The polypill in the primary prevention of cardiovascular disease

Cost-effectiveness in the Dutch population

Paul F van Gils, Eelco A B Over, Heleen H Hamberg-van Reenen, G Ardine de Wit, Matthijs van den Berg, A.J. Schuit, Peter M Engelfriet

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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 modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. 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 Systematic Coronary Risk Evaluation 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 and (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, quality-adjusted life years (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 €7900 and 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 the 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.

Original languageEnglish
Article numbere000363
JournalBMJ Open
Volume1
Issue number2
DOIs
Publication statusPublished - 2011
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cost of Illness
Cost-Benefit Analysis
Quality-Adjusted Life Years
Netherlands
Pharmaceutical Preparations

Keywords

  • Journal Article

Cite this

van Gils, P. F., Over, E. A. B., Hamberg-van Reenen, H. H., de Wit, G. A., van den Berg, M., Schuit, A. J., & Engelfriet, P. M. (2011). The polypill in the primary prevention of cardiovascular disease: Cost-effectiveness in the Dutch population. BMJ Open, 1(2), [e000363]. https://doi.org/10.1136/bmjopen-2011-000363
van Gils, Paul F ; Over, Eelco A B ; Hamberg-van Reenen, Heleen H ; de Wit, G Ardine ; van den Berg, Matthijs ; Schuit, A.J. ; Engelfriet, Peter M. / The polypill in the primary prevention of cardiovascular disease : Cost-effectiveness in the Dutch population. In: BMJ Open. 2011 ; Vol. 1, No. 2.
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abstract = "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 modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. 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 Systematic Coronary Risk Evaluation 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 and (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, quality-adjusted life years (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 €7900 and 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 the 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.",
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van Gils, PF, Over, EAB, Hamberg-van Reenen, HH, de Wit, GA, van den Berg, M, Schuit, AJ & Engelfriet, PM 2011, 'The polypill in the primary prevention of cardiovascular disease: Cost-effectiveness in the Dutch population', BMJ Open, vol. 1, no. 2, e000363. https://doi.org/10.1136/bmjopen-2011-000363

The polypill in the primary prevention of cardiovascular disease : Cost-effectiveness in the Dutch population. / van Gils, Paul F; Over, Eelco A B; Hamberg-van Reenen, Heleen H; de Wit, G Ardine; van den Berg, Matthijs; Schuit, A.J.; Engelfriet, Peter M.

In: BMJ Open, Vol. 1, No. 2, e000363, 2011.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - The polypill in the primary prevention of cardiovascular disease

T2 - Cost-effectiveness in the Dutch population

AU - van Gils, Paul F

AU - Over, Eelco A B

AU - Hamberg-van Reenen, Heleen H

AU - de Wit, G Ardine

AU - van den Berg, Matthijs

AU - Schuit, A.J.

AU - Engelfriet, Peter M

PY - 2011

Y1 - 2011

N2 - 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 modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. 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 Systematic Coronary Risk Evaluation 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 and (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, quality-adjusted life years (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 €7900 and 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 the 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.

AB - 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 modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. 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 Systematic Coronary Risk Evaluation 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 and (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, quality-adjusted life years (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 €7900 and 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 the 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.

KW - Journal Article

U2 - 10.1136/bmjopen-2011-000363

DO - 10.1136/bmjopen-2011-000363

M3 - Article

VL - 1

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 2

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