A Cost-Effectiveness Analysis of the CNIC-Polypill Strategy, Compared to Usual Care, in Secondary Cardiovascular Prevention from a Spanish Perspective Using Data from the Secure Trial
Author(s)
Hopmans M1, Castellano Vázquez JM2, Gaziano T3, Dymond A4, Looby A4, Mealing S4, Hansell N4, Eastwood I4, Montpart Viñas F1, Owen R5, Pocock S5, Cordero A6, Gonzalez-Juanatey JR7, Fernández A8, Merkely B9, Linhart A10, Schiele F11, Doehner W12, Roncaglioni MC13, Ponikowski P14, Fuster V2
1Ferrer, Barcelona, Spain, 2Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, 3Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, 4York Health Economics Consortium, York, UK, 5London School of Hygiene & Tropical Medicine, London, UK, 6Hospital Universitario de San Juan, Alicante, Spain, 7Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 8Hospital Universitario Clinico San Carlos, Madrid, Spain, 9Városmajori Szív- és Érgyógyászati Klinika, Budapest, Hungary, 10Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic, 11Regional University Hospital Jean Minjoz, Besancon, France, 12Charité - Universitätsmedizin Berlin, Berlin, Germany, 13IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy, 14Wrocław Medical University, Wrocław, Poland
Presentation Documents
OBJECTIVES: A cardiovascular polypill (CNIC-Polypill) demonstrated efficacy in the reduction of MACE in secondary cardiovascular prevention. The SECURE outcomes randomised controlled trial (phase III, NCT02596126) was conducted to assess the efficacy of the CNIC-Polypill compared to standard of care (SoC) (monocomponents recommended by guidelines) when taken within six months of a myocardial infarction. We aimed to estimate the cost-effectiveness of the CNIC-Polypill from a Spanish perspective using data from the SECURE trial.
METHODS: A Markov model, using monthly cycles, was developed to compare the CNIC-Polypill to SoC over a lifetime time horizon. Most input parameters were derived from the SECURE trial (using complete case analysis). Parametric distributions were fitted to extrapolate beyond the observed time to reinfarction, ischemic stroke or death (cardiovascular and non-cardiovascular). Goodness of fit statistics were based on Akaike and Bayesian Information Criterion (AIC/BIC) and predictive plausibility. AIC/BIC statistics indicated log-normal, Weibull and exponential curves were best fitting for time to reinfarction, stroke and cardiovascular death, respectively.
Cost and utility data were sourced from literature and discounted at 3%. The model captured direct medical costs associated with treatment acquisition (within the SECURE trial) and acute/ongoing cardiovascular events. Patients were at risk of urgent revascularisations throughout the model. Revascularisation was associated with further costs and disutilities. Probabilistic sensitivity analysis and scenario analyses were conducted.RESULTS: The model demonstrated that the CNIC-Polypill is a dominant strategy when compared to SoC. The CNIC-Polypill is associated with per patient cost-savings and quality-adjusted life year gains of €592 and 0.079 respectively. The model also estimated the prevention of 40 reinfarctions and 42 strokes over the SECURE patient cohort and a lifetime horizon.
CONCLUSIONS: The CNIC-Polypill is a dominant strategy in secondary cardiovascular prevention when compared to SoC and, therefore, should be a therapeutic strategy of choice for patients after a cardiovascular event/secondary prevention.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE615
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas