title: An economic case for a cardiovascular polypill? A cost analysis of the Kanyini GAP trial.
abstract: OBJECTIVE
  To measure the costs of a polypill strategy and compare them with those of usual care in people with established cardiovascular disease (CVD) or at similarly high cardiovascular risk.
  
  
  METHODS
  A within-trial cost analysis of polypill-based care versus usual care with separate medications, using data from the Kanyini Guidelines Adherence with the Polypill (GAP) trial and linked health service and medication administrative claims data.
  
  
  METHODS
  Kanyini GAP participants who consented to Australian Medicare record access.
  
  
  METHODS
  Mean health service and pharmaceutical expenditure per patient per year, estimated with generalised linear models. Costs during the trial (randomisation January 2010 - May 2012, median follow-up 19 months, maximum follow-up 36 months) were inflated to 2012 costs.
  
  
  RESULTS
  Our analysis showed a statistically significantly lower mean pharmaceutical expenditure of $989 (95% CI, $648-$1331) per patient per year in the polypill arm compared with usual care (P < 0.001; adjusted, excluding polypill cost). No significant difference was shown in health service expenditure.
  
  
  CONCLUSIONS
  This study provides evidence of significant cost savings to the taxpayer and Australian Government through the introduction of a CVD polypill strategy. The savings will be less now than during the trial due to subsequent reductions in the costs of usual care. Nonetheless, given the prevalence of CVD in Australia, the introduction of this polypill could increase considerably the efficiency of health care expenditure in Australia.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN126080005833347.
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia. tlaba@georgeinstitute.org.au.
authors.forename: Tracey-Lea
authors.initials: TL
authors.lastname: Laba
authors.affiliation: School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Hayes
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Peiris
authors.affiliation: Department of General Practice, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rafter
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics , Monash University, Melbourne, VIC, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Webster
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Neal
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001315:Australia; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D004338:Drug Combinations; D001241:Aspirin