Evaluating the costs and benefits of using combination therapies

Philip M Clarke and Alex B Avery
Med J Aust 2014; 200 (9): 518-520. || doi: 10.5694/mja14.00199

Fixed-dose combination therapy can improve compliance; but at what cost?

Fixed-dose combination (FDC) therapies, which involve combining two or more pharmaceutical drugs in a single tablet, are being increasingly prescribed in Australia, particularly for people with long-term chronic conditions such as diabetes and cardiovascular disease. The use of combination therapies can reduce out-of-pocket costs to the patient (ie, there is only one dispensing fee of $6.60 and copayment of up to $36.90). There is evidence that patients given combination therapies have greater adherence and compliance than those taking these medications separately.1 However, combination therapies that are subsidised through Australia's Pharmaceutical Benefits Scheme (PBS) can be more costly than using the component therapies. Our aim is to review evidence on benefits, use and the costs of combination therapies. We then propose a framework for pricing and evaluation of combinations that would ensure they are a cost-effective option for the Australian health care system.

Please login with your free MJA account to view this article in full

  • Philip M Clarke
  • Alex B Avery

  • Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.

Competing interests:

No relevant disclosures.

  • 1. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55: 399-407.
  • 2. National Heart Foundation of Australia (National Blood Pressure and Vascular Disease Advisory Committee). Guide to management of hypertension 2008. Updated December 2010. (accessed Apr 2014).
  • 3. Raz I. Guideline approach to therapy in patients with newly diagnosed type 2 diabetes. Diabetes Care 2013; 36 Suppl 2: S139-S144.
  • 4. Thom S, Poulter N, Field J, et al; UMPIRE Collaborative Group. Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial. JAMA 2013; 310: 918-929.
  • 5. Pharmaceutical Benefits Advisory Committee. Guidelines for preparing, submissions to the Pharmaceutical, Benefits Advisory Committee. Version 4.4. 2008. (accessed Apr 2014).
  • 6. National Institute for Clinical Excellence. Ezetimibe for the treatment of primary (heterozygous-familial and non-familial) hypercholesterolaemia. NICE technology appraisal guidance 132. London: NICE, 2007. (accessed Apr 2014).
  • 7. Australian Government Department of Health and Ageing. Pharmaceutical Benefits Scheme expanded and accelerated price disclosure arrangements. Procedural and operational guidelines. 2010. (accessed Apr 2014).
  • 8. Squizzato A, KellerT, Romualdi E, Middeldorp S. Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease. Cochrane Database Syst Rev 2011; (1): CD005158.
  • 9. Clarke PM. The pricing of statins and implications for Pharmaceutical Benefits Scheme expenditure. Med J Aust 2013; 198: 260. <MJA full text>
  • 10. Claxton K, Briggs A, Buxton MJ, et al. Value based pricing for NHS drugs: an opportunity not to be missed? BMJ 2008; 336: 251-254.
  • 11. Australian Government Department of Health and Ageing. Strategic review of health and medical research: better health through research. Canberra: Commonwealth of Australia, 2013. (accessed Apr 2014).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.