Polypills may be cost-effective for CVD prevention in underserved US communities
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Key takeaways:
- A polypill-based strategy may be cost-effective for primary CVD prevention in historically underserved communities.
- The estimated cost was $8,560 to $13,400 per quality-adjusted life-year gained.
A daily polypill was estimated to be cost-effective for primary CVD prevention among U.S. adults living in historically underserved communities with limited health care access and low income, researchers reported.
The cost-effectiveness analysis was conducted in two simulated U.S. cohorts — one based on the Southern Community Cohort Study (SCCS) the other on all trial-eligible U.S. adults — and the results were published in JAMA Cardiology.
“The U.S. spends a disproportionately high proportion of its GDP on health care, compared with other high-income countries. Despite this, ‘preventable’ premature mortality is higher in the U.S. than many other high-income countries. And while rates of CVD were declining until around 2010 in the U.S., this decline has halted over the last 15 years,” Ciaran N. Kohli-Lynch, PhD, health economist and assistant professor of preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine, told Healio. “Given these facts, the underlying motivation for our work is to identify efficient ways to distribute health care budgets in the U.S. to prevent CVD and improve population health.
“This specific analysis was motivated by results from the SCCS. This trial showed that a CV polypill was a highly effective means of controlling BP and LDL in a majority low-income and majority Black population with elevated BP,” Kohli-Lynch said. “In this population, which is typically underserved by preventive health care services, we aimed to assess the longer-term health and economic outcomes associated with the polypill, to establish whether it would be a cost-effective way to prevent CVD.”
SCCS was a randomized controlled trial conducted in Mobile, Alabama, for which 303 low-income, mostly Black adults with limited health care access were randomly assigned to a polypill containing atorvastatin 10 mg, amlodipine 2.5 mg, losartan 25 mg and hydrochlorothiazide 12.5 mg or usual care (mean age, 56 years; 40% men; 96% Black).
As Healio previously reported, a polypill-based strategy was associated with greater reductions in systolic BP and LDL compared with usual care in a historically underserved population.
For the present study, Kohli-Lynch and colleagues simulated the long-term cost-effectiveness of a polypill-based strategy for primary prevention in a SCCS trial-representative cohort of 100,000 individuals (mean age, 57 years; 62% women) and in more than 3.6 million trial-eligible non-Hispanic Black U.S. adults (mean age, 55 years; 56% women).
Polypills cost-effective for primary prevention
The researchers simulated direct health care costs and quality-adjusted life-years, both discounted 3% annually, and the incremental cost per QALY gained over a 10-year duration with polypill treatment priced at $463 per year in the base-case analysis.
Kohli-Lynch and colleagues estimated that a polypill-based primary prevention strategy in a simulated SCCS cohort would yield an average 1,190 additional QALYs compared with usual care (95% CI, 287-2,159), at an estimated cost of $8,560 per QALY gained compared with usual care. Primary prevention with a polypill was a high-value intervention among the historically underserved population in SCCS in 99% of simulations, at a cost of less than $50,000 per QALY gained, the researchers wrote.
“Previous studies have identified that CV polypills are a safe and effective preventive intervention for CVD,” Kohli-Lynch told Healio. “What our study adds is the fact that, over a 10-year period, polypill treatment represents a high value investment in health. Our results are more likely to influence health care policymakers and payers than the FDA. However, this study could help build support for expedited processing of the polypill and widespread use if it is approved.”
In the second simulated analysis among 3.6 million trial-eligible non-Hispanic Black U.S. adults, the polypill strategy remained high value, with an estimated cost of $13,400 per QALY gained, according to the study.
“As with any research study, uncertainty surrounds the estimates from our analysis,” Kohli-Lynch told Healio. “However, we conducted extensive one-way and probabilistic sensitivity analyses to quantify this uncertainty. The results from these analyses demonstrated that our central findings were highly robust.
“Polypill treatment was estimated to produce greater health gains with a lower cost-per-QALY in patients with lower annual household incomes (income-to-poverty ratio <3),” Kohli-Lynch said. “Therefore, it could be an important tool for policymakers looking to improve both population health and health equity.”
‘Poverty is pervasive, and CVD is epidemic’
In a related editorial, Clyde W. Yancy, MD, MSc, MACP, MACC, FAHA, FHFSA, vice dean for diversity and inclusion, Magerstadt Professor, professor of medicine and medical social sciences and chief of cardiology at Northwestern University Feinberg School of Medicine, and Gregg C. Fonarow, MD, FACC, FAHA, FHFSA, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the preventive cardiology program, co-chief of the division of cardiology and Eliot Corday Chair in Cardiovascular Medicine and Science at the University of California, Los Angeles, discussed the opportunity to improve health equity that exists with the regulatory approval of a polypill for CVD prevention.
“The cohort in SCCS definitively recalibrates the argument. There is no social determinant of health more compelling than poverty, and in many U.S. communities, poverty is pervasive, and CVD is epidemic. The resultant but unmeasurable societal costs are incalculable. A disruptive solution is needed,” Yancy and Fonarow wrote. “The next step toward health equity in the U.S.? Approve and implement a CVD polypill.”
For more information:
Ciaran N. Kohli-Lynch, PhD, can be reached at 680 N Lake Shore Drive, Suite 1400, Office 14-051, Chicago, Illinois 60611.
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