Cost of Polypill Could Limit Its Widespread Use
The polypill, the 6-drug combination first proposed for cardiovascular disease prevention by UK researchers in 2003, has the potential to be a very effective intervention, but the high cost of administering it to large populations could be a barrier to its implementation, Dutch researchers say.
The idea of combining medications in a single daily pill to prevent cardiovascular disease was originally conceived by Professors Nicholas Wald, DSc, and Malcolm Law, MB BS, of the University of London. They theorized that the pill would contain:
They arrived at their formulation after analyzing the results of meta-analyses of randomized trials and cohort studies and estimated that administering it to people aged 55 to 64 years would reduce ischemic heart disease events by 88% and stroke by 80%. However, they did not calculate the likely future costs of this strategy. Now Oscar H. Franco, MD, DSc, and colleagues from the Department of Public Health at the Erasmus MC University Medical Center in Rotterdam report in the Journal of Epidemiology and Community Health that giving the polypill to so many people could drain global health budgets, unless it is carefully targeted and very cheap to manufacture.
The researchers looked at differing levels of risk of developing coronary heart disease (CHD) in men with no history of CHD and the maximum cost of treating them with the polypill. They used data from the US Framingham Heart Study, which involved over 5000 people aged between 28 and 62 years who were monitored for heart disease and stroke in 2-year periods for around 48 years. They also used data from the Framingham Offspring Study, which involved monitoring the children and spouses of those in the original study every 4-8 years.
Overall, it was calculated that giving the polypill would prevent 76 to 179 CHD events and 11 to 33 strokes per 1000 people. However, even if the polypill were offered for free, it would not save any costs at all if given to everyone, irrespective of their risk of developing cardiovascular disease, or if it were given to those at only moderate risk, say the researchers. To be cost-effective, the annual expense of the polypill would have to be no more than €302 (US$362) for those aged </=50 and no more than €410 (US$492) for those aged </= 60 at high risk for CHD. This cost would need to be 2-3 times lower for those at moderate risk, they add. The largest benefits would be obtained if the polypill were given to everyone aged >=60 or to a population at high risk for CHD and > 60 years of age.
The authors point out that irrespective of its value, treatment with the polypill "implies the medicalization of a large section of the population," as well as the threat of exposing healthy people to the risk of side effects.
Funding info: The study was partly funded by the Netherlands Organization for Scientific Research and the Netherlands Heart Foundation.
References
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The polypill, the 6-drug combination first proposed for cardiovascular disease prevention by UK researchers in 2003, has the potential to be a very effective intervention, but the high cost of administering it to large populations could be a barrier to its implementation, Dutch researchers say.
The idea of combining medications in a single daily pill to prevent cardiovascular disease was originally conceived by Professors Nicholas Wald, DSc, and Malcolm Law, MB BS, of the University of London. They theorized that the pill would contain:
A statin (eg, atorvastatin 10 mg or simvastatin 40 mg);
3 antihypertensive drugs (eg, a thiazide diuretic, a beta-blocker, and an angiotensin-converting enzyme inhibitor), each at half standard dose;
Folic acid 0.8 mg; and
Aspirin 75 mg.
They arrived at their formulation after analyzing the results of meta-analyses of randomized trials and cohort studies and estimated that administering it to people aged 55 to 64 years would reduce ischemic heart disease events by 88% and stroke by 80%. However, they did not calculate the likely future costs of this strategy. Now Oscar H. Franco, MD, DSc, and colleagues from the Department of Public Health at the Erasmus MC University Medical Center in Rotterdam report in the Journal of Epidemiology and Community Health that giving the polypill to so many people could drain global health budgets, unless it is carefully targeted and very cheap to manufacture.
The researchers looked at differing levels of risk of developing coronary heart disease (CHD) in men with no history of CHD and the maximum cost of treating them with the polypill. They used data from the US Framingham Heart Study, which involved over 5000 people aged between 28 and 62 years who were monitored for heart disease and stroke in 2-year periods for around 48 years. They also used data from the Framingham Offspring Study, which involved monitoring the children and spouses of those in the original study every 4-8 years.
Overall, it was calculated that giving the polypill would prevent 76 to 179 CHD events and 11 to 33 strokes per 1000 people. However, even if the polypill were offered for free, it would not save any costs at all if given to everyone, irrespective of their risk of developing cardiovascular disease, or if it were given to those at only moderate risk, say the researchers. To be cost-effective, the annual expense of the polypill would have to be no more than €302 (US$362) for those aged </=50 and no more than €410 (US$492) for those aged </= 60 at high risk for CHD. This cost would need to be 2-3 times lower for those at moderate risk, they add. The largest benefits would be obtained if the polypill were given to everyone aged >=60 or to a population at high risk for CHD and > 60 years of age.
The authors point out that irrespective of its value, treatment with the polypill "implies the medicalization of a large section of the population," as well as the threat of exposing healthy people to the risk of side effects.
Funding info: The study was partly funded by the Netherlands Organization for Scientific Research and the Netherlands Heart Foundation.
References
Franco OH, Steyerberg EW, Chris de Laet C. The polypill: at what price would it become cost effective? J Epidemiol Community Health. 2006;60:213-217.
Wald, NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326:1419-1423.
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