Economic evaluation of generic inhalational bronchodilators from the Jan-Aushadi scheme versus branded alternatives.

Introduction: In India, the costs of cancer drugs are exorbitant and cause significant financial toxicity to the affected patient and their family members. Considering this, Jan Aushadhi pharmacy stores were established across the country by the government of India with the objective of providing cheap generic medicines to patients. The objective of this study was to perform a cost comparison study of generic chemotherapeutic drugs provided through Jan Aushadhi pharmacies versus their branded counterparts. This will help patients and physicians get first-hand information on the cost variation between generic and branded anticancer drugs in India.Materials and Methods: The cost of Jan Aushadhi generic drugs and the cost of the most expensive and cheapest marketed branded drugs for the same molecule and dose were ascertained and presented in both Indian Rupees (INR) and US Dollars (as of July 2021). Finally, the difference in costs in INR, cost ratio, and cost variance were calculated, comparing the price of the Jan Aushadhi generic drugs with the most expensive and the cheapest branded drug in the same category.Results: Compared to branded drugs, all the Jan Ausadhi generic drugs were cheaper, except one (methotrexate). The highest cost difference was observed for docetaxel, while the least was observed for methotrexate tablets (2.5 mg). The highest cost ratio (22.24) and cost variance (3327.56) were observed for doxorubicin injection (50 mg).Conclusion: The current study compares the cost difference between the marketed branded and Jan Aushadhi generic anticancer drugs for the first time. Replacing the costly branded anticancer drugs with Jan Aushadhi generic drugs can result in substantial cost savings. The information obtained from this cost difference analysis will be helpful for the healthcare fraternity, patients, policymakers, and society at large.

Medications and pharmaceutical expenses constitute a significant portion of out-of-pocket health expenditures for households in India, posing a substantial financial burden. The objective of this study was to assess the cost differences among drugs utilized in the treatment of chronic obstructive pulmonary disorder (COPD), specifically comparing those available at Jan Aushadhi pharmacies with various branded drug formulations. In the study, we calculated the cost differences (in Indian Rupees), cost ratios, and cost variations by contrasting the cost of generic Jan Aushadhi medications with the most expensive and least expensive branded medications in the same category. Our study revealed that the price of branded drugs prescribed for obstructive pulmonary conditions was higher than that of generic drugs purchased from Jan Aushadhi pharmacies except in the case of doxophylline 400 mg tablet. The highest cost difference was observed in the combination drug of formoterol 6 mcg + fluticasone propionate 250 mcg inhaler (740 and 290). Cost variance and cost ratio were highest in salbutamol 4 mg tablets (2386%) and (24.86) respectively. Findings indicate that across all classes of drugs investigated, the costs associated with generic drugs in Jan Aushadhi centers were markedly lower than those associated with branded drugs. Medications offered by Jan Aushadhi pharmacies are more cost-effective than their branded equivalents, rendering COPD treatment more accessible and affordable for individuals with limited financial means.

Chemotherapy in an integral part of cancer treatment, either administered alone or in combination with radiation. However, the cost of these drugs is often prohibitively high for most patients. To address this issue, the Government of India has established Jan Aushadhi (JAS) stores across the country, where affordable generic medicines are available. In the current study, we performed a cost minimization analysis comparing JAS drugs with branded chemotherapeutic drugs used in various cancer treatment regimens. This study was to conduct a cost-minimization analysis by comparing the costs of different regimens when using JAS drugs, the most expensive branded drugs, and the least expensive branded drugs in the treatment of cancer in India. The study focused on conducting a cost minimization analysis of various chemotherapy drugs used in the treatment of different cancers, considering the availability of anticancer drugs at JAS stores. The costs for different chemotherapy regimens, including both anticancer and supportive drugs, were calculated for single and complete cycles. The costs of the most expensive and least expensive branded drugs were noted from the Current Index of Medical Stores. The cost difference (CD) was calculated by subtracting the cost of the cheaper drug from that of the costliest brand. The cost ratio (CR) and the percentage of cost variation (PCV) were calculated for India-specific conditions. The study analyzed the CD for various regimens using JAS drugs for chemotherapy treatment of breast, esophagus, rectal, colon, stomach, prostate, ovary, endometrial, cervical, head and neck, lung, multiple myeloma, testicular, and lymphoma cancers. It also considered chemoirradiation regimens for brain, head and neck, anorectal, esophageal, and uterine cervical cancers. Significant CDs were observed when both anticancer and supportive drugs were obtained from JAS stores. To the best of the authors' knowledge, this is the first study to consider the CD, CR, and PCV for various regimens using JAS drugs, as well as the costliest and cheapest branded drugs in standard cancer treatment regimens. The results of this study are expected to assist healthcare professionals and pharmacists in understanding the cost-saving benefits of substituting expensive branded drugs with more affordable chemotherapeutic drugs for the treatment of cancer. This substitution can provide financial benefit for socioeconomically marginalized population.

