Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study.
INTRODUCTION AND OBJECTIVES
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.
['Barrios|Vivencio|V|', 'Kaskens|Lisette|L|', 'Castellano|José María|JM|', 'Cosin-Sales|Juan|J|', 'Ruiz|José Emilio|JE|', 'Zsolt|Ilonka|I|', 'Fuster|Valentín|V|', 'Gracia|Alfredo|A|']
D000328:Adult D000806:Angiotensin-Converting Enzyme Inhibitors D001241:Aspirin D000069059:Atorvastatin D002318:Cardiovascular Diseases D003362:Cost-Benefit Analysis D016527:Drug Costs D004359:Drug Therapy, Combination D005260:Female D005500:Follow-Up Studies D005544:Forecasting D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D015994:Incidence D008297:Male D008390:Markov Chains D055118:Medication Adherence D008875:Middle Aged D010975:Platelet Aggregation Inhibitors D019057:Quality-Adjusted Life Years D017257:Ramipril D012189:Retrospective Studies D055502:Secondary Prevention D013030:Spain
Polypill Cost-effectiveness Adherence Adherencia Coste-efectividad Policomprimido Prevención secundaria cardiovascular Secondary cardiovascular prevention