Session Highlights
In this WHF Heart Café conversation, moderator Tom Gaziano (Brigham & Women’s/Harvard) speaks with Enrico G. Ferro, Adrianna Murphy, and Habib Gamra—with contributions from WHF Emerging Leaders—about scaling Single-Pill Combinations (SPCs) for cardiovascular prevention and secondary prevention. The panel distills evidence on adherence and outcomes, the WHF SPC Roadmap, cost-effectiveness, and pragmatic routes to availability, affordability, and adoption across high-, middle-, and low-income health systems.
Key takeaways
- Evidence is solid: SPCs improve adherence (≈10% absolute in primary prevention) and deliver meaningful reductions in SBP, LDL-C, and major adverse cardiovascular events in both primary and secondary prevention.
- From trials to essential use: SPCs/polypills are recognized on essential medicines lists; the WHF Roadmap focuses on turning guideline-level science into implementable policy and services.
- Cost-effectiveness is favorable: Modeling shows low incremental cost per QALY versus separate pills; total system costs can drop with simpler procurement, fewer SKUs, and multi-month dispensing.
- Three barriers, three levers: Availability (regulatory and supply-chain hurdles), Affordability (pricing vs. generics; pooled purchasing; voluntary licensing), and Adoption (prescriber inertia; patient awareness) require coordinated action.
- Front-line pathways matter: Embed SPCs into primary care and nurse-led CVD pathways; align with HEARTS-style protocols, task-sharing, and decision support to reach rural and under-served settings.
- Create “pull” for industry: Clear demand signals from ministries of health, payers, and national societies (standardized formularies, volume commitments) lower prices and expand market entry.
- WHF Emerging Leaders in action: Case projects target availability (supply-chain mapping in Uganda/Nigeria), adoption (co-created e-learning for prescribers in Kenya), and affordability (criteria to add SPCs to national EMLs).
Who should watch?
Cardiologists, internists, GPs, nurses, pharmacists, payers, policymakers, supply-chain leads, and advocates working on hypertension/ASCVD prevention, secondary prevention post-MI, essential medicines policy, and health-system integration in high-, middle-, and low-income contexts.
SPC (Single-Pill Combinations) Session – FAQ
- What is a single-pill combination (SPC) and why use it?
- An SPC combines proven CV drugs (e.g., antihypertensives, statin, antiplatelet) in one pill to improve adherence, control BP/LDL-C, and reduce events compared with taking multiple separate pills.
- Are SPCs cost-effective versus separate generics?
- Yes in most settings. Despite unit-price variation, overall value improves via better outcomes, streamlined procurement, reduced dispensing burden, and fewer stockouts—especially with pooled purchasing and standardized formularies.
- How can countries expand access quickly?
- Add priority SPCs to national EMLs and benefit packages; use pooled procurement and volume guarantees; align regulatory requirements regionally; and adopt HEARTS-like primary-care protocols with multi-month dispensing.
- How do we overcome prescriber inertia and build demand?
- Deploy concise, co-designed e-learning and decision aids for GPs/nurses; embed SPCs in clinical pathways and discharge letters; inform patients about one-pill convenience and outcomes; and secure endorsements from national societies.