title: Predicting the impact of polypill use in a metabolic syndrome population: an effectiveness and cost-effectiveness analysis.
abstract: BACKGROUND
  Individuals with metabolic syndrome (MetS) are at increased risk of cardiovascular disease (CVD), often requiring combination drug therapy for control of risk factors and subsequent risk reduction. This study aims to compare the long-term effectiveness and cost effectiveness of the polypill (a multi-component tablet), and its components (alone or in combination), in a MetS population.
  
  
  RESULTS
  A Markov state transition model, using individual subject data from the Australian Diabetes, Obesity and Lifestyle study, was constructed to simulate the effects of the treatment versus no treatment on CVD events, and costs over 10 years. In 1,991 individuals classified as MetS and free of existing diabetes mellitus or CVD, treatment with the polypill (or its components) was effective at reducing cardiovascular events [statin: 171, aspirin (actetylsalicylic acid): 201, antihypertensive: 186 per 1,000 individuals]. The more drug therapies employed the greater the reduction, with the polypill reducing up to 351 cardiovascular events per 10,000 individuals. Cost-effectiveness analyses were sensitive to drug treatment costs and effectiveness of treatment. At a cost of AUD$42 per person per annum, aspirin was considered cost saving. All other treatment strategies, including the polypill, were not cost effective.
  
  
  CONCLUSIONS
  The polypill is likely to be effective in the reduction of cardiovascular events in a MetS population. It is, however, not cost effective. Nevertheless, in a high-risk population, among whom combination therapy is often prescribed, the polypill is likely to be more cost effective than antihypertensive therapy alone or dual therapy with a statin and antihypertensive combination.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, and Royal Melbourne Hospital, Melbourne, VIC, Australia. ella.zomer@monash.edu
authors.forename: Ella
authors.initials: E
authors.lastname: Zomer
authors.forename: Alice
authors.initials: A
authors.lastname: Owen
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.forename: Zanfina
authors.initials: Z
authors.lastname: Ademi
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D019821:Simvastatin; D001241:Aspirin