LIFESAVING PILL TOO EXPENSIVE FOR BUREAUCRATIZED MEDICINE

A proposal to give every person a pill that combines aspirin, a statin, three agents that lower blood pressure and folic acid could save thousands of lives in Britain each year. But researchers have found that, despite its potential to reduce health problems dramatically, it would not save any money. The daily "polypill" is seen as a possible "magic bullet" for cardiovascular disease (CVD), Britain's biggest killer. Doctors believe that, if taken preventatively, it could slash the risk of coronary artery disease by 88 per cent and stroke by 80 per cent in those aged between 55 and 64.

However, a study by Dutch researchers suggests that even if the polypills cost nothing to make, giving them to everyone, or even only those at moderate risk of CVD, would not save any money because of the huge administrative costs of prescribing them to millions of people. The study, published today in the Journal of Epidemiology and Community Health, found that the polypill could drain global health budgets unless it was carefully targeted and cheap. The formulation, first suggested in 2003, has not been tested on a large number of people, and how the pill's ingredients interact is not known.

To calculate the potential costs, the authors looked at the risk of developing coronary artery disease in different age groups, as well as medical and treatment costs. They used data from the Framingham Heart Study, which monitored more than 5,000 Americans aged between 28 and 62 for heart disease and stroke for almost half a century.

The team from the Erasmus Medical Centre in Rotterdam found that giving the pill to people over 60 or those with a high risk of coronary heart disease would be most beneficial. This proposal was underpinned by analysis of earlier trials of drugs that can lower the risk of cardiovascular disease. More than 750 trials were assessed.

The polypill would be designed to lower the four key risk factors for heart disease: cholesterol, high blood pressure, high homocysteine blood levels and blood platelet function. A statin would reduce high levels of the "bad" low-density lipoprotein cholesterol, cutting the risk of heart disease, while three drugs that lower blood pressure would reduce stroke risk. Folic acid in the pill would cut high homocysteine levels, which can encourage the build-up of fatty plaques in arteries. Aspirin would regulate the function of blood platelets.

The researchers say that giving the polypill to everyone over 60 would prevent between 76 and 179 heart attacks per thousand people and between 11 and 33 strokes per 1,000 people in this age group. "However, this would also imply the medicalisation of a large section of the population and the exposure of otherwise healthy subjects to unwanted adverse effects," they said.

To be cost effective, the annual cost per patient would have to be no more than 208 pounds for those aged 50, and no more than 282 pounds for those aged 60 at high risk of coronary artery disease. The researchers said: "(It) may be the preventive method with potentially the greatest impact on public health in the Western world, but is everything that glisters gold?"

The World Health Organisation has suggested that a 2 per cent annual reduction in chronic disease death rates in Britain, such as from CVD, would result in an economic gain of 1.14 billion pounds over ten years.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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