Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower and middle income countries

Brian Godman, Holly McCabe, Trudy Leong, Debjani Mueller, Antony P Martin, Iris Hoxha, Julius C Mwita, Godfrey Mutashambara Rwegerera, Amos Massele, Juliana de Oliveira Costa, Renata Cristina Rezende Macedo do Nascimento, Livia Lovato Pires de Lemos, Konstantin Tachkov, Petya Milushewa, Okwen Patrick, Loveline Lum Niba, Ott Laius, Israel Sefah, Suhaj Abdulsalim, Fatemeh SoleymaniAnastasia N Guantai, Loice Achieng, Margaret Oluka, Arianit Jakupi, Konstantīns Logviss, Mohamed Azmi Hassali, Dan Kibuule, Francis Kalemeera, Mwangana Mubita, Joseph Fadare, Olayinka O. Ogunleye, Zikria Saleem, Shazhad Hussain, Tomasz Bochenek, Ileana Mardare, Vanda Markovic-Pekovic, Alian A. Alrasheedy, Jurij Fürst, Dominik Tomek, Enos M Rampamba, Abubakr Alfadl, Adefolarin A Amu, Zinhle Matsebula, Thuy Nguyen Thi Phuong, Binh Nguyen Thanh, Aubrey Kalungia, Trust Zaranyika, Nyasha Masuka, Ioana D Olaru, Janney Wale, Ruaraidh Hill, Amanj Kurdi, Angela Timoney, Stephen Campbell, Johanna C Meyer

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Abstract

Introduction: There are positive aspects regarding the prescribing of fixed-dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower and middle income countries (LMICs) which have the greatest prevalence of both infectious and non-infectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis and hypertension are valued and listed in country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which is being addressed.
Original languageEnglish
Pages (from-to)1-26
Number of pages26
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Volume20
Issue number1
Early online date1 Apr 2020
DOIs
Publication statusPublished - 13 Apr 2020

Keywords

  • fixed dose combinations
  • adverse drug reactions
  • World Health Organization

Cite this

Godman, B., McCabe, H., Leong, T., Mueller, D., Martin, A. P., Hoxha, I., Mwita, J. C., Rwegerera, G. M., Massele, A., de Oliveira Costa, J., Nascimento, R. C. R. M. D., Lovato Pires de Lemos, L., Tachkov, K., Milushewa, P., Patrick, O., Niba, L. L., Laius, O., Sefah, I., Abdulsalim, S., ... Meyer, J. C. (2020). Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower and middle income countries. Expert Review of Pharmacoeconomics and Outcomes Research, 20(1), 1-26. https://doi.org/10.1080/14737167.2020.1734456