scholarly journals Rational use and cost variation analysis of antitussive-expectorants available in the Indian market: a pharmacoeconomic study

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):  
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):  
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):  
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):  
Akash Chandra ◽  
Manish Kumar ◽  
Lalit Kumar ◽  
Harihar Dikshit

Background: In now days proton pump inhibitors are prescribing more and more by Indian physicians not only in peptic ulcer,gastroesophageal reflux disease, gastritis but also along with non steroidal anti-inflammatory drugs to overcome the side effects as gastric irritation and discomfort by non steroidal anti inflammatory drugs.There are many brands of PPI drugs available in Indian market. 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 associated with decreased adherence to prescription medication.Hence this study was done to assess the cost variation of proton pump inhibitors [PPI] drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets/capsules was calculated in case of oral drug and the cost of one 1 vial or ampoule was noted in case of injectable drug. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for proton pump inhibitors marketed in india was found to be tablet/capsule Esomeprazole [20mg]:141.17, tablet/capsule Esomeprazole [40mg]:196.29, capsule/tablet Omeprazole[20mg]: 569.53, Tablet/capsule Pantoprazole[40mg]: 248.8, tablet /capsule Rabeprazole[20mg]: 815.78, capsule/tablet Lansoprazole[30mg]: 173.33, Inj. Esomeprazole [40mg] 1 vial: 81.81, Inj. Omeprazole[40mg] 1vial: 47.95, Inj. Pantoprazole[40mg] 1vial: 66.66, Inj.Rabeprazole [20mg] 1vial: 176.625.Conclusions: Tablet Rabeprazole[20mg] shows highest cost ratio and percentage cost variation as 9.15 and 815.78. While Inj. Omeprazole[40mg] 1 vial shows lowest cost ratio and percentage cost variation as 1.47 and 47.95.


Author(s):  
Dinesh Prasad Sinha ◽  
Bhuwaneshwari Sinha ◽  
Santosh Kumar ◽  
Akash Chandra

Background: Fluoroquinolone eye drops is being prescribed by Opthalmologist in many ocular diseases as conjunctivitis, keratitis, bacterial corneal ulcers etc in more and more amount. There are many brands of fluoroquinolones drugs available in Indian market. Costly drugs can lead to economic burden on patients. Modifications in pharmaceutical policy are required, and prices of the drug should be controlled in effective way for all the drugs. Hence this study was done to assess the cost variation of fluoroquinolones opthalmic solutions available in Indian market.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2020 edition and Drug Today April to June 2020 volume 1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of each eye drop was calculated. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for fluoroquinolones eye preparations marketed in India was found to be Eye drop Ciprofloxacin (0.3%) of 5 ml:210.39, Eye drop Ciprofloxacin (0.3%) of 10 ml:162, Eye drop Gatifloxacin (0.3%) of 5 ml:156, Eye drop Moxifloxacin (0.5%) of 5 ml:196.95, Eye drop Ofloxacin (0.3%) of 5 ml:245.16, Eye drop Ofloxacin (0.3%) of 10 ml:62.5, Eye drop Norfloxacin (0.3%) of 5 ml:120.68, Eye drop Sparfloxacin (0.3%):8.31, Eye drop Lomefloxacin (0.3%):16.17.Conclusions: There is a wide difference in the cost of different brands of fluoroquinolones eye preparations available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.


Author(s):  
Sushma V. Naidu ◽  
Vibha Rani

Background: Osteoporosis is a chronic disease leading to weakened and porous bones which increases the risk of fractures. It is a treatable condition using drugs like bisphosphonates. There is wide variation in the cost among various brands of bisphosphonates in the Indian market, so the objective of the study was to analyse cost of different brands of bisphosphonates.Methods: Cost of both oral and injectable bisphosphonates in the same strength and dosage forms was obtained from CIMS India (January-April 2019). For oral form of the drug, price was calculated per 10 tablets, for injectable form the price per ampoule or vial was calculated and cost ratio, percentage of cost variation was calculated.Results: 15 different formulations of bisphosphonates were analyzed and it was found that cost ratio is found to be highest with 60 mg of pamidronate injection and lowest with 10 mg alendronate tablet, also pamidronate 60 mg injection has highest percentage of cost variation (9632%) and lowest cost variation is seen with 10 mg alendronate (35%). Cost ratio of 11 formulations was found to be very high which was >2 while percentage of cost variation of 11 formulations was found to be more 100.Conclusions: This study concludes that there is wide variation in cost of various brands of bisphosphonates in India. The huge price variation creates unnecessary burden leading on the patients resulting in noncompliance which increases the risk of morbidity and mortality. Therefore, there is an urgent need to regulate the cost of various formulations of bisphosphonates which will reduce the financial burden on the patients.


Author(s):  
Prasan R. Bhandari ◽  
Apeksha Bhandary

Background: There are numerous brands of antimalarial existent in the market. Expensive drugs could result in financial drain that causes reduced compliance or even non-compliance. Non-adherence to therapy could consequently cause partial treatment that leads to higher morbidity and in certain cases mortality too. Thus this evaluation was conducted to measure the cost disparity of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in Indian rupee rate was noted by using the latest edition of current index of medical specialities. The cost ratio and the percentage cost variation for individual drug brands were calculated.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Chloroquine DS 500 mg showed the highest cost ratio and cost variation (cost ratio=15.3 and % cost variation=1434). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents.Conclusions: The maximum variation shown by oral antimalarial was found to be for chloroquine DS 500 tablet. 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):  
VIBHA RANI ◽  
SAILAXMI VENEPALLY

Objectives: The objectives of the study are to evaluate the cost variation and cost ratio of different brands of the drugs used in the treatment of benign prostatic hyperplasia (BPH). Methods: The cost of alpha-blockers and 5 alpha-reductase inhibitors used in the treatment of BPH was noted from CIMS (Oct 2019–Jan 2020), Drugs Update, and Medline. The differences between the maximum and minimum cost of various brands of the same drug were analyzed and percentage variation in the cost was calculated. The results of the study were expressed in absolute numbers and percentages. Results: All the drugs used in the treatment of BPH are only available in tablet and capsule forms, in 10 different dosages and in 242 different brand names, of which 10 mg alfuzosin and 2.5 mg finasteride have the highest (518) and lowest (14) percentage of cost variation, while 0.4 mg tablet form of tamsulosin is available in the maximum number of brands-41. Conclusion: This pharmacoeconomic study reveals that there is wide variation in the cost of most of the drugs used in the treatment of BPH. Therefore, it is very much essential for both government and pharmaceutical companies to make combined efforts to reduce the cost of these drugs, which will reduce the economic burden on the patients and also reduce the overall health care costs.


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