Tania P. Abreu-Oliveira (Portugal)
Ferrer Portugal Regulatory AffairsAuthor Of 1 Presentation
COST-EFFECTIVENESS OF THE CNIC-POLYPILL (ASPIRIN, ATORVASTATIN, RAMIPRIL) IN POST-ISCHEMIC STROKE PATIENTS FOR THE PREVENTION OF RECURRENT EVENTS BASED ON IMPROVED CONTROL OF CARDIOVASCULAR RISK FACTORS
Abstract
Background And Aims
The use of the CNIC-polypill has demonstrated cost-effectiveness in decreasing the risk of recurrent cardiovascular (CV) events, especially in coronary heart disease patients. This analysis aims to assess the cost-effectiveness of the CNIC-polypill compared to using the monocomponents separately and concomitantly (usual care), in the prevention of recurrent events in individuals with a history of ischemic stroke.
Methods
A Markov model was developed to estimate the cost-effectiveness of the CNIC-polypill (aspirin 100mg, atorvastatin 20/40mg, ramipril 2.5/5/10mg) compared to usual care over a lifetime horizon, based on improved control of CV risk factors derived from the real-world evidence study NEPTUNO. The base case scenario was set in Portugal and a payer perspective was adopted. Systematic reviews identified epidemiological, costs, utility and mortality data. Outcomes were costs (€, 2020) per life-year (LY) and Quality Adjusted LY (QALY) gained. Sensitivity analyses were conducted to test robustness.
Results
In a cohort of 1,000 patients with a history of ischemic stroke, the incremental cost of the polypill reaches 92,860€, while preventing 17 recurrent CV events, 36 subsequent strokes and 10 CV deaths (Figure 1). The incremental cost-effectiveness ratio is 1,666 €/LY gained and the incremental cost-utility ratio is 2,363 €/QALY gained for the CNIC-polypill (Figure 2). Assuming a willingness-to-pay threshold of 30.000 €/QALY gained, there is a 77.6% probability for the CNIC-polypill to be cost-effective and 49.0% chances to be cost-saving compared to usual care.
Conclusions
Compared to usual care, the polypill strategy is cost-effective in secondary prevention in the post-ischemic stroke population at an affordable incremental cost.