title: Cost-benefit analysis of the polypill in the primary prevention of myocardial infarction and stroke.
abstract: The primary prevention of cardiovascular disease is a public health priority. To assess the costs and benefits of a Polypill Prevention Programme using a daily 4-component polypill from age 50 in the UK, we determined the life years gained without a first myocardial infarction (MI) or stroke, together with the total service cost (or saving) and the net cost (or saving) per year of life gained without a first MI or stroke. This was estimated on the basis of a 50 % uptake and a previously published 83 % treatment adherence. The total years of life gained without a first MI or stroke in a mature programme is 990,000 each year in the UK. If the cost of the Polypill Prevention Programme were £1 per person per day, the total cost would be £4.76 bn and, given the savings (at 2014 prices) of £2.65 bn arising from the disease prevented, there would be a net cost of £2.11 bn representing a net cost per year of life gained without a first MI or stroke of £2120. The results are robust to sensitivity analyses. A national Polypill Prevention Programme would have a substantial effect in preventing MIs and strokes and be cost-effective.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK. n.j.wald@qmul.ac.uk.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wald
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK.
authors.forename: Johannes Michiel
authors.initials: JM
authors.lastname: Luteijn
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK.
authors.forename: Joan K
authors.initials: JK
authors.lastname: Morris
authors.affiliation: UCL School of Pharmacy, BMA/Tavistock House, London, WC1H 9JP, UK.
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Christ Church, Oxford, OX1 1DP, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Oppenheimer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017311:Amlodipine / Q000008:administration & dosage*; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000191:economics; D016022:Case-Control Studies; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D019808:Losartan / Q000008:administration & dosage*; D008390:Markov Chains; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control*; D019338:Polypharmacy; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D019821:Simvastatin / Q000008:administration & dosage* / Q000191:economics; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D006113:United Kingdom
chemical_list: D002317:Cardiovascular Agents; D006852:Hydrochlorothiazide; D017311:Amlodipine; D019821:Simvastatin; D019808:Losartan; D001241:Aspirin
keywords: Cardiovascular diseases; Cost–benefit analysis; Myocardial infarction; Polypill; Primary prevention; Stroke