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

Godman, Brian and McCabe, Holly and Leong, Trudy and Mueller, Debjani and Martin, Antony P and Hoxha, Iris and Mwita, Julius C and Rwegerera, Godfrey Mutashambara and Massele, Amos and de Oliveira Costa, Juliana and Nascimento, Renata Cristina Rezende Macedo do and Lovato Pires de Lemos, Livia and Tachkov, Konstantin and Milushewa, Petya and Patrick, Okwen and Niba, Loveline Lum and Laius, Ott and Sefah, Israel and Abdulsalim, Suhaj and Soleymani, Fatemeh and Guantai, Anastasia N and Achieng, Loice and Oluka, Margaret and Jakupi, Arianit and Logviss, Konstantīns and Hassali, Mohamed Azmi and Kibuule, Dan and Kalemeera, Francis and Mubita, Mwangana and Fadare, Joseph and Ogunleye, Olayinka O. and Saleem, Zikria and Hussain, Shazhad and Bochenek, Tomasz and Mardare, Ileana and Markovic-Pekovic, Vanda and Alrasheedy, Alian A. and Fürst, Jurij and Tomek, Dominik and Rampamba, Enos M and Alfadl, Abubakr and Amu, Adefolarin A and Matsebula, Zinhle and Phuong, Thuy Nguyen Thi and Thanh, Binh Nguyen and Kalungia, Aubrey and Zaranyika, Trust and Masuka, Nyasha and Olaru, Ioana D and Wale, Janney and Hill, Ruaraidh and Kurdi, Amanj and Timoney, Angela and Campbell, Stephen and Meyer, Johanna 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). pp. 1-26. ISSN 1473-7167 (

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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 noninfectious 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 there are 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 the 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 are being addressed.


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