Journal Article

Dynamic View on Affordability of Fixed-Dose Combination Antihypertensive Drug Therapy

Song Hee Hong, Junling Wang and Jun Tang

in American Journal of Hypertension

Published on behalf of American Journal of Hypertension, Ltd.

Volume 26, issue 7, pages 879-887
Published in print July 2013 | ISSN: 0895-7061
Published online March 2013 | e-ISSN: 1941-7225 | DOI:
Dynamic View on Affordability of Fixed-Dose Combination Antihypertensive Drug Therapy

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  • Cardiovascular Medicine
  • Biological Sciences


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The use of fixed-dose combinations (FDCs) has been increasing since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended using ≥2 drugs as the first-line drug therapy for patients with stage 2 hypertension. FDCs simplify the drug therapy regimen and reportedly lower the drug therapy cost compared with the free combination (FC) of 2 single-agent drugs. This study hypothesized that the affordability of FDCs over FCs would change over time depending on the availability of generic single-agent drugs.


This study used the 2009 Medical Expenditure Panel Survey. Antihypertensive drugs were identified based on the Food and Drug Administration national drug directory. Based on the 2 databases, regression models were run to predict average monthly drug cost as well as out-of-pocket cost for each prescription along with their 95% confidence intervals (CIs).


Overall, FDCs (n = 26) had average monthly drug costs similar to respective FCs when FCs were not generically available. However, when FCs were generically available, FDCs (n = 11) had average drugs costs much higher than their respective FCs. For example, Lotrel as an FDC had an average monthly drug cost of $115.97 (95% CI = $96.59–$135.36), whereas its counterpart FC had an average monthly drug cost of $21.00 (95% CI = $18.23–$23.79).


The cost advantage of FDCs over FCs was reversed when FCs were generically available. The finding of this study informs patients, health-care providers, and drug plans of the importance of making dynamic decisions on preferred drug therapy options depending on the availability of generic drugs.

Keywords: access to drug therapy prescription drug costs; antihypertensive drug therapy; blood pressure; fixed-dose combinations; hypertension.

Journal Article.  4740 words.  Illustrated.

Subjects: Cardiovascular Medicine ; Biological Sciences

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