Fixed-Dose Combination Drugs May Benefit Hypertension Patients

Despite higher costs, fixed-dose combination drugs result in less follow-up care among patients with hypertension.

Approximately half of patients with hypertension will require dose adjustments to account for side effects or lack of disease control within the first year of diagnosis. While there are numerous options for patients, a new study published by the Journal of Managed Care Pharmacy found that treatment with 1 fixed-dose combination drug leads to lower costs.

The latest study adds to previous research that demonstrated a fixed-dose combination drug has significant advantages over other therapies. Patients treated with fixed-dose combination therapy are more likely to continue treatment and remain adherent.

Other studies have found that these drugs are nearly 5 times more effective at controlling hypertension compared with other options.

"It's a win-win situation for everyone," said lead investigator Kalyani Sonawane, PhD. "From the patient and physician perspective, you achieve higher efficacy with fixed-dose combination and patients continue on the drug for a longer period of time and have better adherence. From the standpoint of managed-care organizations, you have greater economic savings from lower health services costs."

Nearly one-third of Americans have hypertension, which places them at a high risk of developing heart disease and experiencing a stroke.

For patients prescribed anti-hypertensive drugs, approximately 30% experience side effects, while half do not achieve blood pressure control within the first year. Physicians may add an additional drug, increase the dose, decrease the dose, or switch to a different drug.

In the study, the authors examined prescribing patterns and patient outcomes during medication adjustment. Specifically, they looked at the costs associated with different strategies.

Included in the study were claims data from the BlueCross BlueShield of Texas from 2008 to 2012. The authors gathered data for annual drug costs and costs related to outpatient and inpatient hypertension-related services during medication adjustment for 6000 patients.

The authors discovered that fixed-dose combination therapy cost an average of $310 per year compared with $135 per year for switching drugs, according to the study. The authors found that increasing the dose of current drugs cost $63 annually, while decreasing the dose cost $61 annually.

However, despite having the highest initial costs, follow-up healthcare resulted in the lowest costs for patients on fixed-dose combination drugs, according to the study. For these patients, inpatient costs for related services cost an average of $1731 per year, compared with $2985 for those on decreasing doses.

The authors also discovered that switching to new drugs cost an average of $7076 in inpatient costs per year. Increasing the dose of a current therapy cost an average of $7692 annually, making it the most expensive option in terms of inpatient costs, according to the study.

Some physicians may be hesitant to start patients on a fixed-dose combination therapy, as the initial costs can be high. These new findings suggest that long-term savings due to less follow-up care, in addition to improved adherence and efficacy, make the fixed-dose combination the lowest cost approach overall, according to the study.

"Even though the drug costs for fixed-dose combination appear to be extremely high, it is offset by savings in health services costs, saving almost 7 times the cost in inpatient visits," Dr Sonawane said.