title: Out-of-pocket and total costs of fixed-dose combination antihypertensives and their components.
abstract: BACKGROUND
  Many patients are burdened by prescription costs, yet it is not clear whether brand-named fixed-dose combination medicines are less expensive than the sum of the cost of their generic components.
  
  
  METHODS
  We used the Medical Expenditure Panel Survey, a rigorously conducted, nationally representative, population-based survey, to examine the out-of-pocket and third party costs associated with the most commonly prescribed, brand-named fixed-dose combination antihypertensive drugs. We compared the out-of-pocket and third party cost for a 30-day supply of each of these combination drugs with the sum of these costs for their individual generic components.
  
  
  RESULTS
  Twenty-seven combination antihypertensive medicines were examined. Overall, combination products had higher out-of-pocket costs and lower total costs than did the sum of the costs of their components. For example, the out-of-pocket costs were greater for 24 of 27 combination drugs examined, and the mean increase in monthly out-of-pocket costs associated with combination therapy was $13.38 (95% confidence interval, $12.27-14.50). In contrast, the total cost was lower for 23 of the 27 combination drugs examined, and the mean decrease in monthly total costs was $20.89 (95% confidence interval, $20.10-21.68).
  
  
  CONCLUSIONS
  Given patient burden and nonadherence from out-of-pocket prescription costs, the clinical benefits of brand-named fixed-dose combination antihypertensive therapy should be balanced with their greater out-of-pocket costs.
authors.affiliation: Center for Health and Social Sciences, University of Chicago, Chicago, Illinois, USA.
authors.forename: Atonu
authors.initials: A
authors.lastname: Rabbani
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D003363:Cost Control; D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D010818:Practice Patterns, Physicians'; D011306:Prescription Fees; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D016568:Drugs, Generic