Key result
A fixed-dose polypharmacy approach for primary CVD prevention in men >55 years dominated no treatment, costing $70,000 vs $93,000 and yielding 13.62 vs 12.96 QALYs.
Why the study?
Does a fixed-dose combination of simvastatin, captopril, hydrochlorothiazide, and atenolol improve cost-effectiveness (marginal cost per QALY) in men older than 55 years without CVD, hypertension, or dyslipidemia compared to no treatment?
Does a fixed-dose combination of simvastatin, captopril, hydrochlorothiazide, and atenolol improve cost-effectiveness (marginal cost per QALY) in men older than 55 years without CVD, hypertension, or dyslipidemia compared to no treatment?
A fixed-dose polypharmacy approach (simvastatin, captopril, hydrochlorothiazide, and atenolol) for primary CVD prevention in men older than 55 years without baseline risk factors is a cost-effective strategy.
May support modeled cost-effectiveness of polypharmacy in low-risk older men; leaves open RCT confirmation before practice change.
Pharmacotherapies to lower blood pressure and cholesterol are effective in the primary prevention of cardiovascular disease (CVD). The use of fixed-dose medication combinations has not been well studied. The authors created a Markov model to analyze the cost-effectiveness of 4 fixed-dose medications for primary CVD prevention in men. The initial decision node was to treat or not treat men older than 55 years, without CVD, hypertension, or dyslipidemia with a combination of simvastatin, captopril, hydrochlorothiazide, and atenolol. Probability, costs, and effectiveness were derived from the literature. The outcome variable was marginal cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed. The average cost of treatment was $70,000 compared with $93,000 for non-treatment. Treatment resulted in 13.62 QALYs vs 12.96 QALYs without treatment. Primary prevention of CVD with fixed-dose medications dominated "no-treatment." The use of a fixed-dose polypharmacy approach to CVD prevention in men older than 55 years may be cost-effective.
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Newman et al. (2008) studied Cardiovascular disease prevention. Fixed-dose combination of simvastatin, captopril, hydrochlorothiazide, and atenolol vs. No treatment was evaluated on Marginal cost per quality-adjusted life-year (QALY). A fixed-dose polypharmacy approach for primary CVD prevention in men >55 years dominated no treatment, costing $70,000 vs $93,000 and yielding 13.62 vs 12.96 QALYs.
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