Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study
a Departamento de Cardiología Adultos, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Departamento Científico, Ferrer, Barcelona, Spain
c Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
d Icahn School of Medicine Mount Sinai, New York, United States
e Servicio de Cardiología, HM Hospitales, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
f Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
KeywordsSecondary cardiovascular prevention. Polypill. Adherence. Cost-effectiveness.
AbstractIntroduction 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.