scholarly journals A pharmacoeconomic study of different brands of commonly prescribed antihypertensive drugs

Author(s):  
Pooja C. Upasani ◽  
Rohidas M. Barve ◽  
Rajesh S. Hiray

Background: The hypertension is the most common chronic disease, therefore treatment should be affordable. The antihypertensive drugs of same strength are available in market at different costs. This study was undertaken to create awareness among health care workers and patients, about cost difference among different brands of same antihypertensive drug. So that whenever possible, a cheaper effective brand can be prescribed to ensure better patient adherence.Methods: Maximum retail price (MRP) of various antihypertensive drugs of same strength, manufactured by different pharmaceutical companies was obtained from various offline and online sources. The minimum and maximum cost of 10 tablets/capsules noted. The cost ratio and percentage cost variation was calculated for single drug and fixed dose combinations. The ceiling price (as per DPCO) of essential antihypertensives (as per national list of essential medicines) was compared with their maximum cost.Results: The formulations of single antihypertensive drugs (41) and fixed dose combinations of two drugs (19) and three drugs (9) were included in the study. Among the single antihypertensives analyzed the highest cost difference was of eplerenone (50 mg) and high cost ratio and cost variation percentage was of amlodipine (5 mg). Among fixed dose combination of two drugs analyzed highest cost difference was found that of hydrochlorothazide (12.5 mg)+olmesartan (40 mg) combination and highest cost ratio and percentage cost variation was of amlodipine (5 mg)+telmisartan (40 mg).Conclusions: There was a huge price variation among the antihypertensive drugs manufactured by various companies. Some measures must be taken by the government to bring the uniformity in the price that will help to reduce the economic burden on the patients.

Author(s):  
Kajal S. Gupta ◽  
Milind L. Pardeshi ◽  
Rajesh S. Hiray

Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary lifestyle, the incidence of DM is increasing. The chronic nature of DM causes significant personal suffering and economic difficulty to families. The was aimed at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various pharmaceutical companies were obtained from current index of medical specialties (CIMS) website, Indian drug review (IDR) 2021 issue and National pharmaceutical pricing authority-pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, metformin 500 mg sustained release showed highest price variation (3668%). Minimum cost variation was found with glipizide 2.5 mg (65%). Amongst the fixed dose combinations, highest cost variation was seen with glimepiride 2 mg+metformin 1000 mg (2703%) while minimum cost variation was found with repaglinide 1 mg+voglibose 0.3 mg (29%).Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all.Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands   Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands   Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands         


Author(s):  
Ajay Kumar Shukla ◽  
Astha Agnihotri

Background: Indian drug market has large numbers of branded formulations for every drug molecule. 1 Cost-sensitive healthcare environment has created a challenging workplace for clinicians. Efficient use of healthcare resources without compromising quality of patient care has been a challenging task for healthcare professionals. There is a wide range of variation in the prices of drugs marketed in India. Thus, a study was planned to analyse out cost variations of antiepileptic drugs available in Indian market.Methods: Minimum and maximum costs in Rupees (INR) of different brands of same generic antipsychotic drugs, in the same strength and dosage forms were compared. The cost ratio and percentage cost variation were calculated for each generic antipsychotic drug. The number of formulations for antipsychotic drugs and number of brands for each of them were also taken into consideration.Results: This study shows that in Indian market, there are wide variations in the prices of different brands of same generic antipsychotic drug. The highest cost ratio and percent cost variation was found for risperidone 2 mg [(1:16.27) and 1527.48], followed by risperidone 4 mg [(1:16.25) and 1525.25], risperidone 3 mg [(1:15.67) and 1467.33], risperidone 1 mg [(1:14.86) and 1386.78], olanzapine 10 mg [(1:12.36) and 1136.84], and olanzapine 5 mg [(1:12.31) and 1130.76]. Highest number of brands of antipsychotic drug available in Indian market are for divalproex sodium 500mg(25) followed by olanzapine 15 mg(23), olanzapine 5 mg(23), olanzapine 2.5mg(14), and risperidone 1 mg (14). Highest numbers of formulations of antipsychotic drug available in Indian market are for olanzapine(06), quetiapine(05), haloperidol(05), and aripiprazole(05).Conclusions: In Indian market, the average percentage price variation of different brands of the same oral antipsychotic drugs is very wide. Treatment with antipsychotic drugs usually has a long course with treatment adherence being a crucial factor for successful treatment. Improved adherence to the drug treatment can be ensured by decreasing the cost of therapy. Decreased drug cost expenditure can be ensured by changes in the government policies and regulations, integrating pharmacoeconomics as part of medical education curriculum, and creating awareness among treating physicians for switching to cost effective therapy.


