Ravangard Ramin, Ghanbari Mohadese, Attar Armin, Jafari Abdosaleh
Health Human Resources Research Center, School of Management and Medical Information Sciences Shiraz University of Medical Sciences Shiraz Iran.
School of Management and Medical Information Sciences, Student Research Committee Shiraz University of Medical Sciences Shiraz Iran.
Health Sci Rep. 2024 Jul 5;7(7):e2240. doi: 10.1002/hsr2.2240. eCollection 2024 Jul.
Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran.
This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used.
The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications.
Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.
心血管疾病（CVDs）是发展中国家和发达国家的主要疾病之一，具有高患病率和死亡率。药物干预，尤其是联合用药，对心血管疾病患者具有预防作用。最近，在“伊朗综合干预试验”中，阿托伐他汀、氢氯噻嗪、阿司匹林和缬沙坦或依那普利的组合（复方制剂）作为一级预防策略，在提供生存益处方面显示出有效性。在本研究中，我们考察了在伊朗预防心血管疾病时，使用复方制剂与其单一成分（称为药物单一疗法）相比的成本效益。
这是一项经济评估研究，采用马尔可夫模型并以终身为期限，比较复方制剂与药物单一疗法对10000名35岁以上假设队列人群的成本效用。研究视角为患者视角，估计直接医疗成本、质量调整生命年（QALYs）和增量成本效益比。为应对不确定性，采用了敏感性分析。
结果显示，复方制剂成本最低（871美元）且QALYs最高（14.55），其成本效用高于药物单一疗法。此外，结果表明，最高敏感性与心绞痛和中风状态的效用相关。在21768美元的阈值下，与其他药物相比，复方制剂具有成本效益的概率为92%。
鉴于复方制剂具有最高的成本效用，建议卫生系统政策制定者在设计临床指南时特别关注复方制剂。此外，通过医疗保险组织覆盖这种药物，有可能完善该国预防心血管疾病的药物药典。
