title: Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study.
abstract: OBJECTIVE
  To estimate the health benefits and cost-effectiveness of a polypill intervention (aspirin 100 mg, atorvastatin 20 mg, ramipril 10 mg) compared with multiple monotherapy for secondary prevention of cardiovascular events in adults with a history of myocardial infarction from the perspective of the Spanish National Health System.
  
  
  METHODS
  An adapted version of a recently published Markov model developed and validated in Microsoft Excel was used to compare the cost-effectiveness of the polypill with that of its combined monocomponents over a 10-year time horizon. The population included in the model had a mean age of 64.7 years; most were male and had a history of myocardial infarction. The input parameters were obtained from a systematic literature review examining efficacy, adherence, utilities, and costs. The results of the model are expressed in events avoided, incremental costs, incremental life years, incremental quality-adjusted life years, and the incremental cost-effectiveness ratio.
  
  
  RESULTS
  Over a 10-year period, use of the cardiovascular polypill instead of its monocomponents simultaneously would avoid 46 nonfatal and 11 fatal cardiovascular events per 1000 patients treated. The polypill would also be a more effective and cheaper strategy. Probabilistic analysis of the base case found a 90.9% probability that the polypill would be a cost-effective strategy compared with multiple monotherapy at a willingness-to-pay of 30 000 euros per quality-adjusted life year.
  
  
  CONCLUSIONS
  The polypill would be a cost-effective strategy for the Spanish National Health System with potential clinical benefits.
authors.affiliation: Departamento de Cardiología Adultos, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: vivenciobarrios@gmail.com.
authors.forename: Vivencio
authors.initials: V
authors.lastname: Barrios
authors.affiliation: Departamento Científico, Ferrer, Barcelona, Spain.
authors.forename: Lisette
authors.initials: L
authors.lastname: Kaskens
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine Mount Sinai, New York, United States; Servicio de Cardiología, HM Hospitales, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Castellano
authors.affiliation: Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cosin-Sales
authors.affiliation: Departamento Científico, Ferrer, Barcelona, Spain.
authors.forename: José Emilio
authors.initials: JE
authors.lastname: Ruiz
authors.affiliation: Departamento Científico, Ferrer, Barcelona, Spain.
authors.forename: Ilonka
authors.initials: I
authors.lastname: Zsolt
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine Mount Sinai, New York, United States.
authors.forename: Valentín
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Departamento Científico, Ferrer, Barcelona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gracia
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use*; D000069059:Atorvastatin / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000639:trends*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008390:Markov Chains; D055118:Medication Adherence; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D017257:Ramipril / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D013030:Spain / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D000069059:Atorvastatin; D017257:Ramipril; D001241:Aspirin
keywords: Adherence; Adherencia; Cost-effectiveness; Coste-efectividad; Policomprimido; Polypill; Prevención secundaria cardiovascular; Secondary cardiovascular prevention