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Exact(4)
The reallocation of 20% of the budget (and assuming non-divisibility of clinical interventions) could almost quadruple DALYs averted, enabling the addition of the modified polypill strategy to subjects with an estimated cardiovascular risk above 20%.
Concerning specific interventions, the strategy of lowering salt intake in the population through reducing salt in bread was found to be the most cost-effective (ARS $151 per DALY averted), followed by health education through mass-media campaign (ARS $547 per DALY averted) and the modified polypill strategy.
Concerning the modified polypill strategy, effects are also less than predicted by the regional models, but our cost estimates are considerably higher, which reflects the fact that key intervention resource inputs in Buenos Aires – including human resources, secondary care and drugs – are much more expensive than the regional average.
Against a threshold of average per capita income in Argentina, the two selected population-based interventions (lowering salt intake and health education through mass-media campaigns) plus the modified polypill strategy targeting people with a 20% or greater risk were cost-effective.
Similar(56)
A preliminarily feasible and efficacy-suggesting SMAART trial could inform the future design of a multi-center, double-blinded, placebo-controlled, randomized trial comparing the clinical efficacy of the polypill strategy for vascular risk moderation among stroke survivors in LMICs.
We also sought trial participants' and health professionals' views about the acceptability of a polypill strategy.
If a population-based polypill strategy is to be introduced, significant barriers from professionals will need to be overcome.
In addition, the process evaluation explores the acceptability of a polypill strategy with trial participants and healthcare professionals.
15 16 Wald and Law 11 estimate adopting a polypill strategy could prevent 80% of strokes and 88% of ischaemic heart disease events, with low risk of adverse effects.
In the UK and India, there was support from patients and some healthcare professionals for the polypill strategy due to its simplicity and lower cost (quote 17).
To improve our understanding of the potential strengths and limitations of the polypill strategy, we carried out a process evaluation of the UMPIRE trial.
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