Pharmacoeconomic grounding of using polypill amlodipine with atorvastatin versus monodrugs in patients with hypertension and dyslipidemia in Ukraine

Abstract

Objectives: One reason of the low efficiency of cardiovascular diseases (CVD) treatment in Ukraine is the low adherence of patients. Modern trends improving the quality of treatment and increase patients compliance is use of polypills (PP). The aim: pharmacoeconomic assesment the feasibility of PP amlodipine and atorvastatin versus monodrugs in patients with hypertension and dyslipidemia (DYS) from the Ukrainian perspectives point of view. Methods: The results of clinical studies AVALON (Granger C. B., McMurray J. J., Yusuf S. et al., 2003) were used. Cost minimization analysis of three regimens of patients treatment with hypertension and DYS during 8 weeks: PP amlodipine 5 mg + atorvastatin 10 mg; amlodipine 5 mg; atorvastatin 10 mg. Results: The results of the clinical research AVALON found, that the use of PP amlodipine+atorvastatin provides significant clinical benefit: the largest number of patients reached target levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) (45.5%), versus amlodipine (8.3%), atorvastatin (28.6%), placebo (3.5%). The scheme using amlodipine is the most expensive (cost for course of treatment (CCT) € 20.28), the regimen of atorvastatin 10 mg (CCT € 10.46) and the PP amlodipine+atorvastatin (CCT € 17.72) are less costly. This PP is more cost effective versus amlodipine monotherapy (CER = € 38.95 versus € 244.34 per patient with target levels of BP and LDL-C) and less cost effective compared atorvastatin monotherapy (CER = € 36.57 per patient with target levels of BP and LDL-C). The cost of an additional unit of effectiveness (ICER) showed that the use of PP amlodipine+atorvastatin instead amlodipine provides for the treatment of each 100 patients additional 37.2 patients achieved target levels of BP and LDL-C and saving € 6.88 per patient. Conclusions: Pharmacotherapy of patients with hypertension and DYS based on PP amlodipine+atorvastatin provides significant clinical benefit versus monodrugs and pharmacoeconomic advantages versus amlodipine.