Author(s):  
Shakeel Ahmad Mir

Background: Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. Globally, the overall prevalence of hypertension in adults aged 25 and over was around 40% in 2008.Despite its benefits, treatment of hypertension is costly. Direct medical spending to treat hypertension totalled $42.9 billion in 2010, with almost half ($20.4 billion) in the form of prescription medications. Being, a silent disease, adherence to antihypertensive drugs is poor. One of the important factors of poor adherence to antihypertensives is the cost of the drugs. There is wide cost variation among different brands of the same antihypertensive drug. Clinician’s awareness of cost of therapeutics is poor. The costly brand of same generic drug is proved to be in no way superior to its economically cheaper counterpart.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antihypertensive agent manufactured by various pharmaceutical companies in the same strength were noted. The cost of 10 tablets/capsules was calculated. The cost ratio and percent cost variation were calculated for each brand.Results: The cost variation observed in the present study was as high as 2337.50 % for Hydralazine. Other significantly high cost variations found in the present study were: 1315.25% (Telmisartan+Hydrochlorthiazide), 870.58% (Amlopdipine), 558.34% (Amlodipine+Atenolol), 537.68% (Valsartan), 394.44% (Metoprolol), 344.44% (Enalapril), 316.22% (Propranolol), 300% (Lisinopril), 290.90% (Carvedilol), 289% (Cilnidipine), 271.99% ( Labetolol), 268.04% (Indapamide), 256.31% (Losartan), 255.19% (Irbesartan), 226% (Methyldopa), 223.04% (Frusemide), 209.78% (Nitrendepine), 192.08% (Terazosin), 189.25% (Atenolol), 142.42% (Bisoprolol) and 120.51% (Felodipine).Conclusions: Financial constraints are a reality in almost all aspects of medicine. Doctors must consider drug costs to their patients. Increasing pharmaceutical costs negatively impacts patients. Given the increasing healthcare costs, there is growing interest in rational prescribing, which takes costs of medication into account.


Author(s):  
Shreenivas P. R. ◽  
S. Nagaraja Prasad

Background: India is one of the largest Tuberculosis (TB) burden countries in the world. Although Revised National Tuberculosis Control Programme provides free cost of therapy, sometimes patient get treated by private practioners. This can sometimes lead to irregular course of treatment due to decreased patient compliance. This in turn may lead to multi drug resistance among TB bacilli. One of the reasons for decreased patient compliance is cost of therapy. The present study was undertaken to evaluate the cost of therapy of various anti-TB drugs and their combinations available in India.Methods: The maximum and minimum cost in rupees (INR) of all anti-TB drugs manufactured by various pharmaceutical companies was noted. The cost of 10 tablets/capsules or their fixed dose combinations (FDCs) was calculated. The cost ratio and percentage price variation were calculated for each brand and compared.Results: Percentage variation in cost of oral anti-TB drugs marketed in India was highest in ethambutol 400mg (474.51), cycloserine 250mg (384.61), ethambutol 800mg (321.84) and rifampin 450mg (258.45). The lowest percentage cost variation was seen with pyrazinamide 225mg (10.04), ethambutol 1000mg (18.82) and rifampin 100mg (22.78). Among the FDCs lowest percentage cost variation seen with rifampin 150mg +isoniazid 75mg+pyrazinamide 400mg (0.16) and highest percentage cost variation is seen with rifampin 450mg+isoniazid 300mg+pyrazinamide 750mg+ethambutol 800mg (232.73).Conclusions: There is a significant variation in the cost of different brands of oral anti-TB drugs and their FDCs available in India. The National Pharmaceutical Pricing Authority (NPPA) should take more proactive steps for bringing down the prices of first line anti-TB drugs and the clinicians prescribing them should be aware of the price variation among the various brands of anti-TB drugs available in India.


