Background
The evidence-based secondary prevention for patients presenting with acute coronary syndrome with persistent ST-segment elevation myocardial infarction (STEMI) includes a therapy with acetylsalicylic acid, statins, angiotensin-converting enzyme (ACE) inhibitors and frequently beta-blockers to reduce the risk of subsequent events or death. An efficient therapy requires good adherence which might be reduced with an increasing complexity of drug intake. A polypill consisting of acetylsalicylic acid, atorvastatin and ramipril was developed to reduce the dosing complexity and increase adherence.
Objective
The Markov model, originally developed for the UK, was adapted to the German setting to analyze the cost-effectiveness of the polypill in comparison to the standard of care (SOC).
Material and methods
The analysis of the incremental cost-effectiveness per quality adjusted life year (QALY) was based on a 3-month cycle model and adopted the perspective of the German statutory health insurance. The cohort included patients with a history of myocardial infarction in the previous 2 years. Input parameters were adapted to the German setting. To reduce uncertainty, multiple one-way sensitivity analyses were performed.
Results
The polypill caused 203,653 € in additional costs per 1000 patients compared to SOC due to 100% higher drug costs. The incremental cost-effectiveness relation (ICER) was 9228 €/QALY. Sensitivity analyses showed results within a range of 5000–30,000 €/QALY.
Conclusion
The introduction of the polypill in Germany seems to be in a cost-effective range when compared to other technologies. With respect to the cost data a conservative approach was chosen. Consequently, costs caused by low adherence are presumably lower in the model than in reality.