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PLoS One. 2017 Sep 5;12(9):e0182625. doi: 10.1371/journal.pone.0182625. eCollection 2017.

Cost-effectiveness analysis of use of a polypill versus usual care or best practice for primary prevention in people at high risk of cardiovascular disease.

Author information

1
Health Economics Unit, Institute of Applied Health Research, University of Birmingham, West Midlands, United Kingdom.
2
Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, West Midlands, United Kingdom.
3
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxfordshire, United Kingdom.
4
Primary Care Unit, Department of Public Health & Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, Cambridgeshire, United Kingdom.

Abstract

BACKGROUND:

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.

OBJECTIVE:

To 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.

METHODS:

A 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.

RESULTS:

A 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.

CONCLUSIONS:

For 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.

PMID:
28873416
PMCID:
PMC5584935
DOI:
10.1371/journal.pone.0182625
[Indexed for MEDLINE]
Free PMC Article

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