T H E B U S I N E S S O F D I A B E T E S Combination Medications in Diabetes Care: An Steven B. Leichter, MD, FACP, FACE, and Stephanie Thomas, CRC During the past few years,new improve patient adherence to treatment scription that is cheaper than the sum of rate medications. At present, these prod- journal Diabetes Care suggests that, in areas related to diabetes: diabetes itself, Combination Drugs and Patient
lipidemia, and hypertension (Table 1).
diabetic patients do not have a reduction Adherence
scribed. If true, this eliminates one pos- evaluation of combination medications.
Patients with these conditions often take less patients adhere to the full treatment entail high daily costs for prescriptions.
drugs that have already been marketed.
In all cases thus far, providers have had Table 1. Newer Combination Products for the Treatment of Diabetes,
Lipidemia, and Hypertension*
ence with both of the combined drugs assingle agents, as well as moderate expe- Product Brand Name
Marketing Company**
resistant cases. Clearly, a primary motivefor developing and marketing the combi- extend the patent life and profitability of to create a new market for an agent thatwould perform better than the single- ucts seem understandable, the benefitsof these combination agents for patients *Established combinations of diuretics and anti-hypertensive agents were excluded from thisanalysis.
**In some cases, the marketing company and the manufacturer are not the same.
detail. One possibility, that these drugs CLINICAL DIABETES • Volume 21, Number 4, 2003 T H E B U S I N E S S O F D I A B E T E S Cost Advantages of Combination
recent study in diabetic patients claimed therapy is a complex task. There are dif- Adherence to oral medication
findings were based on subjective report- regimens in diabetic patients
ing by diabetic patients during telephone sumers in any given geographical area.
on actual pill counts, arguably a stronger ent to their drug treatment regimens over Effects of combination medications
lyzed is the effect of a change in formu- on adherence
Surprisingly few studies are available on increase overall provider prescribing for poor adherence. A British study of statin relates to consumers, health plans, or the specifically pertains to the costs of med- betes, health plans often prefer the first 81% reduction in reported side effects.
of side effects patients might be expect- adherence in the treatment of diabetes or ing literature suggests that the reduction treatment of these conditions are includ- reduces patient adherence to treatment in treatment of all of these conditions.
Volume 21, Number 4, 2003 • CLINICAL DIABETES T H E B U S I N E S S O F D I A B E T E S evidence suggests that diabetic patients, individual agent. Prices were assessed at cost savings to patients with prescription medications eliminate one copayment.
tion agents cost the same or less than the formin, rosiglitazone, and a sulfonylurea might take a total of eight pills per day if ications on a higher copayment “tier” prescribed. In contrast, the total number of pills taken per day could be halved if Clinical Application of Combination
tatin and generic niacin, or with generic fication of the treatment regimen. By our betic patients than the literature current- purchase of generic lovastatin and gener- References
cost of being a diabetic patient: variables for physician prescribing behavior. Clin Diabetes18:42–44, 2000 2Grant RW, Devita NG, Singer DE, Meigs JB: Table 2. Cost of Combination Medications Versus Individual Constituents*
Polypharmacy and medication adherence inpatients with type 2 diabetes. Diabetes Care26:1408–1412, 2003 Product Brand Name
Cost/30 Doses ($)
Cost/30 Doses ($)**
ance in patients with chronic disease: issues in dialysis and renal transplantation. Am J ManCare 9:155–171, 2003 Kroenke K, Pinholt EM: Reducing polyphar- macy in the elderly: a controlled trial of physician feedback. J Am Geriatr Soc 39:103–105, 1991 channel blockers in hypertension. Adv Intern Med 6Patel RP, Taylor SD: Factors affecting med- ication adherence in hypertensive patients. Ann 7Degli Esposito L, Degli Esposito E, Valpiani G, Di Martino M, Saragoni S, Buda S, Baio G, *Based on a survey of four local pharmacies in Columbus, Ga.—two chain pharmacies and Capone A, Sturani A: A retrospective, population- two locally owned pharmacies—and two online pharmacies.
based analysis of persistence with anti-hyperten-sive drug therapy in primary care practice in Italy.
**Represents the sum of the cost of 30 doses of each of the two component medications.
CLINICAL DIABETES • Volume 21, Number 4, 2003 T H E B U S I N E S S O F D I A B E T E S disease hypertension: looking toward the next 17Ramsdell J, Braunstein S, Stephens J, Bell Shah AB, Kim J: Utilization of oral hypo- millenium. Am J Hypertens 11:158S–162S, 1998 C, Botteman M, Devine S: Economic model of glycemic agents in a drug-insured U.S. Popula- first-line drug strategies to achieve recommended 13Blonde L: Management of type 2 diabetes: tion. Diabetes Care 24:1441–1445, 2001 glycaemic control in newly diagnosed type 2 dia- update on new pharmacological options. Manag betes mellitus. Pharmacoeconomics 21:819–837, 9Armitage CR, Parish S, Sleigh P, Peto R: MRC/BHF Heart Protection Study of cholesterol- lowering with simvastatin in 5,963 people with impact of dose frequency on patient compliance.
diabetes: a randomized placebo-controlled study.
Diabetes Care 20:1512–1517, 1997 Steven B. Leichter, MD, FACP, FACE, is Dezii CM: A retrospective study of persist- co-director, and Stephanie Thomas, ence with single pill combination therapy versus naro N, Bergman U: Lack of adherence to lipid concurrent two-pill therapy in patients with CRC, is a licensed practical nurse and lowering drug treatment. Brit J Pharmacol hypertension. Manag Care 9 (Suppl. 9):2–6, 2000 clinical research coordinator at the Sapienze S, Sacco P, Floyd K, DiCesare J, Sica DA: Rationale for fixed dose combina- Doan QD: Results of a pilot pharmacotherapy tions in the treatment of hypertension: the cycle Columbus, Ga. Dr. Leichter is also a quality improvement program using fixed-dose, repeats. Drug Ther 62:443–462, 2002 combination amlodipine/benazapril anti-hyper- professor of medicine at Mercer Univer- 12Bakris GL: The role of combination anti- tensive therapy in a long-term care setting. Clin sity School of Medicine in Macon, Ga. hypertensive therapy and the progression of renal Volume 21, Number 4, 2003 • CLINICAL DIABETES

Source: http://clinical.diabetesjournals.org/content/21/4/175.full.pdf

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