Cost utility analysis of fixed-dose and free-dose combinations of oral medications in type 2 diabetes patients

Objectives Fixed‐dose combinations (FXD), medications with more than one active drug ingredient in them, have been a strategy to enhance adherence, but their costs have not been determined, nor have they been compared to the free‐dose combinations (FRC). The objective of this study was to evaluate the cost‐effectiveness of FXD versus the FRC of oral medications among type 2 diabetes patients. Methods The study was done from a third‐party payer perspective using Medical Expenditure Panel Survey. The sample was divided into two cohorts, FXD group, which includes patients taking only FXD medication, and FRC group, which includes patients not taking any FXD medication and only taking their individual component drugs. The costs include only direct costs, and the effectiveness was measured in QALYs (Quality Adjusted Life Years) using the utility score from Short Form‐6D. To control for selection bias, a propensity score matching technique was performed. Sensitivity analysis was performed to assess the impact of different assumptions on the results. Key findings On matching, 93 patients were included in the FXD and FRC groups. The mean annual cost for the FXD group was $6016.65, and the cost was $6919.58 for the FRC group. The mean utility gained using FXD over FRC was 0.04. The base case analysis shows that the costs of FXD are lower and there is a gain in QALY over FRC, so FXDs are a better choice than FRC. Probabilistic sensitivity analysis showed that FXD exceeded FRC for all willingness to pay (WTP) values. Conclusion Although the cost‐effectiveness of a single pill strategy was within the acceptable WTP threshold, the QALY difference was minimal. Further research is recommended in this area to look into the long‐term impact in terms of the quality of life of patients using these drugs.