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Journal of Medical Economics

Clinical Articles, Lead Article

Single tablet regimens reduce events

Patients treated with single tablet regimens (STRs) are less likely to experience serious cardiovascular events than those on individual component therapy, according to a study published online recently by the Journal of Medical Economics.1

A retrospective cohort study was carried out using The Health Improvement Network database, comparing 9,929 hypertensive patients on STRs with 18,665 patients on individual component therapy. Data were collected for prescriptions, significant cardiovascular events and out-patient referrals over a minimum follow-up period of 5 years after initiation of therapy. Current NHS costings were applied to the data, to arrive at an estimate of comparative resource use.

There were significantly more cardiovascular events in the individual component group than those treated with a single tablet regimen. Hospital admission costs were lower in the STR group but drug costs were higher. In a UK context this analysis has shown that potential hospital savings broadly offset the additional drug acquisition costs associated with STRs, say the authors, meaning that these agents can be considered cost neutral.

Speaking to BJC Arrhythmia Watch, author Dr Jonathan Belsey said: “It is widely recognised that the one of the biggest barriers to achieving the results seen in trials in normal clinical practice is the problem of poor compliance, as between one half and one third of all medication in long-term disease is not taken as prescribed.2

“Indeed, a recent Cochrane Review concluded that improvement in compliance is likely to have a greater impact on clinical outcomes than any improvements in the medications themselves.3 There is a substantial body of research over a range of disease areas that demonstrates that the use of single dose ‘combination tablets’ is a highly effective way to improve compliance – however in the UK we have been traditionally unwilling to adopt this strategy. Our research shows that the clinical benefits to be gained by the use of single tablet regimens are considerable, without incurring additional costs or clinician input.”

“Although our study was limited to antihypertensives, given that the management of many cardiovascular conditions requires multiple therapies, it seems likely that the lessons learned in this analysis will be equally applicable to many other patient types. Provided that prescribing of combinations is tailored to meet the individual dosing needs of patients, the potential clearly exists for improving compliance – and thereby clinical outcomes – without incurring increased prescribing costs.”


1. JD Belsey. Optimising adherence in hypertension: a comparison of outcomes and costs using single tablet regimens versus individual component regimens. Journal of Medical Economics 2012. doi: 10.3111/13696998.2012.689792

2. Horne R et al. Concordance, adherence and compliance in medicine-taking. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D. 2005.

3. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev2008;CD000011.

Published on: May 24, 2012

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  • ArrhythmiaAlliance
  • Stars
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  • Atrial Fibrillation Association

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