Cost Variation Analysis of Biological Agents (bDMARDs) Used in the Treatment of Rheumatoid Arthritis in the Indian Market

IntroductionCardiovascular diseases (CVDs) have become one of the major causes of mortality among the Indian population. The costs of anticoagulant, antiplatelet, and fibrinolytic drugs that are used to treat various thromboembolic disorders and used as prophylactics for individuals at high risk of CVDs vary widely in the Indian pharmaceutical market. The aim of this study was to evaluate the cost variation of different brands of drug formulations and to compare the branded prices of the formulations with their corresponding generic and ceiling prices.Materials and methodsThis study followed an analytical method. Costs of various drugs were obtained from the October - December 2019 edition of the Current Index of Medical Specialities (CIMS) and December 2019 edition of the Monthly Index of Medical Specialities (MIMS) India. Cost ratio and percentage variation in cost per tablet/capsule/injection of different drugs available in the Indian market and manufactured by different pharmaceutical companies were calculated. Comparison of the branded prices with generic and ceiling prices was also performed for different drugs by using information available from official websites.ResultsPercentage variation in cost among the commonly prescribed drugs for the management of thromboembolic disorders was found to be highest for prasugrel 10 mg tablet (1,408.44%) while it was lowest for fondaparinux 2.5 mg / 0.5 ml injection (20%). Among the commonly prescribed drugs that are under Drugs Prices Control Order (DPCO) price control, streptokinase 1.5 MIU injection had the highest cost variation (132.02%) while enoxaparin 60 mg / 0.6 ml injection had the lowest (4.99%). Among some of the important formulations under the Jan Aushadhi scheme (JAS), acenocoumarol 2 mg tablet had the highest cost variation (680.09%) and cilostazol 50 mg tablet had the lowest (55.46%).ConclusionsWide differences exist in the costs of various anticoagulants, antiplatelets, and fibrinolytics available in the Indian market. The prescribing physician should be aware of theses variations and prescribe medicines accordingly, keeping in mind the financial status of the patients.

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

Introduction: Proton pump inhibitors (PPIs) effectively suppress acid secretion and play an essential role in peptic ulcer disease and gastroesophageal reflux disease. There is a genuine concern about overutilizing PPIs, leading to significantly high costs and undesirable outcomes. An increase in the patient medication cost was associated with decreased adherence to prescription medication. Hence, this study assessed the cost variation of proton pump inhibitors (PPI) drugs.
 Methods: The cost of different brands of commonly used PPIs was sorted out by referring latest “Monthly Index of Medical Specialties” October – December 2021, and 1mg online pharmacy. The cost of 10 dosage forms (Tablets/capsules) in INR of each brand, Cost Ratio, and Percentage Cost Variation for individual drug brands was calculated in the case of an oral drug, and the cost of one vial or ampoule was noted in the case of injectable drug. At last, the cost ratio and percentage cost variation of various brands was compared.
 Results: The data analysis showed a significant variation in the costs of different brands of proton pump inhibitors available In the Indian market. Percentage variation in cost for oral preparations of proton pump inhibitors marketed in India was found to be tablet/capsule Rabeprazole 20mg (1540%), Omeprazole 20 mg(718.18%), Pantoprazole 40mg (504.16%), Esomeprazole 20mg (173.68%), Lansoprazole 15 mg (84.90 %), Omeprazole 40 mg (60.34%) and with injectable preparations IVR abeprazole 20mg (1090.90%), Omeprazole 40 mg (347.36%), Esomeprazole 40mg (216.66%), Pantoprazole 20mg (164.44 %), Pantoprazole 40mg (51.16%).
 Conclusion: There is a wide variation in the prices of proton pump inhibitors available in the market. Regulatory authorities, pharma companies, and physicians should maximize their efforts to reduce the cost of drugsThe need to search for reliable process indicators for the effectiveness of anti-diabetic therapy has been expressed in the literature. Process indicators have been described as essential processes that contribute to achieving outcomes

