Abstract
BackgroundClinical trials suggest that use of fixed-dose combination therapy (‘polypills’) can improve adherence to medication and control of risk factors of people at high risk of cardiovascular disease (CVD) compared to usual care, but cost-effectiveness is unknown.ObjectiveTo determine whether a polypill is cost-effective compared to usual care and optimal guideline-recommended treatment for primary prevention in people already on statins and/or blood pressure lowering therapy.MethodsA Markov model was developed to perform a cost-utility analysis with a one year time cycle and a 10 year time horizon to compare the polypill with usual care and optimal implementation of NICE Guidelines, using patient level data from a retrospective cross-sectional study. The model was run for ten age (40 years+) and gender-specific sub-groups on treatment for raised CVD risk with no history of CVD. Published sources were used to estimate impact of different treatment strategies on risk of CVD events.ResultsA polypill strategy was potentially cost-effective compared to other strategies for most sub-groups ranging from dominance to up to £18,811 per QALY depending on patient sub-group. Optimal implementation of guidelines was most cost-effective for women aged 40–49 and men aged 75+. Results were sensitive to polypill cost, and if the annual cost was less than £150, this approach was cost-effective compared to the other strategies.ConclusionsFor most people already on treatment to modify CVD risk, a polypill strategy may be cost-effective compared with optimising treatment as per guidelines or their current care, as long as the polypill cost is sufficiently low.
Highlights
Poor uptake of pharmacotherapy for people at high risk of cardiovascular disease, and lack of adherence in people who are prescribed drugs, has generated interest in the potential for fixed dose combination pills (‘polypills’).[1,2] These can bring about important reductions in blood pressure and LDL cholesterol,[3] and are associated with improved adherence to therapy. [4,5,6,7] despite evidence from trials demonstrating that polypills are largely safe and effective, [8] availability still remains limited compared with other disease areas [9]
A polypill strategy was potentially cost-effective compared to other strategies for most subgroups ranging from dominance to up to £18,811 per quality-adjusted life years (QALYs) depending on patient subgroup
For most people already on treatment to modify cardiovascular disease (CVD) risk, a polypill strategy may be costeffective compared with optimising treatment as per guidelines or their current care, as long as the polypill cost is sufficiently low
Summary
Clinical trials suggest that use of fixed-dose combination therapy (‘polypills’) can improve adherence to medication and control of risk factors of people at high risk of cardiovascular disease (CVD) compared to usual care, but cost-effectiveness is unknown
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