Heart attacks and strokes are collectively the leading cause of death in most low- and middle-income countries (LMICs) worldwide. Treatment with four drugs — aspirin, a statin, an angiotensin converting-enzyme (ACE)-inhibitor, and a beta blocker — improves survival and quality of life among patients who have had a heart attack or stroke in the past; however, fewer than a quarter of eligible patients in LMICs receive these medications due to concerns about pill burden and cost.
To address this gap, a team of researchers led by Dhruv S. Kazi, MD, MSc, MS, Associate Director of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center (BIDMC) evaluated whether it would be cost-effective to combine several medications into a single “cardiovascular polypill” for patients who have had a previous heart attack or stroke, instead of prescribing the four drugs individually. The findings were published on August 30 in Lancet Global Health.
The researchers built a mathematical model that simulated all adults with a prior heart attack or stroke in five LMICs across a wide range of economic development: India, China, Mexico, Nigeria, and South Africa. These countries were chosen because they have a large burden of cardiovascular disease in their population. Kazi and colleagues used real-world data to model each country’s current rates of medication use and cardiovascular outcomes, and then examined what would happen if patients currently receiving one or more of the evidence-based therapies for cardiovascular disease were switched to the polypill instead. In this simulation model, the researchers followed individuals for their entire lifetime, keeping track of heart attacks, strokes, and deaths, as well as all health care costs. They also estimated patients’ survival and quality-of-life, allowing them to estimate, for each country, a metric called the incremental cost-effectiveness ratio (or ICER). The ICER indicates how much money it would cost to prevent the loss of one disability-adjusted life year.