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*A13* *A13* 04.07.2024 14:59

Use of fixed-dose combinations for cardiovascular indications from 2018 to 2023: a nationwide population-based study
F. Götzinger¹, M. Kieble², A. Espinosa Daudí², M. Kunz¹, L. Lauder¹, M. Böhm³, U. Laufs⁴, F. Mahfoud¹, M. Schulz^5
1Abt. für Kardiologie, Universitätsspital Basel, Basel, CH; ²Deutsches Arzneiprüfungsinstitut e.V., Berlin; ³Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar; ⁴Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig; ⁵GB Arzneimittel, ABDA-Bundesvereinigung Deutscher Apothekerverbände e. V., Berlin;

Aims  
Clinical guidelines support the use of fixed-dose combinations (FDC) for prevention of cardiovascular disease. Implementation of FDC into clinical care remains challenging, and current population-based data are scarce.

Methods and results
Claims data on dispensed drugs in an outpatient care setting of approximately 87% of the German population were analysed regarding the use of FDC according to time, age of the insured persons, and active ingredients. The overarching trend for all FDC revealed a decrease from 77.3 defined daily doses per 1,000 statutory health-insured (SHI) persons per day (DID) in the second half-year of 2018 (2018HY02) to 60.8 DID in the first half-year of 2023 (2023HY01) (Spearman ρ = -0.988; P < 0.001). The total DID for all antihypertensives (AHT) increased from 590.6 in 2018HY02 to 624.8 in 2023HY01 (ρ = 0.855; P = 0.002), but the DID for fixed-dose AHT (AHT-FDC) declined from 74.1 in 2018HY02 to 55.0 in 2023HY01 (ρ = -0.988; P < 0.001). Conversely, the use of all lipid-lowering agents (LLA) and LLA-FDC continuously increased: The total DID of all LLA rose from 92.5 in 2018HY02 to 134.4 in 2023HY01 (ρ = 1.000; P = 0.000), and for LLA-FDC from 3.1 in 2018HY02 to 5.5 DID in 2023HY01 (ρ = 0.915; P < 0.001). AHT-FDC and LLA-FDC were less frequently dispensed to patients ≥80 years than to patients <80 years. Dispensing of multiple purpose FDC increased from 2018HY02 to 2023HY01 from 0.11 DID to 0.26 DID (ρ = 1.000; P = 0.000) but remained negligible.

Conclusion
Use of AHT-FDC in Germany is declining. In contrast, FDC containing LLA are increasingly prescribed. Dispensing of multiple purpose FDC is very low. Strategies are needed to facilitate the use of FDC as recommended by current guidelines.

Figure

Dispensing trends of cardiovascular fixed-dose combinations by type at the expense of the Statutory Health Insurance from July 2018 to June 2023.

AHT, antihypertensives; DID, defined daily doses per 1,000 statutory health-insured persons (inhabitants) per day; FDC, fixed-dose combinations; HCT, hydrochlorothiazide; HY, half-year; LLA, lipid-lowering agent; polypills, multiple purpose FDC.