial infarction. ACS, acute coronary syndrome; CHF, congestive heart failure; CV, cardiovascular; ICER, incremental cost-effectiveness ratio; MI, myocardial infarction.
Figure 2
Figure 2
Percentage decrease in total cardiovascular events with the polypill relative to monocomponents.
See this image and copyright information in PMC

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