Abstract 14538: Cost-Effectiveness of a Fixed-Dose Combination Pill for Secondary Prevention of Cardiovascular Disease in China, India, Mexico, Ghana, and South Africa
Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Though medicines for secondary prevention improve survival, fewer than 25% of eligible patients in low- and middle- income countries (LMICs) receive them. The fixed dose combination “polypill” improves adherence and costs less than its components separately. We aim to assess the cost-effectiveness of the polypill in 5 LMICs: China, India, Mexico, South Africa, and Ghana.
Methods: We developed microsimulation models of 100,000 adults age 35-84 years with prior myocardial infarction or stroke in each of China, India, Mexico, Ghana, and South Africa. We evaluated 2 strategies: 1) Usual care: aspirin, atenolol, lisinopril, and simvastatin separately at real-world levels of prescription and adherence, and 2) Polypill containing the above medications at identical levels of prescription. The main analyses assumed the polypill would be as efficacious as all individual components, cost 80% of the sum of its components, and increase adherence by 44%. We adopted a health system perspective and 10-year analytic horizon.
Results: At real-world levels of adoption, the use of the polypill for secondary prevention instead of usual care would avert 510-2,900 CVD deaths per 100,000 people in the countries studied. It would be very cost-effective (ICER<GDP/capita) in China and Ghana (ICER $I 86-$I 122 per DALY averted) and cost saving in India, Mexico and South Africa. In sensitivity analyses, the polypill remains cost-effective even when 80% as effective or costs 2x as much as individual components due to increased adherence (Figure 1).
Conclusions: In our simulation-based analysis, the polypill would be very cost-effective for secondary prevention of CVD in China and Ghana, and cost-saving in India, Mexico, and South Africa. Strategies to improve access to an appropriately priced polypill such as its addition to the WHO essential medications list may improve CVD outcomes in LMICs.
Author Disclosures: J.K. Lin: None. A.E. Moran: None. A.P. Tobias: None. D.S. Kazi: None.
- © 2016 by American Heart Association, Inc.