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

Abstract

Purpose The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain. Patients and Methods An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated. Results After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments. Conclusion CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.

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

“…cerebrovascular diseases and PDA), except that lost work productivity (sick leave) costs were similar between treatment cohorts. 24 The reason for this difference could be related to the differential proportion of patients with productivity losses due to morbidity between CVD categories, which in Europe is higher among patients with stroke than IHD, 58 and in Spain represents 27 and 16% of all non-healthcare costs, respectively. 57 Finally, our study found that the CNIC-polypill was a dominant strategy (i.e.…”

Guía latinoamericana de recomendaciones al egreso de un síndrome coronario agudo

“…En el estudio NEPTUNO, los pacientes del grupo de polipíldora cardiovascular también mostraron un menor uso de recursos en comparación con las otras cohortes [357][358][359] . Las pérdidas de productividad también fueron menores en los pacientes que recibieron la polipíldora cardiovascular en comparación con las otras cohortes, no solo en cuanto al número de pacientes que no tuvieron reinserción laboral (11.5% vs. 14.7% en grupo de monocomponentes, 15.2% en grupo de equipotentes y 15.6% en grupo de otras terapias; p < 0.003), sino también en cuanto al número de días no trabajados por enfermedad durante el periodo de seguimiento (6.4 días vs. 8.4 días en grupo de monocomponentes, 8.3 días en grupo de equipotentes y 7.9 días en grupo de otras terapias; p < 0.001).…”

“…-Por todas las evidencias hasta ahora expuestas en este consenso, la OMS ha incluido la polipíldora cardiovascular (AAS, atorvastatina y ramipril) como combinación fija para la prevención cardiovascular secundaria en su listado de 2023 de medicamentos esenciales 363 , y recomienda que, si no hay ninguna razón que contraindique la utilización de una polipíldora conteniendo AAS, atorvastatina y ramipril, se debería considerar su uso como tratamiento de base al momento del egreso en todo paciente tras un IAM, ya que mejora el pronóstico de los pacientes al reducir los eventos recurrentes y la mortalidad, y además es coste-efectiva [352][353][354][355][356][357][358] .…”

Redefining the polypill: pros and cons in cardiovascular precision medicine

“…Studies have further provided evidences on cost-effectiveness of the recently trialled CNIC-Polypill ( Becerra et al, 2015 ; Cordero et al, 2021 ). The economic analyses in the recent NEPTUNO study carried out on 6,456 patients in Spain has shown that the CNIC-Polypill used for secondary CV prevention is cost-effective compared to monotherapy and its use incurs a relatively lower utilization of the healthcare resources and total costs ( González-Juanatey et al, 2022 ; Cordero et al, 2023 ). This further provided information on the associated cost-savings ranging between €17,790 to €26,257 per patient without CVE.…”