Cost-Effectiveness of the CNIC-Polypill Strategy Compared With Separate Monocomponents in Secondary Prevention of Cardiovascular and Cerebrovascular Disease in Portugal: The MERCURY Study

Abstract

Background: Cardiovascular (CV) diseases remain a leading and costly cause of death globally. Patients with previous CV events are at high risk of recurrence. Secondary prevention therapies improve CV risk factor control and reduce disease costs. Objectives: To assess the cost-effectiveness of a CV polypill strategy (CNIC-Polypill) compared with the loose combination of monocomponents to improve the control of CV risk factors in patients with previous coronary heart disease or stroke. Methods: A Markov model cost-utility analysis was developed using 4 health states, SMART risk equation, and 3-month cycles for year 1 and annual cycles thereafter, over a lifetime horizon from the perspective of the National Health System in Portugal (base case). The NEPTUNO study, Portuguese registries, mortality tables, official reports, and the literature were consulted to define effectiveness, epidemiological costs, and utility data. Outcomes were costs (estimated in 2020 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 4% discount rate was applied. Alternative scenarios and one-way and probabilistic sensitivity analyses tested the consistency and robustness of results. Results: The CNIC-Polypill strategy in secondary prevention provides more LY and QALY, at a higher cost, than monocomponents. The incremental cost-utility ratio is €1557/QALY gained. Assuming a willingness-to-pay threshold of €30 000/QALY gained, there is a 79.7% and a 44.4% probability of the CNIC-Polypill being cost-effective and cost-saving, respectively, compared with the loose combination of monocomponents. Results remain consistent in the alternative scenarios and robust in the sensitivity analyses. Discussion: The model reflects increments in the number of years patients would live and in quality of life with the CNIC-Polypill. The clinical effectiveness of the CNIC-Polypill strategy initially demonstrated in the NEPTUNO study has been recently corroborated in the SECURE trial. The incremental cost of the CNIC-Polypill strategy emerges slightly above the comparator, but willingness-to-pay estimates and sensitivity analyses indicate that the CNIC-Polypill strategy is consistently cost-effective compared with monocomponents and remains within acceptable affordability margins. Conclusion: The CNIC-Polypill is a cost-effective secondary prevention strategy. In patients with histories of coronary heart disease or stroke, the CNIC-Polypill more effectively controls CV risk factors compared with monocomponents.

The CNIC-polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischaemic heart disease

“…This result is in line with the results of the MERCURY cost-effectiveness analysis, where the CNIC-polypill strategy was cost-effective compared with monocomponents from the perspective of the National Health System in Portugal in patients who have suffered a CHD event or a stroke. 23 This is also in line with the conclusions of a recent systematic literature review where the CV polypill (consisting of ASA, a lipid-lowering agent, and at least one antihypertensive drug) was cost-effective compared with the standard treatment for secondary prevention in patients with at least one non-fatal coronary heart event. 59 …”

“… 22 Additionally, health economic assessments conducted in the MERCURY cost-effectiveness analysis (CEA) and model-based CEAs based on NEPTUNO effectiveness data concluded that the CNIC-polypill is a cost-effective therapeutic strategy compared with other approaches. 23–25 These findings underscore the growing body of evidence advocating for the incorporation of polypills in CV care. 26–28 …”

Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study

“…The incremental cost–utility ratio was €2328 per QALY in patients with coronary heart disease and €553/QALY in those with a previous stroke, being cost-effective for a threshold of €30,000/QALY. 37 …”

The cardiovascular polypill as baseline treatment improves lipid profile and blood pressure regardless of body mass index in patients with cardiovascular disease. The Bacus study

“…However, a recent meta-analysis of socioeconomic studies concluded that polypills resulted in improved adherence and quality of life at a price equal to or lower than multiple monotherapies, with the price (which was below the commonly accepted thresholds or cost saving in both primary and secondary prevention) as one of the key drivers of the cost-effectiveness [ 16 ]. Similarly, a cost-utility analysis conducted in Portugal documented that the CV polypill was consistently cost-effective compared with monocomponents in secondary prevention [ 17 ].…”