Generalized cost-effectiveness analysis of pharmaceutical interventions for primary prevention of cardiovascular disease in Thailand

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Khonputsa, P
Veerman, LJ
Bertram, M
Lim, SS
Chaiyakunnaphruk, N
Vos, T
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2012
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Abstract

Objectives: To assess the cost-effectiveness of blood pressure (BP)-lowering and cholesterol-lowering drugs for cardiovascular disease (CVD) prevention.

Methods: We constructed a Markov model in which the Thai population was classified by 10-year absolute CVD risk and modeled the use of BP- and cholesterol-lowering drugs, including a “polypill” (three BP-lowering drugs and a statin). We applied “do-nothing” as the comparator, a health sector perspective on lifetime cost-effectiveness, 3% discounting of costs and effects, and used probabilistic sensitivity analysis. Outcomes are expressed as average and incremental cost-effectiveness in Thai baht per disability-adjusted life-year averted.

Results: The polypill would be a very cost-effective option for CVD prevention even in people at modest risk (10-year risk of 5%–9.9%). Use of the three most cost-effective BP drugs is also associated with a net cost saving and large health gain at risk levels greater than 5%. Adding a generic statin gives a price per disability-adjusted life-year of 0.5 (10-year risk at 20%+) to 1.5 (10-year risk at 5%–9.9%) times Thai per-capita gross domestic product using lowest available annual costs. However, at current average drug prices, adding a statin would be considered cost-effective only for those with a 10-year absolute CVD risk of 20% and more.

Conclusions: Primary CVD prevention with the polypill or a combination of three generic BP-lowering drugs is very cost-effective in the Thai population.

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Value in Health Regional Issues

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1

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1

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© 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.

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Pharmacology and pharmaceutical sciences

Preventative health care

Applied economics

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