Association of polypill adherence with the incidence, admissions, and costs of major adverse cardiovascular events in a large South African medical scheme
1
Research and Development, Government Employees Medical Scheme, Pretoria, South Africa
2
Statistics Department, University of South Africa (UNISA), Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Cardiovascular disease (CVD) is a leading cause of premature mortality in South Africa, and poor medication adherence reduces treatment effectiveness. Fixed-dose polypills may improve adherence, but real-world evidence on their impact on major adverse cardiovascular events (MACE) is limited. This study examines whether polypill adherence is associated with lower MACE incidence, cardiovascular admissions, and healthcare costs in a large South African medical scheme.
METHODS:
A retrospective cohort study was conducted among 382 843 eligible members using linked 2024 membership, pharmacy, and hospital claims data. High polypill adherence was defined as sustained exposure over 10–12 months and analysed as a binary and dose–response exposure. MACE incidence was modelled using modified Poisson regression with robust standard errors; recurrent events used Poisson or negative binomial models, and cardiovascular costs were analysed using generalized linear models with a Gamma distribution and log link. All models adjusted for demographic, socio-economic, geographic, and clinical covariates, with sensitivity analyses including cost winsorisation.
RESULTS:
High polypill adherence was consistently associated with improved cardiovascular outcomes and lower healthcare costs. In fully adjusted analyses, members with sustained high adherence experienced a lower incidence of MACE (adjusted RR 0.60, 95% CI 0.57–0.62; p < 0.001), with effects consistent across subgroups. High adherence was also associated with fewer recurrent cardiovascular admissions, including a 46% reduction in MACE-related admissions (IRR ≈ 0.54). Cost analyses showed high adherence was associated with markedly lower MACE-related expenditure, with sensitivity analyses indicating an estimated 57% cost reduction (cost ratio ≈ 0.43), supporting a robust association between sustained polypill adherence, reduced cardiovascular risk, and lower healthcare costs.
CONCLUSIONS:
High polypill adherence was associated with lower MACE risk, reduced cardiovascular admissions, and lower hospital costs. These findings support simplified fixed-dose combination therapy and adherence-support interventions in reducing cardiovascular events and informing strategies to target high-risk populations.
Cardiovascular disease (CVD) is a leading cause of premature mortality in South Africa, and poor medication adherence reduces treatment effectiveness. Fixed-dose polypills may improve adherence, but real-world evidence on their impact on major adverse cardiovascular events (MACE) is limited. This study examines whether polypill adherence is associated with lower MACE incidence, cardiovascular admissions, and healthcare costs in a large South African medical scheme.
METHODS:
A retrospective cohort study was conducted among 382 843 eligible members using linked 2024 membership, pharmacy, and hospital claims data. High polypill adherence was defined as sustained exposure over 10–12 months and analysed as a binary and dose–response exposure. MACE incidence was modelled using modified Poisson regression with robust standard errors; recurrent events used Poisson or negative binomial models, and cardiovascular costs were analysed using generalized linear models with a Gamma distribution and log link. All models adjusted for demographic, socio-economic, geographic, and clinical covariates, with sensitivity analyses including cost winsorisation.
RESULTS:
High polypill adherence was consistently associated with improved cardiovascular outcomes and lower healthcare costs. In fully adjusted analyses, members with sustained high adherence experienced a lower incidence of MACE (adjusted RR 0.60, 95% CI 0.57–0.62; p < 0.001), with effects consistent across subgroups. High adherence was also associated with fewer recurrent cardiovascular admissions, including a 46% reduction in MACE-related admissions (IRR ≈ 0.54). Cost analyses showed high adherence was associated with markedly lower MACE-related expenditure, with sensitivity analyses indicating an estimated 57% cost reduction (cost ratio ≈ 0.43), supporting a robust association between sustained polypill adherence, reduced cardiovascular risk, and lower healthcare costs.
CONCLUSIONS:
High polypill adherence was associated with lower MACE risk, reduced cardiovascular admissions, and lower hospital costs. These findings support simplified fixed-dose combination therapy and adherence-support interventions in reducing cardiovascular events and informing strategies to target high-risk populations.
| eISSN: | 2654-1459 |
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