Association Between Fixed-Dose Combination Use and Medication Adherence, Health Care Utilization, and Costs Among Medicaid Beneficiaries

作者：Donglan Zhang, Jun Soo Lee, Nicole L. Therrien, Lisa M. Pollack, Sandra L. Jackson, Xiaobei Dong, Anand Rajan, Kai Hong, Andrew E. Moran, Feijun Luo · 发表于：JACC Advances · 年份：2025 · DOI：10.1016/j.jacadv.2025.102091 · 被引用次数：4 · 研究领域：Medication Adherence and Compliance、Pharmaceutical Economics and Policy、Complementary and Alternative Medicine Studies

BACKGROUND: Fixed-dose combination (FDC) antihypertensives combine two or more agents. Compared with non-FDC antihypertensives of multiple classes (multi-pill therapy), combination-pill therapy using FDC antihypertensives may improve hypertension control. However, combination-pill therapy remains low. OBJECTIVES: This study aims to assess: 1) the association between combination-pill therapy and medication adherence, health care utilization, and costs; and 2) the potential to mitigate racial and ethnic differences in medication adherence. METHODS: A retrospective cohort analysis was conducted using the 2017-2021 Merative MarketScan Medicaid database. The study sample included adults aged 18 to 64 years with hypertension, continuously enrolled 1 year before and after a random index date of prescription. The propensity score overlap weighting method was used to balance characteristics between individuals using combination- and multi-pill therapy. Logistic models were used for medication adherence (defined as medication possession ratio [MPR] ≥80%), linear models for continuous MPRs, negative binomial models for health care utilization, and generalized linear models for costs. RESULTS: Compared with multi-pill therapy, combination-pill therapy was associated with higher medication adherence (3.17 in MPR; 95% CI: 2.79-3.55), fewer hypertension-related emergency department visits (220 per 1,000 individuals; 95% CI: -235 to -204), fewer hospitalizations (153 per 1,000 individuals, 9...