Author(s):  
Lalit Kumar ◽  
Jyoti Kumar Dinkar ◽  
Lalit Mohan ◽  
Harihar Dikshit

Background: Malaria has been a problem in India for centuries. There are innumerable brands of antimalarial present in the market. Malaria can be extremely fatal if not treated promptly. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non-compliance leads to incomplete treatment which tends to increase morbidity. Increase in the patient medication cost was found to be associated with decreased adherence to prescription medication. Hence this study was done to assess the cost variation of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2017 edition and Drug Today January to March 2017, Vol 2. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets was calculated in case of oral drug and the cost of 1 ampoule or vial was noted in case of injectable drug. At last the cost ratio and % cost variation of various brands was compared.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Artemether injection showed the highest cost ratio and cost variation (cost ratio = 16.96 and % cost variation = 1596). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents. Chloroquine which is one of the most used antimalarial showed very low values for cost variation and cost ratio.Conclusions: The analysis showed that there is not much significant price variation among oral antimalarial drugs. The maximum variation shown by oral antimalarial was found to be for fixed dose combination of Artemether and Lumefantrine [cost ratio>2 (2.03) and % price variation >100 (103.7)]. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment.


Author(s):  
Prashant Wadagbalkar ◽  
Poonam Patel ◽  
Swati V. Raipurkar

Background: Cardiovascular diseases are the most prevalent cause of death and disability in developed and developing countries. There is a wide variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out variation in cost in the ACE Inhibitors available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same ACE Inhibitors and ARBs by calculating percentage variation in cost in Indian rupees.Methods: Minimum and maximum costs in rupees (INR) of antihypertensive agents manufactured by different companies, in the same strength and dosage forms were obtained from “current index of medical specialties” January April 2016 and Drug Today October-December 2016. The cost ratio and percentage cost variation were calculated for each generic antihypertensive agent (ACE Inhibitors and ARBs).Results: This study shows that there is a wide variation in the prices of different brands of same ACE Inhibitors and ARBs in Indian market.Highest cost variation 400% is for Lisinopril (2.5mg), followed by Enalapril (10mg) 394.16%, Telmisartan (20mg) 322.22%.Conclusions: There is a wide difference in the cost of different brands of ACE Inhibitors and ARBs available in India. They have important role in management of hypertension particularly if associated with other morbidities like diabetes. The clinicians prescribing these drugs should be aware of these variations in cost so as to reduce the cost of drug therapy and increase the patient adherence to the therapy.


Author(s):  
Pramod Kumar Manjhi ◽  
Sunil Kumar Singh ◽  
Chakrapani Kumar ◽  
Akhilesh Kumar Rana

Background: Antitussive-expectorants are among the most frequently prescribed drugs by physicians in clinical practice. Upper respiratory tract infections, such as common cold, acute pharyngitis and acute trachea-bronchitis, are the most common of all communicable diseases and significantly increase OPD burden. This study aimed to assess the rational use, cost ratio, and percentage cost variations in different brands of the commonly prescribed antitussive-expectorants available in the Indian market.Methods: The cost of antitussive-expectorant manufactured by different pharmaceutical companies was obtained by using drug today Jan-April 2021 vol 2. The maximum and minimum price was noted down, cost ratio and percentage cost variation of the individual formulation were analysed.  Results: Analysis of cost ratio and percentage cost variation for each formulation of the antitussive-expectorants drug, syrup (100 ml) chlorpheniramine (2 mg), dextromethorphan (10 mg), phenylephrine (5 mg) combinations show the highest cost ratio and percentage cost variation as 5.30 and 430.25 respectively, and syrup (100 ml) dextromethorphan (10 mg), guaifenesin (100 mg), phenylephrine (25 mg), chlorpheniramine (4 mg) combinations show lowest cost ratio and percentage cost variation as 1.17 and 17.69 respectively.Conclusions: There was a wide variation in the cost of different brands of antitussive-expectorant drugs available in the Indian market. So, clinicians should be aware of rational use and variations in cost to reduce the treatment cost and increase patient compliance.


Author(s):  
Manju K. Nair ◽  
Neha M. S.

