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

Abstract

BACKGROUND: Combination-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. METHODS: A retrospective cohort analysis was conducted using the 2017-2021 MerativeTM MarketScan® 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. RESULTS: Compared 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. CONCLUSIONS: Combination-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.