title: The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population.
abstract: Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease.  Design A health economic modelling study.  Setting Primary healthcare in the Netherlands.  Participants Simulated individuals from the general Dutch population, aged 45-75 years.  Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated.  Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care.  Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events.  Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, the Netherlands.
authors.forename: Paul F
authors.initials: PF
authors.lastname: van Gils
authors.forename: Eelco A B
authors.initials: EA
authors.lastname: Over
authors.forename: Heleen H
authors.initials: HH
authors.lastname: Hamberg-van Reenen
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.forename: Matthijs
authors.initials: M
authors.lastname: van den Berg
authors.forename: Albertine J
authors.initials: AJ
authors.lastname: Schuit
authors.forename: Peter M
authors.initials: PM
authors.lastname: Engelfriet