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

Brian Godman*, Holly McCabe, Trudy D. Leong, Debjani Mueller, Antony P. Martin, Iris Hoxha, Julius C. Mwita, Godfrey Mutashambara Rwegerera, Amos Massele, Juliana de Oliveira Costa, Renata Cristina Rezende Macedo Do Nascimento, Livia Lovato Pires de Lemos, Konstantin Tachkov, Petya Milushewa, Okwen Patrick, Loveline Lum Niba, Ott Laius, Israel Sefah, Suhaj Abdulsalim, Fatemeh SoleymaniAnastasia N. Guantai, Loice Achieng, Margaret Oluka, Arianit Jakupi, Konstantīns Logviss, Mohamed Azmi Hassali, Dan Kibuule, Francis Kalemeera, Mwangana Mubita, Joseph Fadare, Olayinka O. Ogunleye, Zikria Saleem, Shazhad Hussain, Tomasz Bochenek, Ileana Mardare, Alian A. Alrasheedy, Jurij Furst, Dominik Tomek, Vanda Markovic-Pekovic, Enos M. Rampamba, Abubakr Alfadl, Adefolarin A. Amu, Zinhle Matsebula, Thuy Nguyen Thi Phuong, Binh Nguyen Thanh, Aubrey Chichonyi Kalungia, Trust Zaranyika, Nyasha Masuka, Ioana D. Olaru, Janney Wale, Ruaraidh Hill, Amanj Kurdi, Angela Timoney, Stephen Campbell, Johanna C. Meyer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1-26
Number of pages26
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Issue number1
Publication statusPublished - 2 Jan 2020


  • Fixed dose combinations
  • adherence
  • infectious diseases
  • lower and middle income countries
  • medicines
  • non-communicable diseases
  • pharmacoeconomics


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