Journal of Pharmacoeconomics and Pharmaceutical Management (Jan 2023)
Impact of Fixed Dose Combination Treatment on Adherence, Blood Pressure Control, Clinical Outcomes and Cost of Treatment
Abstract
Background: Initial combination therapy, preferentially fixed-dose combination (FDC) therapy is recommended by most of the clinical guidelines for the management of hypertension in adults. However, there is inadequate evidence on the impact of FDC on Blood pressure control, clinical outcomes, and cost of treatment. Therefore, this review was conducted to synthesize evidence impact of FDC treatment strategies on adherence, blood pressure control, clinical outcomes, and cost of treatment. Methods: We systematically searched articles written in the English language from January 2000 to January 2020 from the following databases: PubMed/Medline, Embase, and Google scholar. Results: Controlled trials were conducted among 17,465 adult hypertensive patients and retrospective cohort studies were conducted among 1,587,737 adult hypertensive patients. FDC strategy Improved treatment adherence and reduced adverse effects. However, the effect of FDC on blood pressure control, clinical outcomes, overall mortality, major adverse cardiac event-free survival, and overall cost of treatment were variable ranging from small changes to insignificant differences. Conclusion: Fixed-dose combination therapy improved treatment adherence and reduced side effects. However, the role of FDC on treatment outcomes like blood pressure reduction, CVD risk factor reduction, reduction in hospitalization rate, and the overall mortality rate was inconclusive. More strong multi-center trials involving patients with good adherence are required to see the actual effect of FDCs on the treatment outcomes of hypertension patients. In addition, ensuring medicine availability and conducting economic evaluations from different perspectives are required to recommend FDC as a first-line treatment option for the treatment of hypertension in adults.