Background: Cardiovascular diseases (CVDs) emerging as a leading cause of mortality in India, access to affordable medications is crucial for managing these conditions. Our study examined the significant cost variations among different brands of cardiovascular drugs available in the Indian market. The study was conducted to find out the cost variation in the cardiovascular drugs available in India and to evaluate the difference in cost of various brands of the same by calculating percentage of variation in cost. Methods: The analytical study was carried out by taking the cost of a particular drug in the same dosage forms and strength being manufactured by different companies was obtained from July-October 2024 edition of the current index of medical specialities (CIMS) and July-October 2024 edition of monthly index of medical specialties (MIMS) and percentage cost variation was calculated. Results: Our analysis revealed a wide price variation among various drug brands of cardiovascular drugs. Furosemide 40 mg tablet has shown the highest price variation (1572.86%), while least price variation is seen in hydrochlorothiazide 25 mg tablet (3.98%). Conclusions: Prices of various drugs used in the treatment of cardiovascular drugs show a wide variation in the Indian market. Medication adherence, community health, and the financial burden of healthcare costs on the country would all be improved by lowering price variation and making drugs more affordable. The findings highlight the urgency of implementing measures to reduce price variations and improve affordability, thereby enhancing healthcare access and mitigating the financial burden on individuals and society. However, it’s important to note the study’s limitations, including the selection of only a subset of drug brands available in CIMS and MIMS for analysis.

Physicians often face challenges in prescribing the most economical anti-cancer drugs due to a lack of comprehensive, up-to-date comparative information on drug costs. To analyze the variation in cost percentage among various brands of anti-cancer drugs available in the Indian market, this study is designed. For analysis of the costs of the anti-cancer drugs a Pharma Sahi Daam from March 2021 to September 2021 was used to collect study data. For every drug calculation was done to find the difference between the maximum and minimum costs. Similarly, it also done for cost ratio and variation of cost percentage. Among anti-cancer drugs, drug with highest cost is Bevacizumab 400 mg injection; 117625 and drug with lowest cost is temozolomide 20 mg, 100 mg, 250 mg capsule; 0.25. Among anticancer drugs cost ratio is highest for temozolomide (20 mg/100 mg/250 mg Capsule; 8407.192 and cost ratio is lowest for Bleomycin 15 IU injection; 1.002. Among anti-cancer drugs cost variation is highest for Temozolomide 20 mg/100 mg/250 mg capsule; 840619.2 and cost variation is lowest for Fulvestrant 250 mg injection; 40.3318. This study shows among anti-cancer drugs there is a high variation in prices, cost ratio and cost variation. Study may helpful for understanding price variation among anti-cancer drugs. It may useful to doctors to get knowledge regarding the variations of cost among drugs to choose prices which will be cheap to patient. Key words: Cancer, anti-cancer drugs, pharma Sahi Daam, cost variation, cost ratio

Background: Proton-pump inhibitors (PPIs) are among the most prescribed drugs for acid-related gastrointestinal disorders. Various guidelines are available for the clinical use of PPIs; however, their non-judicious use has been reported. PPIs combined with other agents as fixed-dose combinations (FDCs) are available but there is an acute lack of data about cost incurred on their use. This is important since health-care expenditure in India is borne primarily by patients. Aim and Objective: This study aims to evaluate the cost of FDCs of PPIs of different brands and to analyze the price variation among those available in the Indian market. Materials and Methods: An observational, analytical study was carried out in which price of FDCs of PPI in INR manufactured by different Indian pharmaceutical companies was obtained from CIMS (July–September 2020) and IDR (August 2020). Percentage variation and cost ratio were calculated. Results: A total of 842 brands of six PPIs in various FDC were evaluated. Maximum percentage variation in cost and maximum cost ratio was found for rabeprazole + domperidone (20 mg + 30 mg), that is, 633.33% and 7.3, respectively, while minimum percentage variation in cost and minimum cost ratio was found for ilaprazole + domperidone (10 mg+30 mg), that is, 30.30% and 1.3, respectively. Conclusion: This study showed wide variation in prices of FDCs of PPIs available in Indian market. There should be combined efforts from the government and pharmaceutical companies to reduce such a price variation so the prescribing physician can provide maximum benefits to patients.

