Single Pill Combinations for Hypertension: A Cost-Effective and Effective Treatment Strategy

A recent Australian study published in the Journal of Hypertension highlights the significant benefits of using single pill combinations (SPCs) for managing hypertension. The research, led by The George Institute for Global Health with support from Lund University, analyzed 57 SPCs listed under Australia's Pharmaceutical Benefits Scheme (PBS). The findings indicate that SPCs not only provide effective blood pressure control but also lead to considerable cost savings for both patients and the government.

The study revealed that SPCs are generally less expensive than prescribing multiple separate medications at comparable doses, with an average savings of 30% for patients before reaching the PBS safety net. For government expenditure, savings were particularly notable among Concession Card holders, with reductions of up to 26%. International guidelines strongly recommend initiating hypertension treatment with SPCs, as they improve patient adherence, reduce treatment inertia, enhance blood pressure management, and lower the risk of cardiovascular events. Despite this, current PBS restrictions in Australia prevent clinicians from prescribing SPCs as the initial therapy, even though most SPCs are available in affordable generic forms.

Hypertension remains a major health issue in Australia, affecting 34% of adults—about 6.8 million people—of whom half are unaware of their condition. Only 32% of those diagnosed manage to keep their blood pressure within a healthy range, lagging behind countries like Canada. Uncontrolled hypertension significantly increases the risk of serious health problems, including heart attacks, strokes, kidney disease, and cognitive decline. A 25% reduction in prevalence could save approximately 37,000 lives annually.

The study emphasizes the urgent need for policy updates to allow SPCs as first-line therapy. Researchers advocate for changes in the PBS criteria and drug labeling to align with international standards, which could improve health outcomes, reduce costs, and support national health priorities. Professor Alta Schutte, a co-author, underscores the importance of policy reform, stating that current restrictions hinder optimal care and represent a missed opportunity to save lives and resources.

In addition to advocating for policy change, the study calls for the updating of clinical guidelines by Australian health authorities, including the Heart Foundation and Hypertension Australia, to promote the use of dual combination therapies. Addressing treatment inertia—where clinicians delay medication adjustments—could greatly increase the proportion of well-controlled hypertensive patients. Ultimately, adopting SPCs as standard first-line treatment, supported by policy and practice changes, could significantly improve health outcomes and reduce costs across the Australian healthcare system.

For more details, the full study is available in the Journal of Hypertension. The findings reinforce international evidence that SPCs are a safe, effective, and economical approach to hypertension management, underscoring the need for Australia to implement these best practices for better patient and public health outcomes.