OBJECTIVES: Fixed-dose combinations (FDCs) are expected to simplify therapy and improve adherence in managing type 2 diabetes mellitus (T2DM) by combining multiple medications into a single pill. In Europe, metformin-based FDCs are commonly used and tailored to individual patient needs. The most common combinations include metformin with dipeptidyl peptidase-4 inhibitors or sodium-glucose cotransporter-2 inhibitors. This study aims to explore how FDCs are valued relative to their mono-components, by investigating the correlation between price changes of FDCs for T2DM vs. the sum of the mono-components (1+1) and the subsequent market share dynamics in the EU4 and the UK from 2018 to 2022.

METHODS: Four FDCs consisting of metformin + dapagliflozin (A), sitagliptin (B), vildagliptin (C) and sitagliptin (D) were analyzed. The price differential and price evolution between the FDCs with 1+1, and the relationship between these pricing factors and market share trends from 2018 to 2022 were examined to determine the perceived value of each FDC.

RESULTS: The pricing and market dynamics of FDCs for T2DM vary discreetly across European countries. The average price difference in 2022 between the FDC and the 1+1 for FDC-A was -35% (68% to 1%), for FDC-B -18% (-51% to 4%), for FDC-C (-51% to -24%), and for FDC-D -8% (-21% to -3%). FDC-A gained market share in all five countries regardless of price difference vs. the 1+1. FDC-C and D lost market share in 4 out of 5 countries even though they were always cheaper than the 1+1. FDC-B lost market share in every country despite being cheaper than the 1+1 in three out of five countries.

CONCLUSIONS: The moderate market share of 3 out of 4 FDCs between 2018 to 2022, indicates that among physicians there might be a low awareness of the benefits of improving adherence and simplified therapy with price also playing a role.