Background: India being the world’s largest supplier of generic drugs provides 50% of the drugs globally. Selective Serotonin Reuptake Inhibitors (SSRI) (hereafter referred to as SSRI) is the most commonly prescribed drugs for depression (prevalence of 5.25%) and Anxiety (prevalence of 5.8%). The cost of these drugs influences the patient compliance with treatment and thereby the clinical outcome significantly. Aim and Objectives: The aim of the study was to analyze the cost-variation of SSRIs available in the Indian market. Materials and Methods: Maximum and minimum costs of various SSRIs used in the treatment of depression and anxiety were obtained from the monthly index of medical specialties (November 2020) online, Jan Aushadhi Sugam App (Generic drugs), and National Pharmaceutical Pricing Authority online. The cost of various SSRI being manufactured by different companies in the same strength and dosage form were compared. Cost ratio (Maximum cost/Minimum cost) and percentage cost variation ([{Max cost–Min cost}/Min cost] × 100) in INR (₹) were calculated. Data were analyzed and represented using descriptive statistics. Results: Percentage cost variation was maximum with Fluoxetine 20 mg (3477.85%), followed by Sertraline 50 mg (1631.61%) and Escitalopram 10 mg (1288.89%). Percentage cost variation was minimum with Vilazodone 40 mg (16.31%). Conclusion: This study provides awareness about cost variation among different brands of SSRI used in the treatment of depression and anxiety. Wide variation can cause dissatisfaction, poor compliance, and economic burden among patients. It strengthens the usage of generic drugs among general population and healthcare providers.

In 2011, the Agency for Health Care Research and Quality (AHRQ) published a systematic review on the comparative effectiveness of disease-modifying anti-rheumatic drugs (DMARDs) used to treat adults with rheumatoid arthritis (RA). The publication was an update to a 2007 report. A total of 258 published articles were used in the AHRQ review to compare the effectiveness of corticosteroids, and oral and biologic DMARDs in the treatment of RA. Head-to-head studies and prospective cohort trials were used to compare one drug to another in determining efficacy and effectiveness. AHRQ compiled this report in an attempt to summarize and integrate the available data for clinicians to make evidence based practice decisions for their patients since there is limited consensus among the medical community regarding the comparative effectiveness of drugs used to treat RA. The report reveals there is still much research to be done concerning the side effects of these agents and their influence in different patient subgroups. To: (a) utilize review findings to make diagnostic and treatment management decisions in clinical practice, (b) inform clinicians on the findings from the updated AHRQ's 2011 comparative effectiveness review on drug therapy for RA in adults, and (c) identify shortcomings in the current research and future directions revealed by the report. Rheumatoid arthritis is a major public health burden. The 2011 updated AHRQ report includes several new medications approved by the FDA since 2007. The review includes 31 head-to-head randomized clinical trials (RCTs), 1 head-to-head nonrandomized controlled trial, 44 placebo controlled trials, 28 meta-analyses or systematic reviews, and 107 observational studies. Most of the studies used for the comparative analysis are of fair quality with an insufficient to moderate strength of evidence assigned to the findings (Table 1). A mixed treatment comparisons (MTC)meta-analysis from the AHRQ report found that the biologic etanercept has a higher probability of improvement in disease activity compared with other biologic DMARDs, but the MTC findings have a low strength of evidence and caution is recommended in the interpretation of this weak evidence. For patients with early RA, limited evidence precludes conclusions about the superiority of one combination therapy versus another. The data are also inconclusive for comparisons of therapeutic similarity among oral DMARDs including the limitation created by differences inmethotrexate (MTX) dosing across trials. Extensive clinical experience over the years support the preferred use of MTX in most patients versus other oral DMARDs as well as its use in multidrug regimens, whereas there is little data on the use of oral DMARDs in combination with biologic agents. The review does not support a specific biologic DMARD over another due to the lack of head-to-head trials comparing these agents using validated RA outcome measures. The data show that the majority of biologics have approximately the same efficacy except for anakinra, which was found to be less effective. The biologic and oral DMARDs are similar in overall tolerability, but several studies suggest that adverse events are more common with biologic DMARDs versus oral DMARDs. Based on limited evidence, the oral DMARDs do not appear to have an increased risk of severe adverse events including cardiovascular events and cancer. Although most studies also found no increased risk of cardiovascular events or cancer with the biologic DMARDs, cohort studies show an increased risk of heart failure with adalimumab, etanercept, and infliximab compared with oral DMARDs. The updated AHRQ review synthesizes the current literature on therapies used for the treatment of RA in adults. The investigators are also able to identify pertinent research gaps in the literature that can be addressed with future research.

