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Evaluating the costs and benefits of using combination therapies

Fixed-dose combination therapy can improve compliance; but at what cost?

Fixed-dose combination (FDC) therapies, which involve combining two or more pharmaceutical drugs in a single tablet, are being increasingly prescribed in Australia, particularly for people with long-term chronic conditions such as diabetes and cardiovascular disease. The use of combination therapies can reduce out-of-pocket costs to the patient (ie, there is only one dispensing fee of $6.60 and copayment of up to $36.90). There is evidence that patients given combination therapies have greater adherence and compliance than those taking these medications separately.1 However, combination therapies that are subsidised through Australia’s Pharmaceutical Benefits Scheme (PBS) can be more costly than using the component therapies. Our aim is to review evidence on benefits, use and the costs of combination therapies. We then propose a framework for pricing and evaluation of combinations that would ensure they are a cost-effective option for the Australian health care system.

The growth in use of combination drugs to treat diabetes and cardiovascular disease is illustrated in Box 1, which shows total expenditure on these therapies over time. Australian guidelines for the treatment of blood pressure (BP) recognise that combinations of antihypertensive drugs are required to achieve BP targets.