Authors: Itamar Megiddo, Susmita Chatterjee , Arindam Nandi, Ramanan Laxminarayan
Background: Cardiovascular diseases are the single largest cause of death in India, with acute myocardial infarction (AMI), commonly known as heart attack, accounting for a third of all heart disease deaths. Although effective treatment is available for AMI, access to treatment is dictated by cost and ability to pay. With scarce treatment resources, healthcare decisions are guided by local cost-effectiveness, for which country-level data are lacking.
Objectives: We calculate the cost-effectiveness of policies that expand the use of aspirin, injection streptokinase, beta blockers, ACE inhibitors (ACEI), and statins for the treatment and secondary prevention of AMI in India. In addition, we estimate the cost-effectiveness of a hypothetical polypill (combining the aforementioned drugs) for secondary prevention.
Methods: We conduct cost-effectiveness analyses of AMI treatment and secondary prevention for patients with prior coronary heart disease events in India.
Results: Increasing coverage of AMI treatment with aspirin and streptokinase is cost-effective and can avert approximately 335,336 (190,584–502,641) disability-adjusted life years (DALYs) among 30- to 69-year-olds in India. Reducing the time between pain onset and arrival at the hospital could avert an additional 157,000 DALYs. Secondary prevention with aspirin and beta blockers at 80% coverage is highly cost-effective, and the addition of ACEI is also cost-effective. Introducing the polypill dominates a strategy of a four-drug regimen with the aforementioned drugs and statins. The cost-effectiveness ratio of 80% coverage with the polypill is $1,691 ($1,218–$2,407) per DALY averted.
Conclusions: Policies expanding both treatment and preventive therapies are cost-effective compared with the commonly used threshold of gross domestic product (GDP) per capita. Reducing the time to treatment of AMIs could significantly reduce the burden and save lives. Introducing the polypill for secondary prevention would be more effective than providing all of its components separately, even without accounting for the likely increase in treatment adherence.