Cost variation analysis of commonly prescribed anti-diabetic drugs available in Indian market: a pharmaco-economic study

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

Analysis of cost of various topical and oral antifungal drugs for superficial fungal infections available in India

Background: In tropical countries like India, superficial fungal infections are quite common and certain infections like tinea is rampantly spreading in epidemic proportions and frequent relapses after treatment have increased the need for long term therapy significantly increasing the cost of treatment, so the treatment of fungal infection can raise economic burden on the patient. The aim of the study was to analyze the cost variation of topical antifungal drugs and oral antifungal drugs of various brands for superficial fungal infection available in India.Methods: Cost in Indian Rupees (INR) of antifungal agents manufactured by different pharmaceutical companies in India was collected from the Current index of medical specialities (CIMS) October to December 2019. Minimum cost, maximum cost, cost ratio, cost variation was calculated.Results: In oral dosage form, fluconazole, Itraconazole show the maximum cost variation. In topical single drug therapy luliconazole, terbinafine show maximum cost variation.Conclusions: There is wide cost variation among antifungal agents available in Indian Market. There is need of strict actions for cost policy regulation and sensitization of doctor for selection of appropriate brand drugs.

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

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.

EP.TH.1046Probing the cost variation in Laparoscopic Cholecystectomy using PLICS

Aims This pilot study followed the introduction of PLICS (Patient-Level Information and Costing Systems) in our trust. Data for for Q2 2018 was probed to understand cost variation in procedures and to plan how to utilize this system. Methods Elective laparoscopic cholecystectomy data was extracted, providing costing for each procedure across a number of domains. We established a system to assess the domains with the most variation. We calculated the coefficient of variation (CV) for each domain. CV > 1 was seen as high variation and these domains were probed further to identify causes. Results Domains identified to be of notable variation (CV > 1) were length of stay, pathology test costs, drugs administered, medical staffing costs and pharmacy costs. Domains such as interest costs and device costs appeared to be arbitrary and directed our feedback on how to improve the system. Conclusion We identified variation of costs due to dispensation of drugs unrelated to laparoscopic cholecystectomy which can be easily addressed. Staffing cost variation provided data to drive theatre utilization strategies. Improvements in data capture such as device costs per procedure are imperative to evaluate and change practice for further cost efficiencies. Key statement PLICS is a powerful system to probe procedure costs, variation and drive efficiency. Our combined clinical and management team collaborated to understand the data. To use PLICS to the best advantage the data must be accurate, truly recorded at the patient level and be subject to regular scrutiny.

Analysis of the variations in price of anti-glaucoma eye preparations available in Indian pharmaceutical market

Background: The aim of the study was to analyze the percentage cost variations among different brands of the commonly prescribed anti–glaucoma 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 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 anti-glaucoma eye preparations marketed in india was found to be eye drop timolol maleate (0.5%) of 5 ml:263.63, eye drop dorzolamide (2%) of 5 ml:9.77, eye drop pilocarpine (2%) of 5 ml:160.40, eye drop Betaxolol (0.5%) of 5 ml:56.54, eye drop Latanoprost (50 mcg/ml) of 2.5ml:135.88, eye drop Brimonidine tartarate (0.15%) of 5 ml:183.9, eye drop Levobunolol (5 mg/ml) of 5 ml:32.38.Conclusions: Glaucoma is the most common ocular disease and eye drops are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.

Cost variation analysis of different brands of oral anti-epileptic drugs available in India

Background: Epilepsy is a group of neurological disorders, characterized by seizures, loss of consciousness, muscular contraction. Prevalence of epilepsy in India is about 1%. High medical care cost should be cause of concern for policy makers and service providers. Hence, a study was planned to analyse cost ratio and percentage cost variations of oral antiepileptic drugs available in India.Methods: An analytical study with maximum and minimum price of 10 tablets/capsules and syrup of one bottle of available strength of each drug was noted in Indian Rupee, using “Current Index of Medical Specialties” July to October 2020; “Drug Today” July To October 2020 volume-1 and “Indian Drug Review” 2020 volume-26 issue 6. Percentage cost variation and cost ratio for individual drugs was compared.Results: Significant cost variations were found in different brands of same drug. Among established oral antiepileptic drugs, Divalproex sodium 250 mg has highest cost ratio 16.071 and 1507.14% price variation and Clonazepam 0.25 mg with cost ratio 16.005 and 1500.55% price variation. Diazepam 2 mg has lowest cost ratio 1.024 and 2.43% price variation. Among newer oral antiepileptic drugs, Levetiracetam 500 mg has highest cost ratio 66.389 and 6538.93% price variation; least is Oxcarbazepine 450 mg with cost ratio 1.317 and 31.75% price variation.Conclusions: Epilepsy has long course of treatment. Increased adherence to treatment is achieved by switching to cost-effective therapy and by making Pharmacoeconomics an integral part of Undergraduate and Postgraduate Curriculum.

A pharmacoeconomic study of different brands of commonly prescribed antihypertensive drugs

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.