Background: Several brands of antihypertensive drugs are available in the Indian market with huge price variations. This study was undertaken to find out the percentage cost variation and cost ratio of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation.Methods: Costs of different brands of renin angiotensin aldosterone axis modulatory drugs with antihypertensive action for the same dosage form and strength were found out using current index of medical specialties-134, July-October 2016. The maximum and minimum price of different brands of each drug was noted. Data was entered in Microsoft excel 2010. Percentage cost variation and cost ratio was calculated for each drug.Results: 16 antihypertensive drugs were analysed. Most of them were tablets. Ramipril and Valsartan were available as capsules also. Among tablets, percentage cost variation was highest for Atenolol 12.5 mg (683.93%) and least for Bisoprolol 2.5 mg (3.6538%). Valsartan capsules (160 mg) had no difference in the costs between the available 2 brands. Cost ratio ranged from 1.04 to 7.84 among the tablet form of drugs.Conclusions: There is a huge difference in the cost of antihypertensive drugs manufactured by different companies in the same strength and dosage form. To promote rational drug use and cost effective therapy, it is essential to create an awareness among clinicians regarding the availability of multiple brands for these drugs and the discrepancies in their costs.


Author(s):  
S. Nagaraja Prasad ◽  
Vedavathi H.

Background: Schizophrenia is a disorder of relatively high point prevalence, low incidence and high disability. It accounts for nearly 1.5-3% of total national expenditure on health care. There is a gross variation in the cost of various branded and generic versions of antipsychotics available in India. This can lead to decreased patient compliance. The present study was undertaken to highlight this variation in the cost of various preparations of antipsychotics (branded and generic) available in India.Methods: Cost ratio and Percentage variation in cost of various antipsychotics available were calculated by standard formulae and analysed.Results: There is a very high variation in the cost of various antipsychotics available in India. The highest variation in cost ratio was seen with risperidone 2mg, 3mg and olanzapine 10mg, while the highest percentage cost variation was seen with risperidone 3mg, 4mg, 1mg; olanzapine 2.5mg, 5mg, 50mg, 100mg; levosulpiride 25mg and chlorpromazine 20mg. The lowest percentage cost variation was seen with Flupenthixol 3mg and Amisulpiride 300mg.Conclusions: There is a definite need to further strengthen the Drug Price Regulatory Mechanisms with regard to antipsychotics available in India in order to improve the patient compliance and thus cure rates of this burdensome and costly illness.


Author(s):  
Mayur B Phulpagare ◽  
Smita A Tiwari ◽  
Rajesh S Hiray

Introduction: Poor drug compliance affects clinical outcome and increases healthcare costs in various disease setting. Several type II diabetes mellitus patients, not controlled on oral hypoglycaemics eventually require insulin therapy. Antidiabetic treatment is to be taken lifelong and in such a setting insulin price variation imposes a huge economic burden on poor diabetic patients. Moderating drug cost is associated with improved adherence to the medication regimen. Aim: To study the variation in cost amongst various brands of insulin analogues. Materials and Methods: This was an observational, cross-sectional study. Data regarding the 116 formulations and cost of 18 types of insulin preparations was collected from sources like Current Index of Medical Specialties (CIMS), National Pharmaceutical Pricing Authority (NPPA), Government of India official website (https://nppaimis.nic.in/nppaprice/pharmasahidaamweb.aspx) and compared with its lowest counterpart. The cost ratio and percentage cost variation was analysed and expressed as percentages. Results: This study showed a noticeable variation in the prices of insulin analogues. The highest percentage of cost variation was found for Insulin (Highly Purified) Zinc-40 IU (135.17%), followed by Insulin (Analogue) Glargine-100 IU (109.31%). The lowest percentage were for: Insulin (Human-Isophane Recombinant)-40 IU (1.40%), and Insulin (Analogue) Aspart- 100 IU (6.26%). Conclusion: A noticeable variation in cost prices was observed especially in commonly used intermediate acting insulin that help basal glycaemic control. Similarly, the lowest variation was observed with recombinant counterparts as an effect of pre-existing high prices of each. Need for vital medication like insulin at affordable costs has incited national and global efforts to make it cheaper and accessible to maximum beneficiaries.


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