Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study

Barrios, Vivencio; Kaskens, Lisette; Castellano, José María; Cosı́n-Sales, Juan; Ruiz, José Emilio; Zsolt, Ilonka; Fuster, Valentín; Gracia, Alfredo

doi:10.1016/j.rec.2016.05.009

Cited by 23 publications

(53 citation statements)

References 29 publications

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“…The general characteristics of the included articles organised by treatment strategies are summarised in Table 1. Of the selected studies, ten evaluated ezetimibe [12,13,32,33,35,36,[42][43][44][45], 15 PCSK9 inhibitors [12, 26, 28-30, 33, 37-39, 43-48], five n-3 PUFAs [31,40,[49][50][51], and seven the polypill [27,34,41,[52][53][54][55]. Four out of the 15 studies focusing on PCSK9 inhibitors also reported the ICERs of ezetimibe versus statins, but considering ezetimibe as a comparator [12,33,43,44], and those results have also been included and reported in this review.…”

Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

2020

Heart, Lung and Circulation

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Background New pharmacological therapies for the treatment of cardiovascular disease (CVD) have emerged in recent years. The high rates of CVD and the need for long-term treatment to decrease risk factors makes cost-effectiveness crucial for their successful long-term implementation. Objective This study assessed cost-effectiveness studies of novel pharmacological treatments (ezetimibe, proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors, omega-3 polyunsaturated fatty acids [n-3 PUFAs], and the cardiovascular polypill) compared with standard care for the secondary prevention of CVD. Methods We searched seven databases and the reference list of selected literature reviews for eligible cost-effective analyses (CEA) published between January 2009 and January 2020 that evaluated the above novel treatments versus standard care. Two independent reviewers performed the screening and evaluation in accordance with the Consolidated Health Economic Evaluation Reporting Standards statement. Cost results were adapted to 2018 US dollars (US$) to facilitate comparisons between studies. Consideration of cost-effectiveness was based on the original study criteria. Results Thirty-two studies were included in this review, most of them adopting a healthcare perspective. Studies evaluating ezetimibe, PCSK9 inhibitors and n-3 PUFAs assessed their addition to standard care compared with standard care alone, while studies analysing the polypill evaluated the replacement of multiple monotherapies for a fixed-dose combination. Ten studies reported on ezetimibe, fifteen evaluated PCSK9 inhibitors, five focused on n-3 PUFAs and seven on the polypill. From a healthcare perspective, ezetimibe was cost effective in 62.5% of the studies (incremental cost-effectiveness ratios [ICERs]

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Section: General Characteristics Of the Included Studiesmentioning

confidence: 99%

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

2020

Heart, Lung and Circulation

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“…Previous cost-effectiveness analyses of polypills have primarily been concerned with treatment of secondary prevention patients [ 10 , 11 ], or, in primary prevention, comparing their use to no treatment, rather than to usual care or improved implementation of guidelines. [ 12 , 13 ] The aim of this study was to estimate the cost-effectiveness of a polypill strategy compared with current treatment or treatment as per guidelines for primary prevention for patients with known high cardiovascular risk who are already prescribed statins and/or blood pressure lowering therapy.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of use of a polypill versus usual care or best practice for primary prevention in people at high risk of cardiovascular disease

et al. 2017

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BackgroundClinical trials suggest that use of fixed-dose combination therapy (‘polypills’) can improve adherence to medication and control of risk factors of people at high risk of cardiovascular disease (CVD) compared to usual care, but cost-effectiveness is unknown.ObjectiveTo determine whether a polypill is cost-effective compared to usual care and optimal guideline-recommended treatment for primary prevention in people already on statins and/or blood pressure lowering therapy.MethodsA Markov model was developed to perform a cost-utility analysis with a one year time cycle and a 10 year time horizon to compare the polypill with usual care and optimal implementation of NICE Guidelines, using patient level data from a retrospective cross-sectional study. The model was run for ten age (40 years+) and gender-specific sub-groups on treatment for raised CVD risk with no history of CVD. Published sources were used to estimate impact of different treatment strategies on risk of CVD events.ResultsA polypill strategy was potentially cost-effective compared to other strategies for most sub-groups ranging from dominance to up to £18,811 per QALY depending on patient sub-group. Optimal implementation of guidelines was most cost-effective for women aged 40–49 and men aged 75+. Results were sensitive to polypill cost, and if the annual cost was less than £150, this approach was cost-effective compared to the other strategies.ConclusionsFor most people already on treatment to modify CVD risk, a polypill strategy may be cost-effective compared with optimising treatment as per guidelines or their current care, as long as the polypill cost is sufficiently low.

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“…However, this study did not incorporate the impact of improved adherence to therapy due to the introduction of polypill and did not consider the cost of hospitalizations due to polypill treatment in their analysis(39). More recently, a Markov model based CEA demonstrated the benefits of improved adherence with a cardiovascular polypill versus multiple monotherapy for the secondary prevention of CVD in the UK and Spain(24,40). The UK study found that an additional 6.7% CVD events can be prevented for 10% increase in adherence and ICERs ranged between cost-saving and £21,430[$27,319.4] per QALY gained(24).…”

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confidence: 99%

Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial

Singh

Crossan²,

Laba

et al. 2018

International Journal of Cardiology

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Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study

Cited by 23 publications

References 29 publications

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

743 WITHDRAWN:Â Novel Treatment Strategies for Secondary Prevention of Cardiovascular Disease: A Systematic Review of Cost-Effectiveness

Cost-effectiveness analysis of use of a polypill versus usual care or best practice for primary prevention in people at high risk of cardiovascular disease

Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial

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