Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study

Abstract

Background and aims: Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran.

Methods: This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used.

Results: The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications.

Conclusion: Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

Keywords: Iran; Markov model; Polypill; cardiovascular diseases; cost‐utility analysis.

Figure 1

Markov model of cardiovascular diseases. MI, Myocardial infarction; PVD, Peripheral Vascular Disease.

Figure 2

The flowchart of required data for Markov model.

Figure A1

Tornado diagram of the one‐way sensitivity analysis of polypill compared to medication monotherapy. This figure indicated that the results of the study were most sensitive to the utilities of angina and stroke states. (A–D) Polypill had the lowest costs (871 USD) and the highest QALYs (14.55) compared to atorvastatin, hydrochlorothiazide, aspirin, valsartan, and enalapril, and was, therefore, the dominant option.

Figure A2

The results of the probabilistic sensitivity analysis of polypill compared to medication monotherapy. The results of Figure 4 indicated that polypill was the dominant option (i.e. it had the lowest cost and highest QALYs) compared to other medications. QALYs, quality‐adjusted life‐years.

Figure A3

The cost‐effectiveness acceptability curve of polypill compared to medication monotherapy. The results of Figure 5 indicated that at the willingness to pay 21,768 USD, polypill had a 92% probability of being cost‐effective versus other medications.