Single-Pill vs Free-Equivalent Combination Therapies for Hypertension: A Meta-Analysis of Health Care Costs and Adherence

Beth Sherrill, Michael Halpern, Shahnaz Khan, Jie Zhang, Sumeet Panjabi

Research output: Contribution to journalArticle

102 Scopus citations


This meta-analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single-pill combinations (SPCs) vs free-equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual all-cause and hypertension-related health care costs was $1357 (95% confidence interval [CI], $778-$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC groups was twice as likely as the FEC groups (pooled risk ratio, 2.1; 95% CI, 1.1-4.1). Improved adherence and persistence may have contributed to the lower costs in the SPC groups via improved clinical outcomes.

Original languageEnglish (US)
Pages (from-to)898-909
Number of pages12
JournalJournal of Clinical Hypertension
Issue number12
Publication statusPublished - Dec 2011
Externally publishedYes


ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this