Fixed-Dose Combination Use and Drug Adherence, Healthcare Utilization, and Costs

BACKGROUNDCombination-pill therapy using fixed-dose combination (FDC) antihypertensives has the potential to improve hypertension control and management. However, combination-pill therapy remains low. This study aims to assess 1) the association between combination-pill therapy and subsequent medication adherence, healthcare utilization, and costs and 2) the potential to mitigate racial and ethnic disparities in medication adherence, among Medicaid beneficiaries. METHODSA retrospective cohort analysis was conducted using the 2017-2021 MerativeTM MarketScan(R) Medicaid claims database. The study sample included adults aged 18-64 years with hypertension, continuously enrolled one year before and after a random index date of prescribed antihypertensives. Combination-pill therapy was compared with multi-pill therapy. The propensity-score overlap weighting method was used to balance characteristics between individuals using combination- and multi-pill therapy. Logistic models were used for medication adherence, linear models for medication possession ratios (MPRs), negative binomial models for healthcare utilization, and generalized linear models for healthcare costs. RESULTSCompared with multi-pill therapy, combination-pill therapy was associated with improved medication adherence (3.17 in MPR, 95% CI: 2.79 - 3.55), fewer hypertension-related emergency department visits (220 per 1,000 individuals, 95% CI: -235 - -204), fewer hospitalizations (153 per 1,000 individuals, 95% CI: -160 - -146), and lower medical costs ($2,862 per person, 95% CI: -$3,035 - -$2,689). However, disparities in medication adherence between non-Hispanic White and non-Hispanic Black adults existed for both FDC and multi-pill therapy. CONCLUSIONSCombination-pill therapy could improve hypertension management and save costs for the Medicaid program and beneficiaries. These findings may inform policies on FDC antihypertensive coverage and programs. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.