Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

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.

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

“…In addition, our principal aim was to provide a comprehensive analysis of the current situation across Africa, including the potential implications for other infectious and non-infectious disease areas within the African continent, to stimulate ongoing debates regarding potential future activities. This is important across Africa with high prevalence rates for both infectious and non-infectious diseases, We have successfully used this dual approach in previous publications to stimulate debate in important healthcare areas and situations to provide future guidance as countries seek to improve the quality and efficiency of their approaches to medicine use, including during pandemics (Godman et al, 2014a;Godman et al, 2014b;Godman et al, 2015;Ermisch et al, 2016;Bochenek et al, 2017;Ferrario et al, 2017;Moorkens et al, 2017;Godman et al, 2018;Godman et al, 2019;Godman et al, 2020b;Godman et al, 2020c;Godman et al, 2020d;Miljkovićet al, 2020).…”

“…This includes a lack of support and access to facilities to improve lifestyle management, monitor patient and regularly provide essential medicines (Kluge et al, 2020). Ongoing national plans to reduce morbidity and mortality due to NCDs, especially CVD and diabetes, across continents including Africa (Mensah et al, 2015;Amegah, 2018;Godman et al, 2020c;Godman et al, 2020d) could also be compromised by reduced access to medicines, cancelled or missed appointments due to patients' reduced access to facilities and fear of coming into contact with COVID-19 patients in healthcare facilities, and not following lifestyle advice (Kabale et al, 2020;Kluge et al, 2020;Nachimuthu et al, 2020). However, we are aware that governments are committing extra resources to try and minimise these unintended consequences (Ebrahim and Lakay, 2020).…”

“…Alongside this, there are ongoing challenges with available financial and human resources across Africa (Craven et al, 2020;Glied and Levy, 2020;Jayaram et al, 2020;Shepherd and van der Mark, 2020) including more limited availability of healthcare personnel and hospital beds including intensive care unit (ICU) beds (Murthy et al, 2015;Bates et al, 2018;Godman et al, 2019;El-Sadr and Justman, 2020;Godman et al, 2020c;Godman et al, 2020d;Martinez-Alvarez et al, 2020;United Nations, 2020b). Reports suggest there were just 1.8 hospital beds per 1,000 people across Africa before the pandemic, less than a third of those in France (Bavier, 2020).…”

“…However, we need to be mindful of a range of healthcare issues including the unintended consequences on both health and socioeconomic circumstances. This builds on Table 3, as well as Tables 3A and 4A, for individual African countries combined with recommendations for all key stakeholder groups in Africa going forward in the management of both infectious and non-infectious diseases as well as clinical and economic issues surrounding fixed dose combinations (Godman et al, 2019;Godman et al, 2020a;Godman et al, 2020b;Godman et al, 2020c;Godman et al, 2020d).…”

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

“…We combined the data collected with the experience of the co-authors regarding issues of health policy, health, pharmaceutical care, and self-purchasing in LMICs, to provide future direction, building on comments from the interviewees. We have successfully used this approach before to provide future direction [143][144][145][146][147][148] . The findings on the purchasing patterns, issues of shortages, and price changes will be compiled into tabular format.…”