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Polypill Treatment for Cardiovascular Disease Shows Affordability for Majority Black Populations
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Key Takeaways
- Polypill treatment could improve cardiovascular disease management in low-income, majority Black populations, potentially reducing health disparities.
- Young Black patients face increased cardiovascular disease risk and worsened in-hospital outcomes, highlighting the need for effective interventions.
Investigators found that the polypill treatment improved cardiovascular disease and lowered health care costs.
Polypill treatment for cardiovascular disease could improve affordability for low-income, majority Black populations who have limited access to health care, according to results of a study published in JAMA Cardiology. The study authors report that this could potentially reduce health disparities.1
Cardiovascular Disease, Polypill, Affordability, Adherence | Image Credit: santoelia | stock.adobe.com
In a study published in the Journal of the American Heart Association, investigators found an increased burden of CVD risk and worsened in-hospital outcomes for young Black patients in recent years. In an analysis that compared sociodemographic characteristics, comorbidities, and inpatient outcomes between 2007 and 2017, a total of 2,922,743 young Black individuals with a mean age of 31 years and 70.3% women were included in the study. The adjusted multivariable analysis showed worsening in-hospital outcomes, which included major adverse cardiac events (adjusted odds ratio [aOR], 1.21), acute myocardial infarction (aOR, 1.34), cardiogenic shock (aOR 3.12), atrial fibrillation (aOR, 1.34), ventricular fibrillation (aOR, 1.32), cardiac arrest (aOR, 2.55), pulmonary embolism (aOR, 1.89), and stroke (aOR, 1.53).2
Cardiovascular polypills are fixed-dose medications for blood pressure- and low-density lipoprotein cholesterol (LDL-C)-lowering medications. Treatment with a polypill can enhance adherence, reduce dose intensification, and reduce adverse effects (AEs), according to the authors of the current study. Currently, there are no polypills available that contain half doses of atorvastatin, amlodipine, losartan, and hydrochlorothiazide, which have been proven effective in the Southern Community Cohort Study (SCCS) Polypill Trial. Investigators aimed to estimate the long term cost effectiveness of the cardiovascular polypill in the SCCS Polypill Trial-representative cohort and an all non-Hispanic Black US adult cohort. The authors also estimated the distributional effect of the polypill on health disparities.1
Investigators adapted the CVD Policy Model to simulate clinical and economic outcomes of the SCCS Polypill Trial, including the simulation of health care processes for CVD prevention and management such as physician visits, probability of medication initiation, and adherence to help project blood pressure, LDL-C changes, fatal and nonfatal CVD events, survival, and direct health care costs, according to the study authors. For comparison, individuals received either the polypill or continued with the usual care. If individuals discontinued the polypill, they reverted to the standard of care. The primary end point of the study included health care costs, quality-adjusted life-years (QALYs), and the incremental cost-effective ratio.1
There were 100,000 individuals included in the study, 61.8% of whom were female with a mean age of 56.9 years, and individuals were compared over 10 years. Investigators estimated that polypill treatment prevented approximately 2180 incidents and 2740 total CVD events, resulting in approximately 1 CVD event prevented per 36 patients on the polypill treatment. Primary care visits were reduced by 14,900 and serious AEs were estimated to increase by 881, indicating 1 serious AE per 114 individuals treated with a polypill. Furthermore, the polypill produced 1190 discounted QALYs for a cost of approximately $10,152,000 and 847 non-discounted life-years, according to the study authors.1
At the base-case price of $463 per year, the investigators estimated that the polypill treatment cost $8560 per QALY gained compared with the usual care. Medication costs increased by $136,700,000 and were offset by $61,300,000 in savings for acute CVD care and $84,900,000 for chronic CVD care, according to the study authors. Furthermore, adherence and price had the largest impact on cost-effectiveness and annual prices for cost savings would be below $443 and high value at prices below $559.1
The study had limitations, which included adopting a health care sector perspective, which including only costs related to health care goods and services. Additionally, the time was limited to 10 years.1
