Cheaper four-in-one heart pills

G.S. Mudur, TT, Apr 08, 2018, New Delhi: A single pill that delivers four medicines to prevent serious cardiovascular events in survivors of heart attacks or strokes may be cheaper than the usual four-pill care, researchers have said.

The researchers had carried out a clinical trial in India to examine the efficacy and cost implications of the polypill, a fixed-dose combination of aspirin, two blood pressure medications and a statin.

Several pharmaceutical companies have developed polypills, and multiple studies have shown that patients are likelier to adhere to treatment when they have to swallow a single pill instead of four pills a day.

While earlier studies had shown that polypills can help reduce blood pressure and cholesterol levels, doctors say that no one had compared the costs of polypills and multiple pills before.

"All data on costs until now were based on computer modelling and simulations. Now, for the first time, we have real data based on real patients," said Dorairaj Prabhakaran, senior cardiologist and vice-president (research) at the Public Health Foundation of India.

Prabhakaran and his colleagues from the Centre for Chronic Disease Control and other institutions had tracked the medicine costs of 501 patients who received polypills and 499 who took the usual four or more tablets each day.

They followed both groups of patients for 15 months and found that the polypills cost significantly less, by about $248 or Rs 16,000 per person, over the 15-month period.

The researchers found that even at a cost of Rs 25 or Rs 50 per pill, the polypill was cheaper. The findings have just been published in the International Journal of Cardiology.

As expected, the researchers found that patients on the polypill had on the whole a better control of blood pressure than those under usual care (an upper value of 123 versus 126) and lower cholesterol levels (81 versus 93).

However, the study found higher hospitalisation costs and higher counts of cardiovascular events among patients who received polypills than those who received usual care.

"This study was primarily aimed at comparing costs and looking at blood pressure and cholesterol levels," said Kavita Singh, a researcher at the Centre for Chronic Disease Control and lead author of the study. "This study was not intended to compare the long-term outcomes for patients."

The researchers say the higher rates of hospitalisation observed in the study could be an insignificant chance finding.

"One possible explanation is that when patients stop taking polypills, they are stopping four medications. This may have worse outcomes than when patients under usual care stop taking only one medication," Prabhakaran said.

"This finding is not a major concern because it is not significant (and) the study was not (designed) to study these differences. At best it will remain a hypothesis to be tested."