Background: Coronary artery disease is one of the most prevalent causes of death and disability in developed and developing countries. There is a wide variation in the prices of oral antiplatelet drugs marketed in India. Thus, a study was planned to find out the variation in cost in the oral antiplatelet drugs available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiplatelet drug by calculating percentage variation in cost. Methods: Cost of oral antiplatelet drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “current index of medical specialties” October 2015-January 2016. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost per 10 tablets was calculated. Results: Percentage variation in cost for oral antiplatelet drugs marketed in India was found to be-clopidogrel 75 mg (1067.3%), clopidogrel 150 mg tablet (148.7%), prasugrel 5 mg (94.4%), aspirin 150 mg (69.8%), prasugrel 10 mg (54.8%), aspirin 75 mg (51.5%), clopidogrel 300 mg tablet (42.9%) and ticlopidine 250 mg (32%). The lowest percent cost variation found is ticagrelor 90 mg (0%). In combination therapy the highest price variation (235.6%) was found for aspirin (75 mg)+clopidogrel (75 mg) followed by aspirin (150 mg)+clopidogrel (75 mg) (24.2%). Conclusions: There is a wide difference in the cost of different brands of oral antiplatelet drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.

Rheumatoid arthritis (RA) affects an estimated 1.3 million Americans and is a complex inflammatory disease associated with synovitis and joint destruction. The development of biologic disease-modifying anti-rheumatic drugs (DMARDs) that target specific mediators of inflammation has led to several highly successful therapies for the treatment of RA. The imperfect efficacy of biologic DMARDs has resulted in the absence of clear guidelines on how biologic DMARDs should be used in the clinic to optimize treatment of RA patients. This makes it imperative that better data be available to physicians and RA patients about the comparative effectiveness of different biologic DMARDs. Prior to 2008, there were no randomized trials comparing biologic DMARDs for the treatment of RA. Since then, there have been published studies that directly compared biologic DMARDs for the treatment of RA, and several studies that estimated the relative efficacy of different biologic DMARDs by comparing published results of studies that included treatment of RA patients with biologic DMARDs who had previously experienced an inadequate response to methotrexate or tumor necrosis factor (TNF) antagonists. There are two recent studies that directly compared biologic DMARDs with optimal combinations of oral DMARDs and these are important because there are significant differences in costs and side effects between oral and biologic DMARDs. Among the studies that directly compared biologic DMARDs, it has been reported that RA patients who fail a TNF antagonist have a higher response rate (based on disease activity score [DAS28] measurements) to treatment with rituximab as compared with another TNF antagonist. In addition, in the ATTEST trial, the investigators found that, for RA patients with an inadequate response to methotrexate, treatment with abatacept versus infliximab resulted in response rates that were roughly equal. There are also several head-to-head studies of biologic DMARDs that are currently enrolling or about to enroll RA subjects. Pharmaceutical companies have taken more interest in comparative effectiveness studies, in part due to the emphasis that has been placed on this type of research by the US federal government and associated organizations including the Patient-Centered Outcomes Research Institute (PCORI). Therefore, while there is currently a relative lack of comparative effectiveness research to inform clinical decisions about biologic DMARDs for RA patients, it appears likely that there will be wider availability of such data in the near future.

Background: AIDS is one of the most prevalent causes of death due to infectious origin which requires a lifelong therapy. There is variation in prices of antiretroviral drugs available in Indian market. Thus, a study was planned to find out variation in prices of antiretroviral drugs either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiretroviral drugs by calculating percentage variation in cost in Indian rupees. Methods: Cost of antiretroviral drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” Vol. XXI, Issue No. 4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost was calculated. Results: Percentage variation in cost for antiretroviral drugs marketed in India was found to be zidovudine (100 mg) - 436%, lamivudine (100 mg) - 268%, tenofovir (300 mg) - 149.5%, didanosine (250 mg) - 73.75%, indinavir (400 mg) - 35.26%. Among the combination therapy, price variation was lamivudine + zidovudine (150 + 300 mg) - 314%, lamivudine + stavudine (150 + 40 mg) - 105%, lopinavir + ritonavir (133.3 + 33 mg) - 25%. Conclusion: There is wide variation in the prices of antiretroviral agents available in the market. Regulatory authorities, pharma companies, physicians should maximize their efforts to reduce the cost of drugs.

