https://orcid.org/0000-0003-0000-7109
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Abstract
Purpose
The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.
Patients and Methods
An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.
Results
After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.
Conclusion
CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.
Data Sharing Statement
The datasets generated during the current study are available from the corresponding author on reasonable request. All analyzed data are included in this article and its supplementary files.
Ethics Approval and Consent to Participate
This study was approved by the Ethics Committee of the Hospital of Terrassa (Barcelona). Patient consent was not necessary, according to the Article 5 of Royal Decree 957/2020, of November 3, which regulates observational studies with medicines for human use.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
AC reports a) honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Ferrer, Boehringer Ingelheim, MSD, and Amgen; b) consulting fees from AstraZeneca, Ferrer and Amgen. RDGG has received consulting fees from Ferrer International. LM has received honoraria for lectures and/or consulting work from Amgen, Sanofi, Novartis, Ferrer, Servier, Daiichi-Sankyo, Amarin and Amryt.
VF reports grants from H2020 related to conducting the ongoing SECURE trial. JMC reports grants from H2020 related to conducting the ongoing SECURE trial as well as receiving honoraria and reimbursement for travel expenses from Ferrer, Pfizer, Bayer, and Servier. JERO and IZ are currently working at Ferrer International. ASM was an employee of Atrys Health when the study was developed. Atrys Health is a contract research organization that received funds from Ferrer International to conduct this study. JRGJ has received honoraria for consulting and lectures from Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, MSD, Daiichi-Sankyo, Ferrer International, Novartis, Lilly, Sanofi and Servier. The authors report no other conflicts of interest in this work.