P046 FIRST-LINE TREATMENT OF HYPERTENSION WITH SINGLE PILL COMBINATIONS: A SIMPLE STRATEGY TO SAVE COSTS FOR THE PATIENT AND GOVERNMENT

Background: Single pill combinations (SPCs) of blood pressure (BP) lowering medicines contribute to improved BP control by reducing treatment inertia and improving medication adherence. But high out-of-pocket payments reduce adherence. We compared the costs for SPCs and free-drug combinations for the patient and government in Australia. Methods: We reviewed the “Pharmaceutical Benefits Scheme item drug map” to identify all BP lowering SPCs, their free-drug combinations, and their costs in March 2024. We reviewed costs before and after reaching the “Safety Net” – a threshold where people access medicines at lower rates, differing for general patients and Concession Card holders (typically pensioners or low paid workers). We also calculated the total cost per mmHg systolic BP (SBP) reduction based on a mean reduction of 9, 16 and 23 mmHg for treatment with one, two or three drugs at standard dose. The main outcome measures were the total costs for patients and the government in Australian Dollars. Results: For patients, SPCs always cost less than free drugs with the greatest savings for general patients before reaching the safety net, averaging 30%. For the government SPCs cost less than free drugs for Concession Card holders both before (11%) and after reaching the safety net (26%) and in general patients after the safety net (11%). There was a slight increase in costs (16%) for the government for patients before reaching the safety net. The mean cost per mmHg SBP reduction was 27% lower in SPCs compared to free drugs. Dual SPCs cost little more than monotherapy but provide a much lower cost per mmHg SBP reduction. Conclusion: In Australia, SPCs, instead of free-drug combinations, result in cost savings, for both patient and government. These are the direct costs, and do not factor in the expected benefits from improved adherence and BP control. The large cost savings of SPCs should be considered when prescribing multiple separate pills or starting treatment.