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Prescribing polypill to lower-risk patients may not be cost-effective
A microsimulation model exploring lifetime predictions for CVD events, diabetes and death showed that periodic risk assessment using lower risk thresholds to determine the initial prescribing of preventive drugs would most likely not be cost-effective in a population approach.
Prescribing a polypill (a statin and three antihypertensive agents) may become cost-effective if drug prices were reduced, according to research conducted in the United Kingdom and published in Heart.
“Although less restrictive risk assessment and polypill scenarios prevented more CVD events and attained larger survival gains, these benefits were offset by the additional costs and disutility of daily medication use. Lowering the risk threshold for prescription of statins to 10% was economically unattractive, costing 40,000 [pounds] per [quality-adjusted life-years] gained,” Bart S. Ferket, MD, PhD, of the department of population health science and policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, and colleagues wrote.
A total of 259,146 participants aged 40 to 69 years from the UK Biobank, who were asymptomatic for CVD, were selected for the microsimulation model.
The researchers evaluated incremental costs and quality-adjusted life-years (QALYs) for different doses of a polypill in different scenarios. The polypill included simvastatin 20 mg, amlodipine 2.5 mg, losartan 25 mg and hydrochlorothiazide 12.5 mg. The scenarios looked at starting age and periodic risk assessment with 10-year CVD risk thresholds of 10% and 20%.
The ideal strategy was when statins and antihypertensives were prescribed when risk was greater than 20%. This gained 123 QALYs per 10,000 participants. The extra cost was 1.45 million pounds compared with current practice.
The most cost-effective scenario was starting the polypill at age 60 years or older along with annual drug prices reduced below 240 pounds.
“There is an international trend toward recommending medication use to prevent CVD in individuals at lower [CV] risk. It has been estimated that the new U.S. cholesterol treatment guidelines will increase the number of adults eligible for statins by 11%. Around the world, these changes to guidelines have sparked the debate on ‘over-medicalization.’ We now provide evidence that expanding the use of statins and antihypertensive drugs for CVD prevention appears to improve survival but that the incremental costs per QALY gained are high, mainly because the general population assigns a small quality of life decrement to preventive pill use,” the researchers wrote. – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures.