A polypill for cardiovascular disease may be cost saving and a high value treatment in a low-income, majority Black population with limited health care access at a price point of $463, according to findings from a cost-effectiveness study published Jan. 8 in JAMA Cardiology.

Ciaran Kohli-Lynch, PhD, et al., used a computer simulation model to assess the cost-effectiveness of a cardiovascular polypill compared with usual care over 10 years. The primary cohort consisted of a trial representative cohort of 100,000 individuals from the Southern Community Cohort Study (SCCS) who were probabilistically sampled from 3,720 individuals in the National Health and Nutrition Examination Survey.

The SCCS showed that at 12 months a cardiovascular polypill (single pill containing one statin and three half-standard dose antihypertensives) compared with usual care was associated with a mean reduction in systolic blood pressure by 7 mm Hg and LDL-C by 11 mg/dL in a population without cardiovascular disease. The mean age of the 303 study patients was 56 years, 96% were Black (self-reported), 60.1% women, and most (75%) had an annual income <$15,000.

The present analysis estimated that 2,180 incident and 2,740 total cardiovascular disease events would be prevented with the polypill, translating to preventing one event per 36 patients treated with a polypill.

Results showed that polypill treatment was projected to yield a mean of 1,190 additional quality-adjusted life-years (QALYs) compared with usual care, at a cost of approximately $10,152,000. At an estimated cost of $8,560 per QALY gained vs. usual care, polypill treatment was considered high value (<$50,000 per QALY gained) in 99% of simulations. Further analysis determined that at an annual price of ≤$559 polypill treatment would be high value and at ≤$463 it would be cost saving.

In a secondary analysis of 3,602,427 non-Hispanic Black adults who were eligible for the SCCS trial, polypill treatment was also found to be high value, with an estimated cost of $13,400 per QALY gained.

In an underserved population with limited access to health care services, implementation of the polypill could reduce health disparities as well, note the authors.

"The SCCD polypill is not only affordable, but most importantly, treatment with a polypill using reasonable estimates would lead to 90,700 fewer [cardiovascular disease] events over 10 years, all at an acceptable risk profile," write Clyde W. Yancy, MD, MSc, MACC, and Gregg C. Fonarow, MD, FACC, in an accompanying editorial comment. These data "overwhelmingly endorse cost-effectiveness and improved health economics."

Noting a polypill is available outside the U.S., they write the next step toward health equity in this country is for the U.S. Food and Drug Administration to "approve and implement a [cardiovascular disease] polypill." They add: "No intervention is more credible than simply treating those at risk with an efficacious, low-risk, high-value, cost-saving therapy that lowers disease burden and saves scarce health care resources regardless of country."