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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:42-9 - Vol. 70 Num.01 DOI: 10.1016/j.rec.2016.05.009

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

Vivencio Barrios a,, Lisette Kaskens b, José María Castellano c,d,e, Juan Cosin-Sales f, José Emilio Ruiz b, Ilonka Zsolt b, Valentín Fuster c,d, Alfredo Gracia b

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

Keywords

Secondary cardiovascular prevention. Polypill. Adherence. Cost-effectiveness.

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.

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved