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How cost-effective is the CNIC polypill for the secondary prevention of cardiovascular and cerebrovascular disease in Portugal? An assessment of its health- economic value
Session:
CO 09 - Cardiologia Preventiva
Speaker:
Gabriel Rubio Mercade
Congress:
CPC 2021
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gabriel Rubio Mercade; Carlos Aguiar; Francisco Araújo; David Carcedo; Tânia Oliveira; Silvia Paz; Jose Maria Castellano; Valentín Fuster
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Corbel",sans-serif">Background: </span></strong><span style="font-family:"Corbel",sans-serif">The cardiovascular (CV) polypill strategy has proven to successfully reduce healthcare costs by decreasing the CV risk in secondary prevention patients. Previous pharmacoeconomic studies based the improvements in health outcomes on the increased adherence exerted by the CV polypill. Real-life clinical studies have now demonstrated the superiority of the CV polypill over usual care in positively modifying CV risk factors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Corbel",sans-serif">Purpose: </span></strong><span style="font-family:"Corbel",sans-serif">To assess the cost-effectiveness of the CV polypill (aspirin 100mg, atorvastatin 20/40mg, ramipril 2.5/5/10mg) compared to usual care – combination of individual components - to satisfactorily modify CV risk factors in patients with a history of coronary heart disease (CHD) or ischaemic stroke (IS) in Portugal.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Corbel",sans-serif">Methods: </span></strong><span style="font-family:"Corbel",sans-serif">A Markov cost-effectiveness model (payer perspective; direct medical costs; lifetime horizon) based on changes in CV risk factors obtained from a real-life study conducted in Mexico (limitation) was set for Portugal. The probability of transition between states was based on the SMART risk equation. Cost-effectiveness was calculated for a mixed cohort of post-CHD (</span>representative of the population in the proACS registry<span style="font-family:"Corbel",sans-serif">) and post-IS patients (</span>representative of the database of the Portuguese Ministry of Health’s Central Administration for the Health System<span style="font-family:"Corbel",sans-serif">) (n= 1000). Outcomes were costs (€ 2020) per life year (LY) and Quality Adjusted LY (QALY) gained. One-way (OWA) and probabilistic sensitivity analyses (PSA) tested the consistency of results.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Corbel",sans-serif">Results: </span></strong><span style="font-family:"Corbel",sans-serif">In the weighted population, the incremental cost reaches 607,053 €, 757,092 € for post-CHD and 394,539 € for post-IS. There are less subsequent CV events (90) and CV deaths (17) with the polypill compared to usual care in the overall population, as well as in post-CHD (CV events: 90, CV deaths: 16) and post-IS (CV events: 82,5, CV deaths: 16). The overall incremental cost-effectiveness ratio (ICER) is 5,508€/LY, or 6,519€/LY for CHD and 4,455€ /LY for IS; and the incremental cost-utility ratio (ICUR) is 6,324€/QALY in the mixed cohort, and 6,320€/QALY for CHD and 6,378€/QALY for IS. Assuming a willingness-to-pay (WTP) threshold of 30,000 €/QALY gained, there is a 71% chance for the polypill being a cost-effective strategy compared to usual care and 24% of being cost saving.</span></span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Corbel",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Corbel",sans-serif">The polypill is a cost-effective strategy in post-CHD and post-IS patients compared to the individual monocomponents in the secondary prevention of CV disease in Portugal.</span></span></p>
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