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Heart. 2017 Jan 11. pii: heartjnl-2016-310529. doi: 10.1136/heartjnl-2016-310529. [Epub ahead of print]

Cost-effectiveness of the polypill versus risk assessment for prevention of cardiovascular disease.

Author information

  • 1Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • 2Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
  • 3Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.
  • 4Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • 5William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, UK.
  • 6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • 7Division of Cardiology, UCSF Medical Center, San Francisco, California, USA.

Abstract

OBJECTIVE:

There is an international trend towards recommending medication to prevent cardiovascular disease (CVD) in individuals at increasingly lower cardiovascular risk. We assessed the cost-effectiveness of a population approach with a polypill including a statin (simvastatin 20 mg) and three antihypertensive agents (amlodipine 2.5 mg, losartan 25 mg and hydrochlorothiazide 12.5 mg) and periodic risk assessment with different risk thresholds.

METHODS:

We developed a microsimulation model for lifetime predictions of CVD events, diabetes, and death in 259 146 asymptomatic UK Biobank participants aged 40-69 years. We assessed incremental costs and quality-adjusted life-years (QALYs) for polypill scenarios with the same combination of agents and doses but differing for starting age, and periodic risk assessment with 10-year CVD risk thresholds of 10% and 20%.

RESULTS:

Restrictive risk assessment, in which statins and antihypertensives were prescribed when risk exceeded 20%, was the optimal strategy gaining 123 QALYs (95% credible interval (CI) -173 to 387) per 10 000 individuals at an extra cost of £1.45 million (95% CI 0.89 to 1.94) as compared with current practice. Although less restrictive risk assessment and polypill scenarios prevented more CVD events and attained larger survival gains, these benefits were offset by the additional costs and disutility of daily medication use. Lowering the risk threshold for prescription of statins to 10% was economically unattractive, costing £40 000 per QALY gained. Starting the polypill from age 60 onwards became the most cost-effective scenario when annual drug prices were reduced below £240. All polypill scenarios would save costs at prices below £50.

CONCLUSIONS:

Periodic risk assessment using lower risk thresholds is unlikely to be cost-effective. The polypill would become cost-effective if drug prices were reduced.

PMID:
28077465
DOI:
10.1136/heartjnl-2016-310529
[PubMed - as supplied by publisher]
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