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Budget impact analysis and public health benefit of the CNIC polypill strategy for the secondary prevention of cardiovascular and cerebrovascular disease in Portugal
Session:
Posters - J. Preventive Cardiology
Speaker:
Gabriel Rubio Mercade
Congress:
CPC 2021
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.3 Secondary Prevention
Session Type:
Posters
FP Number:
---
Authors:
Gabriel Rubio Mercade; Francisco Araújo; Carlos Aguiar; 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>Background:</strong> Cardiovascular (CV) disease remains a leading cause of morbidity and mortality in Portugal, representing 29% of all deaths and over 12,000 yearly hospital admissions for myocardial infarction only. A significant proportion of CV disease morbidity and mortality is preventable through the reduction of CV risk factors. A CV polypill that combines aspirin, atorvastatin and ramipril has been available in Portugal since 2014 to serve as baseline treatment and optimise management of patients on secondary CV prevention through a better control of CV risk factors.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong><span style="color:black">To assess the economic and health implications of an increased uptake of a polypill strategy (aspirin 100mg, atorvastatin 20/40mg, ramipril 2.5/5/10mg) for the secondary prevention of CV and cerebrovascular events into the current formulary set up in Portugal.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> <span style="color:black">Budget impact (BI) model based on clinical effectiveness (reduction risk factors; SMART risk equation), pharmacological and event costs, to calculate the cost implications for two treatment strategies for patients on secondary CV prevention: with the polypill or with the individual components, at a 5 year-time horizon (2020-2024).</span> The BI was calculated for a mixed cohort of patients with previous coronary heart disease (CHD, representative of the population in the proACS registry), or ischaemic stroke (IS, representative of the database of the Portuguese Ministry of Health’s Central Administration for the Health System) (weighted post-CHD event: 57.9%; post-IS: 42.1%). Systematic reviews, registries, mortality tables and official reports were searched to collect effectiveness, epidemiological and costs (€, 2020) data.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> If the CV polypill uptake reaches 8.6% at year 5, 15,454 secondary CV and cerebrovascular disease prevention patients would be treated with the CV polypill, from 3,528 in year 1. 239 CV events and 46 CV related deaths would be prevented by the increased uptake of the CV polypill strategy over 5 years, or 82 CV events and 16 deaths during the 5<sup>th</sup> year. The increased uptake of the CV polypill strategy would mean a BI of 286,046€, 573,218€, 810,401€, 1,009,241€ and 1,165,241€ in years 1 to 5, respectively. It would represent a total cumulative BI across 5 years for the Portuguese NHS of 3.8 million €. The estimated 5-years BI ?represents 0.52% of the total expenditure of managing this population during this period.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Under the BI model assumptions, the use of the CV polypill for the secondary prevention of CV and cerebrovascular events is affordable in Portugal and has the potential to improve health outcomes.</span></span></p>
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