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Fixed Dose Drug Combinations–Are They Pharmacoeconomically Sound? Findings and Implications Especially for Lower- and Middle-Income Countries Publisher Pubmed



Godman B1, 2, 3, 4 ; Mccabe H5 ; Leong TD6 ; Mueller D7, 8 ; Martin AP9, 10 ; Hoxha I11 ; Mwita JC12 ; Rwegerera GM13 ; Massele A14 ; De Oliveira Costa J15, 16, 17 ; Do Nascimento RCRM1, 17 ; De Lemos LLP15, 16 ; Tachkov K18 ; Milushewa P19 Show All Authors
Authors
  1. Godman B1, 2, 3, 4
  2. Mccabe H5
  3. Leong TD6
  4. Mueller D7, 8
  5. Martin AP9, 10
  6. Hoxha I11
  7. Mwita JC12
  8. Rwegerera GM13
  9. Massele A14
  10. De Oliveira Costa J15, 16, 17
  11. Do Nascimento RCRM1, 17
  12. De Lemos LLP15, 16
  13. Tachkov K18
  14. Milushewa P19
  15. Patrick O20, 21
  16. Niba LL20, 22
  17. Laius O23
  18. Sefah I24
  19. Abdulsalim S25
  20. Soleymani F26, 27
  21. Guantai AN28
  22. Achieng L29
  23. Oluka M29
  24. Jakupi A30
  25. Logviss K31
  26. Azmi Hassali M4
  27. Kibuule D32
  28. Kalemeera F32
  29. Mubita M32
  30. Fadare J33, 34
  31. Ogunleye OO35, 36
  32. Saleem Z37
  33. Hussain S38
  34. Bochenek T39
  35. Mardare I40
  36. Alrasheedy AA41
  37. Furst J42
  38. Tomek D43
  39. Markovicpekovic V44
  40. Rampamba EM2, 45
  41. Alfadl A42, 46
  42. Amu AA47
  43. Matsebula Z48
  44. Thi Phuong TN49
  45. Thanh BN49
  46. Kalungia AC50
  47. Zaranyika T51
  48. Masuka N52
  49. Olaru ID53, 54
  50. Wale J55
  51. Hill R56
  52. Kurdi A1, 57
  53. Timoney A1, 58
  54. Campbell S59, 60
  55. Meyer JC2
Show Affiliations
Authors Affiliations
  1. 1. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
  2. 2. Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  3. 3. Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
  4. 4. School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
  5. 5. Department of Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, United Kingdom
  6. 6. Essential Drugs Programme, Affordable Medicines Directorate, South African National Department of Health, Pretoria, South Africa
  7. 7. Department of Public Health Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
  8. 8. Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
  9. 9. Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
  10. 10. HCD Economics, The Innovation Centre, Daresbury, United Kingdom
  11. 11. Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
  12. 12. Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
  13. 13. Faculty of Medicine, Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
  14. 14. Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
  15. 15. SUS Collaborating Centre for Technology Assessment & Excellence in Health, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
  16. 16. Programa De Pos-Graduacao Em Saude Publica, Faculdade De Medicina, Universidade Federal De Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  17. 17. Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
  18. 18. Departament of Pharmacy, School of Pharmacy, Federal University of Ouro Preto (UFOP), Ouro Preto, Brazil
  19. 19. Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
  20. 20. Effective Basic Services (Ebase) Africa, Bamenda, Cameroon, Cameroon
  21. 21. Adelaide University, Adelaide, Australia
  22. 22. Department of Public Health, University of Bamenda, Bambili, Cameroon
  23. 23. State Agency of Medicines, Tartu, Estonia
  24. 24. Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Ghana
  25. 25. Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
  26. 26. Pharmaceutical Management & Economic Research Center, Tehran University of Medical Sciences, Tehran, Iran
  27. 27. Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  28. 28. Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
  29. 29. Department of Clinical Medicine and Therapeutics, School of Medicine, University of Nairobi, Nairobi, Kenya
  30. 30. UBT – Higher Education Institution, Prishtina, Kosovo
  31. 31. Institute of Public Health & Department of Dosage Form Technology, Faculty of Pharmacy, Riga Stradins University, Latvia
  32. 32. Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
  33. 33. Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
  34. 34. Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
  35. 35. Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
  36. 36. Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
  37. 37. Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
  38. 38. National Institute of Health, Islamabad, Pakistan
  39. 39. Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  40. 40. Faculty of Medicine, Public Health and Management Department, “Carol Davila� University of Medicine and Pharmacy Bucharest, Bucharest, Romania
  41. 41. Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
  42. 42. Health Insurance Institute, Ljubljana, Slovenia
  43. 43. Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
  44. 44. Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  45. 45. Department of Pharmacy, Tshilidzini Hospital, Limpopo Department of Health, Limpopo Province, South Africa
  46. 46. Medicines and Poison Board, Federal Ministry of Health, Khartoum, Sudan
  47. 47. Eswatini Medical Christian University, Mbabane, South Africa
  48. 48. Raleigh Fitkin Memorial Hospital, Manzini, South Africa
  49. 49. Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Viet Nam
  50. 50. Department of Pharmacy, University of Zambia, Lusaka, Zambia
  51. 51. Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  52. 52. Independent Health Systems Consultant, Harare, Zimbabwe
  53. 53. Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
  54. 54. Biomedical Research and Training Institute, Harare, Zimbabwe
  55. 55. Independent Consumer Advocate, Brunswick, Victoria, Australia
  56. 56. Liverpool Reviews and Implementation Group, Whelan Building, Liverpool University, Liverpool, United Kingdom
  57. 57. Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
  58. 58. NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
  59. 59. Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
  60. 60. NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom

Source: Expert Review of Pharmacoeconomics and Outcomes Research Published:2020


Abstract

Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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