Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysisReportar como inadecuado

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BMC Health Services Research

, 13:124

Utilization, expenditure, economics and financing systems


BackgroundThe prescription of fixed-dose combinations FDC of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction.

In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs.

MethodsClaims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers ARBs. Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC control group. Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers’ characteristics.

ResultsThere were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers’ characteristics. The switch to FDC was associated with an annual saving of 10,420 yen US$112.0 in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen US$25.5.

ConclusionsFor hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs.

KeywordsAntihypertensive drug Fixed-dose combination Economic benefit Drug costs Social experiment Switching AbbreviationsACEAngiotensin-converting enzyme

ARBAngiotensin-receptor blocker

CCBCalcium-channel blocker


FDCFixed-dose combination


MPRMedication possession ratio

NHINational health insurance

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-124 contains supplementary material, which is available to authorized users.

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Autor: Manabu Akazawa - Katsushi Fukuoka


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