title: Single-pill vs free-equivalent combination therapies for hypertension: a meta-analysis of health care costs and adherence.
abstract: This meta-analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single-pill combinations (SPCs) vs free-equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual all-cause and hypertension-related health care costs was $1357 (95% confidence interval [CI], $778-$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC groups was twice as likely as the FEC groups (pooled risk ratio, 2.1; 95% CI, 1.1-4.1). Improved adherence and persistence may have contributed to the lower costs in the SPC groups via improved clinical outcomes.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA. bsherrill@rti.org
authors.forename: Beth
authors.initials: B
authors.lastname: Sherrill
authors.forename: Michael
authors.initials: M
authors.lastname: Halpern
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Khan
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Sumeet
authors.initials: S
authors.lastname: Panjabi
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016001:Confidence Intervals; D004359:Drug Therapy, Combination / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics; D010594:Pharmacies / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents