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Rev Esp Cardiol (Engl Ed). 2017 Jan;70(1):42-49. doi: 10.1016/j.rec.2016.05.009. Epub 2016 Jul 26.

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

[Article in English, Spanish]

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Departamento de Cardiología Adultos, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address:
Departamento Científico, Ferrer, Barcelona, Spain.
Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine Mount Sinai, New York, United States; Servicio de Cardiología, HM Hospitales, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain.
Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain.
Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine Mount Sinai, New York, United States.



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.


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.


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.


The polypill would be a cost-effective strategy for the Spanish National Health System with potential clinical benefits.


Adherence; Adherencia; Cost-effectiveness; Coste-efectividad; Policomprimido; Polypill; Prevención secundaria cardiovascular; Secondary cardiovascular prevention

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