| Autor: |
van Gils PF; National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, the Netherlands., Over EA, Hamberg-van Reenen HH, de Wit GA, van den Berg M, Schuit AJ, Engelfriet PM |
| Jazyk: |
angličtina |
| Zdroj: |
BMJ open [BMJ Open] 2011 Dec 21; Vol. 1 (2), pp. e000363. Date of Electronic Publication: 2011 Dec 21 (Print Publication: 2011). |
| DOI: |
10.1136/bmjopen-2011-000363 |
| Abstrakt: |
Objectives The aim of the present study was to estimate the cost-effectiveness of the polypill in the primary prevention of cardiovascular disease. Design A health economic modelling study. Setting Primary healthcare in the Netherlands. Participants Simulated individuals from the general Dutch population, aged 45-75 years. Interventions Opportunistic screening followed by prescription of the polypill to eligible individuals. Eligibility was defined as having a minimum 10-year risk of cardiovascular death as assessed with the Systematic Coronary Risk Evaluation function of alternatively 5%, 7.5% or 10%. Different versions of the polypill were considered, depending on composition: (1) the Indian polycap, with three different types of blood pressure-lowering drugs, a statin and aspirin; (2) as (1) but without aspirin and (3) as (2) but with a double statin dose. In addition, a scenario of (targeted) separate antihypertensive and/or statin medication was simulated. Primary outcome measures Cases of acute myocardial infarction or stroke prevented, quality-adjusted life years (QALYs) gained and the costs per QALY gained. All interventions were compared with usual care. Results All scenarios were cost-effective with an incremental cost-effectiveness ratio between €7900 and 12 300 per QALY compared with usual care. Most health gains were achieved with the polypill without aspirin and containing a double dose of statins. With a 10-year risk of 7.5% as the threshold, this pill would prevent approximately 3.5% of all cardiovascular events. Conclusions Opportunistic screening based on global cardiovascular risk assessment followed by polypill prescription to those with increased risk offers a cost-effective strategy. Most health gain is achieved by the polypill without aspirin and a double statin dose. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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