The "magic bullet" could drain global health budgets, unless it is carefully targeted and very cheap to manufacture, suggest the authors.

The formulation has not been tested out on large numbers of people, and how the various constituents will interact is as yet unknown, say the authors.

But in theory, the polypill, which combines aspirin, a statin, three blood pressure lowering agents, and folic acid into one tablet, has the potential to slash the risk of coronary artery disease by 88% and stroke by 80% in those aged between 55 and 64.

To calculate potential costs of widespread treatment with the polypill, the authors looked at differing levels of risk of developing coronary artery disease in different age groups, and medical and treatment costs.

They used data from the US Framingham Heart Study, which involved over 5,000 people aged between 28 and 62, who were monitored for heart disease and stroke in two year periods for almost half a century.

And they also used data from the Framingham Offspring Study, which involved monitoring the children and spouses of those in the original study every four to eight years.

Even if the polypill cost nothing, it would not save anything at all if given to everyone, irrespective of their risks of developing cardiovascular disease, or if given to those only at moderate risk, say the authors.

Giving the polypill to everyone over the age of 60 would produce the greatest health gains, the authors say. It would prevent between 76 and 179 heart attacks, and between 11 to 33 strokes, per 1000 people in this age group.

But to be cost effective, the annual expense of the polypill would have to be no more than 208 (302) for those aged
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ Specialty Journals
13-Feb-2006