Consumption of single products versus fixed-dose combination medicines for hypertension and hyperlipidemia during 2015–2019 in South Korea

Abstract

Background Fixed-dose combinations can simplify prescribing, and numerous combination products exist for hypertension and dyslipidemia in South Korea. This study’s aim was to compare trends in the consumption of single products versus fixed-dose combinations for hypertension and hyperlipidemia. Methods and findings We analyzed the Korean national health insurance claims database from January 2015 through December 2019. Consumption of medicines was calculated using the defined daily dose per 1,000 inhabitants per day (DIDs) and expenditures over time. During 2015–2019, the use of antihypertensive drugs increased with an annual growth rate (AGR) of 0.9% for single products and with an AGR of 35.6% for fixed-dose combinations. A notable increase was observed for antihyperlipidemic combination drugs with an AGR of 268.1% compared to single products with 35.7%. For older adults (65+ years), the consumption of drugs for hypertension and hyperlipidemia was 3–4.5 and about 3 times higher, respectively, than in adults aged 20–64 years, and a sharp increase was found in antihyperlipidemic fixed-dose combinations among older adults. A large increase was seen for C09 (agents acting on the renin-angiotensin system) with an AGR of 36.5%, especially C09DB (angiotensin II receptor blockers + calcium channel blockers) was widely used and steeply increased with 114.2%. For antihyperlipidemic drugs, C10AA (HMG CoA reductase inhibitors) accounted for a large share and sharply increased, with 52.1 DIDs in 2019 and with an AGR of 78.4%, whereas C10BA (combinations of various lipid modifying agents) increased 9.6 times from 2.9 DIDs (96 million USD) in 2015 to 27.7 DIDs (912 million USD) in 2019. Conclusion The findings of increased consumption and drug spending among older adults underscores the need for real-world evidence about health outcomes of fixed-dose combinations in this population.

Therapeutic Duplication as a Medication Error Risk in Fixed-Dose Combination Drugs for Dyslipidemia: A Nationwide Study

“…[33][34][35] A national drug utilization study in Korea showed a significant increase in FDC usage, indicating their appeal to prescribers. 36) In this study, we found that FDCs were the preferred choice for prescribing a combination of statin and ezetimibe. Statin/ezetimibe FDCs, with 180,837 prescriptions, were prescribed significantly more often than the corresponding FCs, which had 1,292 prescriptions.…”

Management of Hypertension in the Asia-Pacific Region: A Structured Review

“…Countries where CCBs were not the most commonly prescribed agents were Korea [ 118 ], Indonesia [ 129 ], Pakistan [ 112 ] and Vietnam [ 107 ]. In Korea, an analysis of the national health insurance claims database reported that ARBs were the most commonly prescribed antihypertensives, both as monotherapy and in combination [ 118 ], with > 50% of patients receiving combination therapy [ 134 ].…”

“…Countries where CCBs were not the most commonly prescribed agents were Korea [ 118 ], Indonesia [ 129 ], Pakistan [ 112 ] and Vietnam [ 107 ]. In Korea, an analysis of the national health insurance claims database reported that ARBs were the most commonly prescribed antihypertensives, both as monotherapy and in combination [ 118 ], with > 50% of patients receiving combination therapy [ 134 ]. ACEis were also the most commonly prescribed antihypertensive agents in an analysis of prescribing at a hospital in Vietnam ( n = 388) [ 107 ], whereas in Pakistan, ACEis were the second most common class of antihypertensives after β-blockers, according to a survey of general practitioners ( n = 58) and hospital physicians ( n = 42) in Karachi [ 112 ].…”

“…In most studies, the majority of hypertensive patients received combination therapy [ 106 , 110 , 113 , 114 , 118 , 122 – 124 , 135 , 136 ]. The most common combinations in Japan were ARB + CCB or ARB + diuretic [ 113 , 133 ].…”

Prescription Trends of Initial Antihypertensive Medications among Treatment-Naïve Individuals in South Korea: A Retrospective Analysis

“…Additionally, the widespread availability of fixed-dose combination drugs in the market has contributed to the increasing trend in prescription rates. 18 The upward trajectory of fixed-dose combinations underscores a progressive approach in addressing the complexities of multiple conditions, marking a significant stride in optimizing therapeutic strategies for improved patient outcomes.…”