SUMMARY
Fixed-dose combination products vs Single-component products – Cost comparison of selected oral anti-diabetic products

Introduction:
Fixed-dose combination products (FDCs) are drugs which contain two or more drugs in fixed proportions in the same formulation. Fixed-dose combinations are becoming increasingly important because they offer several advantages to the patients. General advantages include lower costs of manufacture, improved patient adherence and decreased distribution costs. Advantages like increased efficacy and increased safety may be possible with certain cases. Combinations are being used in the treatment of various conditions and are specifically useful in the management of HIV, Malaria, Tuberculosis, diabetes and hypertension to name few. A few irrational combinations came to the market place due to certain loopholes existed in the drug regulatory system in India. Certain steps have been taken by Drugs Controller General of India to stop such irrational combinations. However, still the debate is on between the manufacturers and drug regulatory authorities.

Objective:
It is a general belief among the prescribers and other stakeholders of healthcare that FDCs are less costly than their single-component products. However, it cannot be generalised to all FDCs. The present study was taken up with an objective to find out FDCs which are costlier than their single-component counterparts. For which certain oral anti-diabetic drugs were selected and studied.

Methodology:
Data was collected from Current Index of Medical Specialities (CIMS). Data regarding the prices of oral anti-diabetic drugs like Glibenclamide, Gliclazide, Glimepiride, Glipizide, Pioglitazone individually and in combination with Metformin were tabulated and analysed. The prices of the above mentioned drugs were cross checked with other drug indices and also in the pharmacy.

Results and Discussion:
Table 1. Name of the drug (Dose) | Price of Single-component products in Rs. Per 10 Tablets | Price of Fixed-dose combination in Rs. Per 10 tablets | Glibenclamide (5mg) | 3.60 | 24.40 | Metformin (500mg) | 6.25 | | Gliclazide (40mg) | 14.00 | 59.00 | Metformin (500mg) | 6.25 | | Glimepiride (2mg) | 22.00 | 47.20 | Metformin (500mg) | 6.25 | | Glipizide (10mg) | 4.74 | 14.30 | Metformin (500mg) | 6.25 | | Pioglitazone (15mg) | 13.00 | 37.50 | Metformin (500mg) | 6.25 | | It is clearly evident from the above table (Table 1.) that FDCs are priced higher than their single-component counterparts. There were certain examples where FDCs are more than double the cost of their single-component products individually. However, there are several brands of FDCs which less costly than their single-component counterparts. Hence, it cannot be generalised that all FDCs are less costly than their single-component products.

Conclusion:
FDCs provide several advantages over their single-component products. However, it is generally believed by practitioners that FDCs are less costly than their single-component products. The drugs mentioned in the study clearly show the cost difference between FDCs and their single-component products. There are many reasons why certain FDCs are more costly than that of their singe-component products. Prescribers should be aware of certain FDC brands which are costly when especially prescribed taking into account the cost benefit to the patient.

References:
1. Fixed dose combinations. World Health Organization. Available form: http://apps.who.int/prequal/info_applicants/Guidelines/info_for_applicants_guidelines_fdcs.htm. (Accessed on 1/08/11)
2. Current Index of Medical Specialities, 2011. CMPMedia India Private Limited.