Abstract 11833: Cost-Effectiveness Analysis of the Polypill Approach vs Periodic Risk Assessment for Prevention of Cardiovascular Disease
Introduction: There is an international trend towards recommending medication to prevent cardiovascular disease (CVD) in individuals at increasingly lower cardiovascular risk. We sought to assess the cost-effectiveness of a population approach with a Polypill including statin and antihypertensives and periodic risk assessment with different risk thresholds.
Methods: We developed a microsimulation model for lifetime predictions of CVD events, diabetes, and death in 259,146 asymptomatic UK Biobank participants aged 40 to 69, who attended 2006-2010 baseline visits. We assessed incremental costs and quality-adjusted life-years (QALYs) for Polypill scenarios differing for starting age, and periodic risk assessment with 10-year CVD risk thresholds of 10% and 20%. Analyses were undertaken from a UK health service perspective.
Results: Restrictive risk assessment, in which statins and antihypertensives were prescribed when risk exceeded 20% (Old guidelines), was the optimal strategy gaining 123 QALYs (95% CI -173 to 387) per 10,000 individuals at an extra cost of £1.45 million (95% CI 0.89 to 1.94) as compared with current practice with an incremental cost effectiveness ratio of £11,797/QALY (see Figure). 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% (Current guidelines) was economically unattractive, costing £40K per QALY gained. Starting the Polypill from age 60 onwards became the most cost-effective scenario when annual drug prices were to be reduced below £240. All Polypill scenarios would save costs at prices below £50.
Conclusions: Periodic risk assessment using lower risk thresholds is unlikely to be cost-effective. A population approach with the Polypill would become cost-effective if drug prices were to be reduced.
Author Disclosures: B.S. Ferket: None. M. Hunink: None. M. Khanji: None. I. Agarwal: None. K.E. Fleischmann: None. S.E. Petersen: None.
- © 2016 by American Heart Association, Inc.