title: Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK.
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.
  
  
  METHODS
  Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs.
  
  
  METHODS
  General practice in the UK.
  
  
  METHODS
  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.
  
  
  METHODS
  Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy.
  
  
  METHODS
  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.
authors.affiliation: Ferrer, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Becerra
authors.affiliation: Ferrer, Barcelona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gracia
authors.affiliation: Evidera, Hammersmith, London, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Desai
authors.affiliation: Evidera, Hammersmith, London, UK.
authors.forename: Seye
authors.initials: S
authors.lastname: Abogunrin
authors.affiliation: Evidera, Bethesda, Maryland, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Brand
authors.affiliation: Evidera, Hammersmith, London, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Ferrer, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: García Alonso
authors.affiliation: The Mount Sinai Medical Center, New York, New York, USA Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
authors.forename: Ginés
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D019338:Polypharmacy; D011634:Public Health / Q000191:economics*; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents
keywords: CARDIOLOGY; PREVENTIVE MEDICINE