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Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial

Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial
Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial

Background: The Use of Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial, showed that access to a cardiovascular polypill (aspirin, statin and two blood pressure lowering drugs) significantly improved adherence, lowered systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDLc) in patients with or at high risk of cardiovascular disease (CVD). We aimed to analyze the within-trial cost-effectiveness of the polypill strategy versus usual care in India. Methods: Relative effectiveness and costs of polypill versus usual care groups in UMPIRE were estimated from the health sector perspective. Only direct medical costs were considered. The effectiveness of the polypill was reported as a percentage increase in adherence and mean reductions in SBP, and LDL-c, over the 15-month trial period. Healthcare resource utilization and costs were collected for each patient during the trial. Polypill price was constructed using a range of scenarios: $0.06–$0.94/day. The cost-effectiveness of the polypill was measured as the additional cost for 10% increase in adherence, and per unit reduction in SBP and LDL-c. Results: Overall, the mean cost per patient was significantly lower with the polypill strategy (−$203 per person, (95% CI: −286, −119, p < 0.01). In scenario analyses that varied polypill price assumptions, incremental cost-effectiveness ratios for a polypill strategy ranged between cost-saving to $75 per 10% increase in adherence for polypill price of $0.94 per day. Conclusions: The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India.

Cardiovascular disease (CVD), Cardiovascular polypill, Cost-effectiveness analysis (CEA), Fixed dose combination (FDC), India, Secondary prevention
0167-5273
71-78
Singh, Kavita
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Crossan, Catriona
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Laba, Tracey Lea
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Roy, Ambuj
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Hayes, Alison
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Salam, Abdul
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Jan, Stephen
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Lord, Joanne
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Tandon, Nikhil
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Rodgers, Anthony
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Patel, Anushka
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Thom, Simon
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Prabhakaran, Dorairaj
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Singh, Kavita
5591257d-3090-48da-af9e-e6b3a16be624
Crossan, Catriona
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Laba, Tracey Lea
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Roy, Ambuj
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Hayes, Alison
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Salam, Abdul
20c53b7b-aa67-4de9-a933-d1990ca1d552
Jan, Stephen
2b578fde-5a66-4c92-b1cb-512366fcad63
Lord, Joanne
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Tandon, Nikhil
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Rodgers, Anthony
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Patel, Anushka
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Thom, Simon
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Prabhakaran, Dorairaj
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Singh, Kavita, Crossan, Catriona, Laba, Tracey Lea, Roy, Ambuj, Hayes, Alison, Salam, Abdul, Jan, Stephen, Lord, Joanne, Tandon, Nikhil, Rodgers, Anthony, Patel, Anushka, Thom, Simon and Prabhakaran, Dorairaj (2018) Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: within-trial cost-effectiveness analysis of the UMPIRE trial. International Journal of Cardiology, 262, 71-78. (doi:10.1016/j.ijcard.2018.03.082).

Record type: Article

Abstract

Background: The Use of Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial, showed that access to a cardiovascular polypill (aspirin, statin and two blood pressure lowering drugs) significantly improved adherence, lowered systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDLc) in patients with or at high risk of cardiovascular disease (CVD). We aimed to analyze the within-trial cost-effectiveness of the polypill strategy versus usual care in India. Methods: Relative effectiveness and costs of polypill versus usual care groups in UMPIRE were estimated from the health sector perspective. Only direct medical costs were considered. The effectiveness of the polypill was reported as a percentage increase in adherence and mean reductions in SBP, and LDL-c, over the 15-month trial period. Healthcare resource utilization and costs were collected for each patient during the trial. Polypill price was constructed using a range of scenarios: $0.06–$0.94/day. The cost-effectiveness of the polypill was measured as the additional cost for 10% increase in adherence, and per unit reduction in SBP and LDL-c. Results: Overall, the mean cost per patient was significantly lower with the polypill strategy (−$203 per person, (95% CI: −286, −119, p < 0.01). In scenario analyses that varied polypill price assumptions, incremental cost-effectiveness ratios for a polypill strategy ranged between cost-saving to $75 per 10% increase in adherence for polypill price of $0.94 per day. Conclusions: The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India.

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RUPEE-IND paper_Final - Accepted Manuscript
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Accepted/In Press date: 16 March 2018
e-pub ahead of print date: 21 March 2018
Published date: 1 July 2018
Keywords: Cardiovascular disease (CVD), Cardiovascular polypill, Cost-effectiveness analysis (CEA), Fixed dose combination (FDC), India, Secondary prevention

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Local EPrints ID: 421338
URI: http://eprints.soton.ac.uk/id/eprint/421338
ISSN: 0167-5273
PURE UUID: dbad475e-6042-485a-8178-b263fcc9c1f3
ORCID for Joanne Lord: ORCID iD orcid.org/0000-0003-1086-1624

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Date deposited: 01 Jun 2018 16:30
Last modified: 18 Mar 2024 05:18

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Contributors

Author: Kavita Singh
Author: Catriona Crossan
Author: Tracey Lea Laba
Author: Ambuj Roy
Author: Alison Hayes
Author: Abdul Salam
Author: Stephen Jan
Author: Joanne Lord ORCID iD
Author: Nikhil Tandon
Author: Anthony Rodgers
Author: Anushka Patel
Author: Simon Thom
Author: Dorairaj Prabhakaran

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