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

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