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, Kavita; Crossan, Catriona; Laba, Tracey‐Lea; Roy, Ambuj; Hayes, Alison; Salam, Abdul; Jan, Stephen; Lord, Joanne; Tandon, Nikhil; Rodgers, Anthony; Patel, Anushka; Thom, Simon; Prabhakaran, Dorairaj

doi:10.1016/j.ijcard.2018.03.082

Cited by 20 publications

(32 citation statements)

References 48 publications

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“…In a recent analysis comparing the implementation of a cardiovascular polypill (aspirin, statin and angiotensin-converting enzyme (ACE)-inhibitor) compared with multiple monotherapy in adults with a history of myocardial infarction in the UK, the FDC-based therapy proved to be cost-effective: the only improvement in adherence (estimated to be about 20%) was estimated to prevent 15% of fatal and non-fatal cardiovascular events (47 out of 323/1000 patients). 11 Cost-effectiveness of FDC has been demonstrated even in low–middle income countries such as India: interestingly, it appears to be greater in patients with diabetes, 12 further reinforcing the clinical relevance of the present analysis.…”

supporting

confidence: 70%

“…11 Cost-effectiveness of FDC has been demonstrated even in low-middle income countries such as India: interestingly, it appears to be greater in patients with diabetes, 12 further reinforcing the clinical relevance of the present analysis.…”

supporting

confidence: 63%

“…12 Future studies evaluating the efficacy and the cost-efficacy of calcium channel blocker-based FDC therapies are warranted.…”

mentioning

confidence: 99%

“…An increased adherence with two polypill strategies (including lisinopril + atenolol or lisinopril + hydrochlorothiazide, aspirin and simvastatin) compared with usual care in individuals with established cardiovascular disease, as well as the cost-effectiveness of this approach, has been recently demonstrated by the UMPIRE (Use of Multidrug Pill In Reducing cardiovascular Events) study. 12 Future studies evaluating the efficacy and the cost-efficacy of calcium channel blocker-based FDC therapies are warranted.…”

mentioning

confidence: 99%

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Need for fixed combination therapy in type-2 diabetes: Findings from the SMART study

Bruno

Taddei

2018

Eur J Prev Cardiolog

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supporting

confidence: 70%

supporting

confidence: 63%

“…12 Future studies evaluating the efficacy and the cost-efficacy of calcium channel blocker-based FDC therapies are warranted.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Need for fixed combination therapy in type-2 diabetes: Findings from the SMART study

Bruno

Taddei

2018

Eur J Prev Cardiolog

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“…12 It is also cost-saving when compared to usual care. 13 Different formulations of polypill were used in several studies worldwide. [14][15][16][17][18][19][20][21] The results of a pilot study from Iran suggested that a polypill consisted of aspirin 81 mg, enalapril 2.5 mg, atorvastatin 20 mg and hydrochlorothiazide 12.5 mg was well tolerated and participants' compliance to the polypill was satisfactory, with modest reductions in blood pressure and lipid levels.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial

et al. 2019

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Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study

Ravangard,

Ghanbari,

Attar

et al. 2024

Health Science Reports

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Background and AimsCardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost‐effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran.MethodsThis was an economic evaluation study conducted to compare the cost‐utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality‐adjusted life‐years (QALYs), and incremental cost‐effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used.ResultsThe results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost‐utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost‐effective versus other medications.ConclusionConsidering that polypill had the most cost‐utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

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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

Abstract: The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India.

Cited by 20 publications

References 48 publications

Need for fixed combination therapy in type-2 diabetes: Findings from the SMART study

Need for fixed combination therapy in type-2 diabetes: Findings from the SMART study

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study

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