Results of threshold and scenario analyses
| Current practice | Old guidelines | Current guidelines | Alternative guidelines | Polypill age 60+ | Polypill age 55+ | Polypill age 50+ | Polypill age 45+ | Polypill age 40+ | |
|---|---|---|---|---|---|---|---|---|---|
| Threshold analyses | |||||||||
| Cost of the NHS health check: 50–150% of base-case value | None | All | None | None | None | None | None | None | None |
| Cost of antihypertensives: 50–500% of base-case value | 200–500% (290–500%) | 50–200% (50–290%) | None | None | None | None | None | None | None |
| Cost of ARB: £10–£300 | £80–£300 (£150–£300) | £10–£80 (£10–£150) | None | None | None | None | None | None | None |
| Cost of CCB: £10–£500 | £60–£500 (£120–£500) | £10–£60 (£10–£120) | None | None | None | None | None | None | None |
| Cost of diuretic: £5–£50 | None | All | None | None | None | None | None | None | None |
| Cost of statins: £10–£300 | £100–£300 (£210–£300) | £10–£100 (£10–£210) | None | None | None | None | None | None | None |
| Cost of annual polypill use: £10–£400 | None | £240–£400 (£320–£400) | None | None | £10–£240 (£10–£320) | None | None | None | None |
| Cost of acute care of CVD events: 50–150% of base-case value | None | All | None | None | None | None | None | None | None |
| Cost of chronic care after CVD: 50–150% of base-case value | None | All | None | None | None | None | None | None | None |
| Cost of chronic care after DM: 50–150% of base-case value | None | All | None | None | None | None | None | None | None |
| Disutility pill use: 0–18 months required gain in life expectancy | 8–18 (8.5–18) months | 5–8 (5.5–8.5) months | 0–5 (0–5.5) months | None | None | None | None | None | None |
| Odds ratio of statins for DM risk: odds ratio varying from 1–2 | 1.5–2 (1.7–2) | 1–1.5 (1.02–1.7) | None (1–1.02) | None | None | None | None | None | None |
| Scenario analyses | |||||||||
| No additional prescription of statins in elderly regardless of 10-year CVD risk | – | ICER=£12 175 | ICER=£29 307 | Absolutely dominated | ICER=£39 925 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Periodic cardiovascular risk assessment until age 85 in old guidelines | – | ICER=£13 719 | Extendedly dominated (ICER=£71 076) | Absolutely dominated | ICER=£40 336 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Periodic cardiovascular risk assessment until age 75 in current and alternative guidelines | – | ICER=£11 797 | Extendedly dominated (ICER=£57 348) | Absolutely dominated | ICER=£39 945 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Different uptake of preventive programmes for age ≥55 vs age <55: odds ratio equals 2 | – | ICER=£10 975 | Extendedly dominated (ICER=£51 737) | Absolutely dominated | ICER=£43 028 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Adherence to periodic risk assessment in diabetics equal to non-diabetics | – | ICER=£13 136 | Extendedly dominated (ICER=£39 637) | Absolutely dominated | ICER=£37 320 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Full adherence to prevention programmes | – | ICER=£15 156 | Extendedly dominated (ICER=£162 296) | Absolutely dominated | ICER=£50 280 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Full adherence to preventive medication use | – | ICER=£8 576 | ICER=£31 723 | Absolutely dominated | ICER=£52 164 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Full adherence to prevention programmes and preventive medication use | – | ICER=£9 780 | Extendedly dominated (ICER=£48 799) | Absolutely dominated | ICER=£43 469 | Absolutely dominated | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Prescription of polypill if eligible age and SBP ≥120 mm Hg | – | ICER=£11 797 | (40 089 Extendedly dominated) | Absolutely dominated | ICER=£36 356 | ICER=£2 260 942 | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Prescription of polypill if eligible age and SBP ≥130 mm Hg | – | ICER=£11 797 | (40 089 Extendedly dominated) | Absolutely dominated | ICER=£34 016 | ICER=£421 474 | Absolutely dominated | Absolutely dominated | Absolutely dominated |
| Prescription of polypill if eligible age and SBP ≥140 mm Hg | – | ICER=£11 797 | (40 089 Extendedly dominated) | Absolutely dominated | ICER=£29 207 | ICER=£168 483 | Absolutely dominated | Absolutely dominated | Absolutely dominated |
For each threshold analysis it is indicated at which value(s) the strategy will be the most cost-effective programme as compared with the other strategies at £20 k (£30 k). For scenario analyses, incremental cost-effectiveness ratios (ICERs) are given, calculated by comparison of undominated strategies. Absolutely dominated indicates a less effective and more costly programme than the previous programme. Extendedly dominated indicates a programme that is less costly than the next not absolutely dominated programme, but also has a larger incremental cost-effectiveness ratio than this next programme.
ARB, angiotensin receptor blocker; CCB, calcium channel blocker; CVD, cardiovascular disease; DM, diabetes mellitus; NHS, National Health Service; SBP, systolic blood pressure.