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Cost effectiveness analysis of a fixed dose combination pill for primary prevention of cardiovascular disease from an
Andre Lamy1,2, Wesley Tong1, Philip Joseph1,3
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Insights
A fixed-dose combination pill is cost-neutral in high-income countries and highly cost-effective in lower-income countries, especially for patients at high risk of cardiovascular disease (CVD). This strategy significantly reduces CVD risk and improves health outcomes.
Area of Science:
- Cardiovascular Health
- Health Economics
- Public Health Policy
Background:
- Cardiovascular disease (CVD) poses a significant global health burden, exacerbated by medication affordability issues in lower-income nations.
- A fixed-dose combination (FDC) pill, integrating blood pressure medications and a statin with aspirin, demonstrated a 38% reduction in primary CVD prevention in a meta-analysis.
- This study evaluates the in-trial cost-effectiveness of an FDC pill across different global income strata.
Purpose of the Study:
- To determine the cost-effectiveness of a fixed-dose combination (FDC) pill for cardiovascular disease (CVD) prevention.
- To analyze the economic impact of FDC pills in Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC), and High Income Countries (HIC).
- To provide data supporting the adoption of FDC pills in diverse healthcare settings.
Main Methods:
- Countries were classified into LMIC, UMIC, and HIC based on World Bank economic groups.
- Country-specific costs for healthcare events and non-study medications were collected in 2020 USD.
- The price of the FDC pill was calculated using the Cheapest Equivalent Substitute (CES) for each component medication.
Main Results:
- The CES-FDC pill demonstrated cost-neutrality in High Income Countries (HIC) with an incremental cost of $42 per participant.
- In Lower Middle Income Countries (LMIC) and Upper Middle Income Countries (UMIC), the incremental costs were $346 and $838 per participant, respectively.
- The FDC pill yielded an incremental gain in quality-adjusted life years (QALYs) across all income groups, with Incremental Cost-Effectiveness Ratios (ICERs) ranging from $700/QALY in HIC to $13,937/QALY in UMIC. Subgroup analysis for high 10-year CVD risk patients showed ICERs as low as -$6000/QALY.
Conclusions:
- A fixed-dose combination pill strategy, utilizing the Cheapest Equivalent Substitute (CES) pricing, is cost-neutral in High Income Countries (HIC).
- Lower and Middle Income Countries (LMIC & UMIC) should consider the reported Incremental Cost-Effectiveness Ratios (ICERs) against their national health economic thresholds.
- Prioritizing FDC pills for patients with a high 10-year cardiovascular disease (CVD) risk is recommended as an initial step in LMIC and UMIC.
Background:
Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis.
Methods:
Countries were categorized using World Bank economic groups: Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC) and High Income Countries (HIC). Country specific costs were obtained for hospitalized events, procedures, and non-study medications (2020 USD). FDC price was based on the cheapest equivalent substitute (CES) for each component.
Findings:
For the CES-FDC pill versus control the difference in cost was $346 (95% CI: $294-$398) per participant in Lower Middle Income Countries, $838 (95% CI: $781-$895) in Upper Middle Income Countries and $42 (95% CI: -$155 to $239) (cost-neutral) in High Income Countries. During the study period the CES-FDC pill was associated with incremental gain in quality-adjusted life years of 0.06 (95% CI: 0.04-0.08) resulting in an incremental cost-effectiveness ratio (ICER) of $5767 (95% CI: 5735-$5799), $13,937 (95% CI: $13,893-$14,041) and $700 (95% CI: $662-$738) respectively. In subgroups analyses, the highest 10 years CVD risk subgroup had ICERs of $2033, $7322 and -$6000/QALY.
Interpretation:
A FDC pill produced at CES costs is cost-neutral in HIC. Governments of LMI and UMI countries should assess these results based on the ICER threshold accepted in their own country and own specific health care priorities but should consider prioritizing this strategy for patients with high 10 years CVD risk as a first step.
Funding:
Population Health Research Institute.
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