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Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial.
Int J Cardiol. 2018 07 01; 262:71-78.IJ

Abstract

BACKGROUND

The Use of Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial, showed that access to a cardiovascular polypill (aspirin, statin and two blood pressure lowering drugs) significantly improved adherence, lowered systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDLc) in patients with or at high risk of cardiovascular disease (CVD). We aimed to analyze the within-trial cost-effectiveness of the polypill strategy versus usual care in India.

METHODS

Relative effectiveness and costs of polypill versus usual care groups in UMPIRE were estimated from the health sector perspective. Only direct medical costs were considered. The effectiveness of the polypill was reported as a percentage increase in adherence and mean reductions in SBP, and LDL-c, over the 15-month trial period. Healthcare resource utilization and costs were collected for each patient during the trial. Polypill price was constructed using a range of scenarios: $0.06-$0.94/day. The cost-effectiveness of the polypill was measured as the additional cost for 10% increase in adherence, and per unit reduction in SBP and LDL-c.

RESULTS

Overall, the mean cost per patient was significantly lower with the polypill strategy (-$203 per person, (95% CI: -286, -119, p < 0.01). In scenario analyses that varied polypill price assumptions, incremental cost-effectiveness ratios for a polypill strategy ranged between cost-saving to $75 per 10% increase in adherence for polypill price of $0.94 per day.

CONCLUSIONS

The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Singh K
All India Institute of Medical Sciences, New Delhi, India; Centre for Chronic Disease Control, India; Public Health Foundation of India, Gurgaon, Haryana, India. Electronic address: kavita@ccdcindia.org.
Crossan C
BresMed, Ireland.
Laba TL
The George Institute for Global Health, University of New South Wales (NSW), Australia; The University of Sydney, Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, Sydney, NSW, Australia.
Roy A
All India Institute of Medical Sciences, New Delhi, India.
Hayes A
The University of Sydney, Australia.
Salam A
The George Institute for Global Health, Hyderabad, India.
Jan S
The George Institute for Global Health, University of New South Wales (NSW), Australia.
Lord J
University of Southampton, UK.
Tandon N
All India Institute of Medical Sciences, New Delhi, India.
Rodgers A
The George Institute for Global Health, University of New South Wales (NSW), Australia.
Patel A
The George Institute for Global Health, University of New South Wales (NSW), Australia.
Thom S
Imperial College London, UK.
Prabhakaran D
Centre for Chronic Disease Control, India; Public Health Foundation of India, Gurgaon, Haryana, India; London School of Hygiene and Tropical Medicine, UK.

MeSH

Anticholesteremic AgentsAntihypertensive AgentsCardiovascular DiseasesCost of IllnessCost-Benefit AnalysisDrug Therapy, CombinationFemaleFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIncidenceIndiaMaleMedication AdherenceMiddle AgedPlatelet Aggregation InhibitorsRetrospective StudiesRisk FactorsSecondary Prevention

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

29622506

Citation

Singh, Kavita, et al. "Cost-effectiveness of a Fixed Dose Combination (polypill) in Secondary Prevention of Cardiovascular Diseases in India: Within-trial Cost-effectiveness Analysis of the UMPIRE Trial." International Journal of Cardiology, vol. 262, 2018, pp. 71-78.
Singh K, Crossan C, Laba TL, et al. Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial. Int J Cardiol. 2018;262:71-78.
Singh, K., Crossan, C., Laba, T. L., Roy, A., Hayes, A., Salam, A., Jan, S., Lord, J., Tandon, N., Rodgers, A., Patel, A., Thom, S., & Prabhakaran, D. (2018). Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial. International Journal of Cardiology, 262, 71-78. https://doi.org/10.1016/j.ijcard.2018.03.082
Singh K, et al. Cost-effectiveness of a Fixed Dose Combination (polypill) in Secondary Prevention of Cardiovascular Diseases in India: Within-trial Cost-effectiveness Analysis of the UMPIRE Trial. Int J Cardiol. 2018 07 1;262:71-78. PubMed PMID: 29622506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial. AU - Singh,Kavita, AU - Crossan,Catriona, AU - Laba,Tracey-Lea, AU - Roy,Ambuj, AU - Hayes,Alison, AU - Salam,Abdul, AU - Jan,Stephen, AU - Lord,Joanne, AU - Tandon,Nikhil, AU - Rodgers,Anthony, AU - Patel,Anushka, AU - Thom,Simon, AU - Prabhakaran,Dorairaj, Y1 - 2018/03/21/ PY - 2017/09/06/received PY - 2018/03/06/revised PY - 2018/03/16/accepted PY - 2018/4/7/pubmed PY - 2018/11/10/medline PY - 2018/4/7/entrez KW - Cardiovascular disease (CVD) KW - Cardiovascular polypill KW - Cost-effectiveness analysis (CEA) KW - Fixed dose combination (FDC) KW - India KW - Secondary prevention SP - 71 EP - 78 JF - International journal of cardiology JO - Int J Cardiol VL - 262 N2 - BACKGROUND: The Use of Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial, showed that access to a cardiovascular polypill (aspirin, statin and two blood pressure lowering drugs) significantly improved adherence, lowered systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDLc) in patients with or at high risk of cardiovascular disease (CVD). We aimed to analyze the within-trial cost-effectiveness of the polypill strategy versus usual care in India. METHODS: Relative effectiveness and costs of polypill versus usual care groups in UMPIRE were estimated from the health sector perspective. Only direct medical costs were considered. The effectiveness of the polypill was reported as a percentage increase in adherence and mean reductions in SBP, and LDL-c, over the 15-month trial period. Healthcare resource utilization and costs were collected for each patient during the trial. Polypill price was constructed using a range of scenarios: $0.06-$0.94/day. The cost-effectiveness of the polypill was measured as the additional cost for 10% increase in adherence, and per unit reduction in SBP and LDL-c. RESULTS: Overall, the mean cost per patient was significantly lower with the polypill strategy (-$203 per person, (95% CI: -286, -119, p < 0.01). In scenario analyses that varied polypill price assumptions, incremental cost-effectiveness ratios for a polypill strategy ranged between cost-saving to $75 per 10% increase in adherence for polypill price of $0.94 per day. CONCLUSIONS: The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/29622506/Cost_effectiveness_of_a_fixed_dose_combination__polypill__in_secondary_prevention_of_cardiovascular_diseases_in_India:_Within_trial_cost_effectiveness_analysis_of_the_UMPIRE_trial_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓3]

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