Introduction: Proton pump inhibitors (PPIs) effectively suppress acid secretion and play an important role a lot of gastrointestinal disorders. PPIs are generally used long term by the patients. This can cause an increase in patient cost and subsequent decrease in adherence to the prescription. Hence, this study was done to assess the cost variation of PPIs. Methods: The cost of different brands of commonly used PPIs (10 capsules/tablets for oral drugs and one ampoule/vial for injectable drugs) was tabulated by referring to the “Monthly Index of Medical Specialties” October – December 2021, and 1mg online pharmacy. The cost ratio and percentage cost variation for various brands of a particular strength and dosage form was calculated and compared. Cost ratio >2 and cost variation >100% was considered significant. Results: The results showed a huge variation in costs of different brands with the highest being Rabeprazole 20mg (Cost ratio-16.4, Percentage cost variation-1540%) in oral formulation and Rabeprazole 20mg (11.9, 1090%) in the injectable formulation. Among oral drugs, Omeprazole 40mg has the lowest cost ratio and percentage cost variation (1.60, 60.34%) and Pantoprazole 40mg (1.51, 51.16%) in case of injectable formulations. Conclusion: There is a wide variation in the prices of PPIs available in the market. Huge demand for the commonly orally prescribed drugs like Omeprazole 20mg and Pantoprazole 40mg could be the reason for the high cost. Among injectable preparations, Pantoprazole 40mg is the most commonly prescribed but it has an acceptable cost ratio which is a positive sign.

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.

Aim: Analysis of the percentage price differences among the widely prescribed antihypertensive drugs available on the Indian retail market and under the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana (PMBJP) or the Jan Aushadhi scheme. Materials and Methods: The prices of frequently prescribed various antihypertensive brands were collected and organized by using latest Monthly Index of Medical Specialties. The price of 1 dosage form in INR of each brand was extracted. Based on the price of various brands, average price of each drug was calculated and compared with the price of PMBJP drugs. Additionally, literature review was performed to place the results in perspective. Results: The prices of prescribed antihypertensive medicines were analyzed and compared with PMBJP drugs. In monotherapy, Metoprolol 25 mg showed a maximum price difference of 89.08%; in combination therapy, Ramipril 5 mg plus Hydrochlorothiazide 12.5 mg indicates maximum price difference of 90.76%. In addition, Telmisartan 40 mg demonstrate 88.59%, Ramipril 5 mg plus Hydrochlorothiazide 12.5 mg demonstrate 90.76%, Ramipril 5 mg plus Hydrochlorothiazide 12.5 mg and Amlodipine 5 mg indicates 90.38% price variation in one treatment course based on the grading of hypertension. Further, on literature review 11 relevant articles were found which were consistent with the results of this study. Conclusion: The results of our study show huge differences between the prices of PMBJP drugs and branded drugs available in India. It suggests that moving towards PMBJP drugs may lessen the financial strain on the patients and their caregivers. The prescriber should make an informed decision and choose the cheaper antihypertensive drugs to lessen the financial burden on the patient leading to maximum patient adherence.

Background: Coronary artery disease (CAD) is one of the most common causes of cardiovascular mortality and morbidity in developing countries like India. Initial management includes use of many antianginal drugs. There is wide variation in market prices of these drugs. This study was planned to analyse the percentage variation in prices amongst monotherapy and combination therapy of antianginal drugs manufactured and sold under different brand names in Indian market. Methods: Price of antianginal drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties (CIMS)” January-April 2016 and “Indian Drug Review (IDR)” Vol. XXII, Issue No.1, 2016. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price per 10 tablets was calculated. Results: Percentage variation in price for antianginal drugs marketed in India was found to be amlodipine (5 mg) 1128.57% followed by amlodipine (10 mg) 1040% and amlodipine (2.5 mg) 780% as a monotherapy. Whereas atenolol (25 mg), atenolol (50 mg) and nicorandil (10 mg) also showed significant percentage variation in prices 525%, 426.66% and 350.84% respectively. For combination therapy, percentage variation in prices were seen with amlodipine + atenolol (5 + 50 mg) 700%, followed by atenolol + hydrochlorothiazide (50 + 12.5 mg) 362.5% and Isosorbide dinitrate + aspirin (5 + 75 mg) 300%. Conclusions: There is a wide variation in the price of different brands of antianginal drugs available in India. The clinicians prescribing these drugs should be aware of these variations to reduce the financial burden of drug therapy.