Tags

Type your tag names separated by a space and hit enter

Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK.
BMJ Open. 2015 May 09; 5(5):e007111.BO

Abstract

OBJECTIVE

To evaluate the public health and economic benefits of adherence to a fixed-dose combination polypill for the secondary prevention of cardiovascular (CV) events in adults with a history of myocardial infarction (MI) in the UK.

DESIGN

Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs.

SETTING

General practice in the UK.

PARTICIPANTS

Patients with a mean age of 64.7 years, most of whom are men with a recent or non-recent diagnosis of MI and for whom secondary preventive medication is indicated and well tolerated.

INTERVENTION

Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy.

PRIMARY AND SECONDARY OUTCOME MEASURES

CV events prevented per 1000 patients; cost per life-year gained; and cost per quality-adjusted life-year (QALY) gained.

RESULTS

The model estimates that for each 10% increase in adherence, an additional 6.7% fatal and non-fatal CV events can be prevented. In the base case, over 10 years, the polypill would improve adherence by ∼20% and thereby prevent 47 of 323 (15%) fatal and non-fatal CV events per 1000 patients compared with multiple monotherapy, with an incremental cost-effectiveness ratio (ICER) of £8200 per QALY gained. Probabilistic sensitivity analyses for the base-case assumptions showed an 81.5% chance of the polypill being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained compared with multiple monotherapy. In scenario analyses that varied structural assumptions, ICERs ranged between cost saving and £21,430 per QALY gained.

CONCLUSIONS

Assuming that some 450,000 adults are at risk of MI, a 10 percentage point uptake of the polypill could prevent 3260 CV events and 590 CV deaths over a decade.The polypill appears to be a cost-effective strategy to prevent fatal and non-fatal CV events in the UK.

Links

PMC Free PDF

Authors+Show Affiliations

Becerra V
Ferrer, Barcelona, Spain.
Gracia A
Ferrer, Barcelona, Spain.
Desai K
Evidera, Hammersmith, London, UK.
Abogunrin S
Evidera, Hammersmith, London, UK.
Brand S
Evidera, Bethesda, Maryland, USA.
Chapman R
Evidera, Hammersmith, London, UK.
García Alonso F
Ferrer, Barcelona, Spain.
Fuster V
The Mount Sinai Medical Center, New York, New York, USA Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Sanz G
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.

MeSH

AgedCardiovascular AgentsCardiovascular DiseasesCost-Benefit AnalysisDrug Therapy, CombinationHumansMarkov ChainsMedication AdherenceModels, EconomicPolypharmacyPublic Health

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25991449

Citation

Becerra, Virginia, et al. "Cost-effectiveness and Public Health Benefit of Secondary Cardiovascular Disease Prevention From Improved Adherence Using a Polypill in the UK." BMJ Open, vol. 5, no. 5, 2015, pp. e007111.
Becerra V, Gracia A, Desai K, et al. Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK. BMJ Open. 2015;5(5):e007111.
Becerra, V., Gracia, A., Desai, K., Abogunrin, S., Brand, S., Chapman, R., García Alonso, F., Fuster, V., & Sanz, G. (2015). Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK. BMJ Open, 5(5), e007111. https://doi.org/10.1136/bmjopen-2014-007111
Becerra V, et al. Cost-effectiveness and Public Health Benefit of Secondary Cardiovascular Disease Prevention From Improved Adherence Using a Polypill in the UK. BMJ Open. 2015 May 9;5(5):e007111. PubMed PMID: 25991449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK. AU - Becerra,Virginia, AU - Gracia,Alfredo, AU - Desai,Kamal, AU - Abogunrin,Seye, AU - Brand,Sarah, AU - Chapman,Ruth, AU - García Alonso,Fernando, AU - Fuster,Valentín, AU - Sanz,Ginés, Y1 - 2015/05/09/ PY - 2015/5/21/entrez PY - 2015/5/21/pubmed PY - 2016/3/2/medline KW - CARDIOLOGY KW - PREVENTIVE MEDICINE SP - e007111 EP - e007111 JF - BMJ open JO - BMJ Open VL - 5 IS - 5 N2 - OBJECTIVE: To evaluate the public health and economic benefits of adherence to a fixed-dose combination polypill for the secondary prevention of cardiovascular (CV) events in adults with a history of myocardial infarction (MI) in the UK. DESIGN: Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs. SETTING: General practice in the UK. PARTICIPANTS: Patients with a mean age of 64.7 years, most of whom are men with a recent or non-recent diagnosis of MI and for whom secondary preventive medication is indicated and well tolerated. INTERVENTION: Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES: CV events prevented per 1000 patients; cost per life-year gained; and cost per quality-adjusted life-year (QALY) gained. RESULTS: The model estimates that for each 10% increase in adherence, an additional 6.7% fatal and non-fatal CV events can be prevented. In the base case, over 10 years, the polypill would improve adherence by ∼20% and thereby prevent 47 of 323 (15%) fatal and non-fatal CV events per 1000 patients compared with multiple monotherapy, with an incremental cost-effectiveness ratio (ICER) of £8200 per QALY gained. Probabilistic sensitivity analyses for the base-case assumptions showed an 81.5% chance of the polypill being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained compared with multiple monotherapy. In scenario analyses that varied structural assumptions, ICERs ranged between cost saving and £21,430 per QALY gained. CONCLUSIONS: Assuming that some 450,000 adults are at risk of MI, a 10 percentage point uptake of the polypill could prevent 3260 CV events and 590 CV deaths over a decade.The polypill appears to be a cost-effective strategy to prevent fatal and non-fatal CV events in the UK. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/25991449/Cost_effectiveness_and_public_health_benefit_of_secondary_cardiovascular_disease_prevention_from_improved_adherence_using_a_polypill_in_the_UK_ DB - PRIME DP - Unbound Medicine ER -