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An economic case for a cardiovascular polypill? A cost analysis of the Kanyini GAP trial

Tracey-Lea Laba, Alison Hayes, Serigne Lo, David P Peiris, Tim Usherwood, Graham S Hillis, Natasha Rafter, Christopher M Reid, Andrew M Tonkin, Ruth Webster, Bruce C Neal, Alan Cass, Anushka Patel, Anthony Rodgers and Stephen Jan
Med J Aust 2014; 201 (11): 671-673. || doi: 10.5694/mja14.00266

Summary

Objective: To measure the costs of a polypill strategy and compare them with those of usual care in people with established cardiovascular disease (CVD) or at similarly high cardiovascular risk.

Design: A within-trial cost analysis of polypill-based care versus usual care with separate medications, using data from the Kanyini Guidelines Adherence with the Polypill (GAP) trial and linked health service and medication administrative claims data.

Participants: Kanyini GAP participants who consented to Australian Medicare record access.

Main outcome measures: Mean health service and pharmaceutical expenditure per patient per year, estimated with generalised linear models. Costs during the trial (randomisation January 2010 – May 2012, median follow-up 19 months, maximum follow-up 36 months) were inflated to 2012 costs.

Results: Our analysis showed a statistically significantly lower mean pharmaceutical expenditure of $989 (95% CI, $648–$1331) per patient per year in the polypill arm compared with usual care (P < 0.001; adjusted, excluding polypill cost). No significant difference was shown in health service expenditure.

Conclusions: This study provides evidence of significant cost savings to the taxpayer and Australian Government through the introduction of a CVD polypill strategy. The savings will be less now than during the trial due to subsequent reductions in the costs of usual care. Nonetheless, given the prevalence of CVD in Australia, the introduction of this polypill could increase considerably the efficiency of health care expenditure in Australia.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN126080005833347.

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  • Tracey-Lea Laba1
  • Alison Hayes2
  • Serigne Lo1
  • David P Peiris1
  • Tim Usherwood3
  • Graham S Hillis1
  • Natasha Rafter4,5
  • Christopher M Reid6
  • Andrew M Tonkin7
  • Ruth Webster1
  • Bruce C Neal1
  • Alan Cass8
  • Anushka Patel1
  • Anthony Rodgers1
  • Stephen Jan1

  • 1 The George Institute for Global Health, Sydney, NSW.
  • 2 School of Public Health, University of Sydney, Sydney, NSW.
  • 3 Department of General Practice, Sydney Medical School, University of Sydney, Sydney, NSW.
  • 4 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
  • 5 Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
  • 6 Centre of Cardiovascular Research and Education in Therapeutics , Monash University, Melbourne, VIC.
  • 7 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 8 Menzies School of Health Research, Darwin, NT.


Acknowledgements: 

The study was funded by a National Health and Medical Research Council (NHMRC) grant (1004623). Christopher Reid, Anushka Patel and Stephen Jan are funded by NHMRC Senior Research Fellowships. David Peiris is supported by an NHMRC Australian Primary Health Care Fellowship. Tracey-Lea Laba and Alison Hayes are funded by an NHMRC Capacity Building Grant (57132). Dr Reddy's Laboratories provided polypills free of charge for the clinical trial. Dr Reddy's Laboratories has funded the SPACE (single pill to avert cardiovascular events) Collaboration, which supports Ruth Webster and Anthony Rodgers.

Competing interests:

The NHMRC and Dr Reddy's Laboratories had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The George Institute for Global Health recently secured an exclusive global licence for the polypills evaluated in the Kanyini GAP trial, after a decision by Dr Reddy's Laboratories Ltd not to proceed with taking the products to market because of existing regulatory requirements.

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