Cost-minimization analysis of proton pump inhibitors in India

Abstract

Background: Peptic ulcer disease significantly lowers quality of life. The proton pump inhibitors (PPIs) are the most potent suppressors of gastric acid secretion. Although similar in terms of efficacy and safety, PPIs have important differences in their costs. Prescription of costly brands adversely affects expenditure on health care system by patients. Therefore, we conducted this cost-minimization study of all available PPIs to help doctors in selecting the cheapest available option. Methods: Cost-minimization analysis (CMA) compares the cost of equally effective therapeutic options for the given condition. The cost of all PPIs brands available was collected from CIMS (July 2015) and Drug Today (July 2015). Cost range, cost ratio and mean cost of the generic drug was calculated. Results: 1122 PPI brands are available in India. Pantoprazole is most commonly available with 494 brands and dexrabeprazole has only 6 brands. All the PPIs are available in oral and injectable formulations except ilaprazole and dexrabeprazole which are available in oral formulations only. Omeprazole 20 mg and 40 mg is the cheapest in both oral and injectable form respectively while ilaprazole 10 mg is the costliest amongst all oral formulations and rabeprazole 40 mg is the costliest in injectable preparations. Highest cost ratio for oral PPIs is for omeprazole 20 mg and lowest is for omeprazole 10 mg. This variation is mostly due to large numbers of brands available for omeprazole. Conclusions: Prescription of costly brands adversely affects patient’s economy and thereby health seeking behaviour. Therefore knowledge of the doctor about drug cost and its application in practice would be an added benefit to the patient and society.