Data from: The polypill in the primary prevention of cardiovascular disease: cost-effectiveness in the Dutch population

OBJECTIVES: The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. DESIGN: A health economic modeling study. SETTING: Primary health care in the Netherlands. PARTICIPANTS: Simulated individuals from the general Dutch population, aged 45-75 years of age. INTERVENTIONS: Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the SCORE function of alternatively 5%, 7.5%, or 10%. Different versions of the polypill were considered, depending on composition: 1) the Indian polycap, with three different types of blood pressure lowering drugs, a statin, and aspirin; 2) as 1) but without aspirin; 3) as 2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. PRIMARY OUTCOME MEASURES: Cases of acute myocardial infarction or stroke prevented, QALYs gained, and the costs per QALY gained. All interventions were compared with usual care. RESULTS: All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7,900-12,300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as threshold, this pill would prevent approximately 3.5% of all cardiovascular events. CONCLUSIONS: Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose.

研究目的：本研究旨在评估复方制剂（polypill）在心血管疾病一级预防中的成本-效果性。
研究设计：一项卫生经济建模研究。
研究场景：荷兰初级卫生保健体系。
研究对象：来自荷兰普通人群、年龄介于45至75岁的模拟个体。
干预措施：对符合条件的个体开展机会性筛查后开具复方制剂（polypill）处方。入选标准定义为：采用SCORE风险评估函数计算的10年心血管死亡最低风险分别为5%、7.5%或10%（作为筛查阈值）。根据药物组成，共考量了三种不同版本的复方制剂：1）印度复方制剂（polycap），包含三种不同降压药物、一种他汀类药物与阿司匹林；2）与版本1组成一致，但不含阿司匹林；3）与版本2组成一致，但他汀类药物剂量加倍。此外，还模拟了（针对性）单独使用降压药物和/或他汀类药物的干预场景。
主要结局指标：预防的急性心肌梗死或脑卒中病例数、获得的质量调整生命年（Quality-Adjusted Life Years，QALYs）以及每获得1个QALY所需的成本。所有干预措施均与常规诊疗进行对比。
研究结果：所有干预场景均具备成本-效果性，与常规诊疗相比，增量成本效果比介于每获得1个QALY需7900至12300欧元之间。不含阿司匹林且他汀类药物剂量加倍的复方制剂可实现最优健康获益。以10年心血管死亡风险7.5%作为筛查阈值时，该复方制剂可预防约3.5%的全部心血管事件。
研究结论：基于全球心血管风险评估的机会性筛查，随后为风险升高人群开具复方制剂处方，是一种具备成本-效果性的策略。其中，不含阿司匹林且他汀类药物剂量加倍的复方制剂可实现最优健康获益。