According to recent studies, head and neck cancers (HNC) make up a substantial proportion of all cancers in India and are proportionately high in the lower socioeconomic people practising tobacco and alcohol. Chemotherapy is a crucial component of treating HNC, and this study was carried out to determine the Cost Minimization Analysis (CMA) by comparing the price of the high and least expensive branded drugs marketed in India. This study was performed to understand the cost difference (CD), Cost ratio (CR) and percentage of cost variation (PCV) of both individual drugs and the standard anticancer regimens. The Current Index of Medical Stores was used to determine the costs of the most and least expensive branded medications and analysed. The results indicated that Paclitaxel-Cisplatin-5 Fluoruracil chemotherapy regimen exhibited the greatest variance in cost, with the Jan Aushadhi brand of medicine costing 8.1 times and 4.3 times less than the most expensive and cheapest branded drugs, respectively. The cost of the concurrent cisplatin regimen with Jan Aushadi Medicine was Rs 1764, Rs 3489.64 with the lowest branded drug, and Rs 8477 with the most expensive branded drug. Also when compared to Jan Aushadhi medication, the cost of Ciplatin was 4.8 times higher with the most expensive branded drug and 2 times higher with the least expensive branded drug. As far as the authors are aware of this is the first study that addresses the pharmacoeconomic appraisal of treating HNC with various chemotherapy and chemoirradiation regimens. This study will help oncologists, pharmacists, and healthcare workers comprehend the financial advantages of treating breast cancer with less expensive chemotherapeutic agents instead of brand-name medications.

Background: Healthcare costs are a major burden on the society of developing countries like India. Countries like India try to limit healthcare costs in support of generic medicine. So, the Indian government initiated the Jan Aushadhi scheme in 2008 to provide high-quality generic medication at a low cost. Aim: The aim of the study was to compare the cost difference between Jan Aushadhi generic pharmaceutical formulations and branded medications in Tamil Nadu. Settings and Design: Pharmaco economic - Cost minimization observational study. Methods and Material: Study Duration: Five months, from February 2023 to June 2023. Study Place: 10 Jan Aushadhi outlets from various districts of Tamil Nadu. Sampling technique: Convenience sampling technique Statistical analysis used: Mean median, mode and Percentage. Results: A total of 729 medications were available in 10 Jan Aushadhi outlets. The Jan Aushadhi outlet has the most cardiovascular medications and the fewest antimalarial medications among different categories of drugs. Erythropoietin has the biggest cost difference between the average cost of branded medications and Jan Aushadhi drug costs, while Digoxin has the lowest cost difference. Antitubercular drugs, Oxytocics, Antileprosy drugs, Antiparkinsonism categories of drugs also delisted in Jan Aushadhi outlet. Conclusions: Compared to branded drugs, Jan Aushadhi's generic drugs are 64.65 % less costly on an average as observed in our study. The manufacturer of Jan Aushadhi shops is a WHO and GMO-certified company, and they manufacture branded drugs. So, there will be no quality compromise in Jan Aushadhi’s generic drugs.

Background: Antimicrobial medications, which are critical for the treatment of infectious diseases, can be prohibitively expensive, especially for the marginalized population. The objective of the present research was to determine cost-minimization analysis (CMA) by comparing Jan Aushadhi (JA) pharmaceuticals marketed in India with the most expensive and least expensive branded alternatives. Materials and Methods: Prices of the most expensive, least expensive branded, and JA medications were obtained from the designated reference sites. The cost difference (CD), cost ratio (CR), and percentage of cost variation (PCV) were calculated in accordance with the guidelines of the cost-minimization study. Results: The cost analysis included 132 drugs/formulations of antimicrobials used as anthelminthic, anti-TB, antibiotic, antifungal, antimalarial, antiprotozoal, antiseptic, and antiviral drugs. Among the antihelminthic medicines, the most expensive albendazole brand was 18.2 times more expensive than JA. The combined formulation of albendazole and ivermectin had a PCV of 67.3% between the costliest and cheapest brands and 280.3% between the costliest and JA brands. Three antitubercular drugs were examined, and the cost variance was low for all medications in the category, with a PCV of 23.5% to 92.6%. Among the 102 antibiotics examined, cefoperazone brand with a PCV of 1497.8 was 16 times pricier than JA. The costliest ciprofloxacin brand cost 11.9 times more than JA. Five antifungals were examined, and itraconazole from JA was 7.8 times cheaper than branded. Among the six antimalarial drugs, artesunate cost 10.1 times more than JA when compared to the more expensive brand. The costliest antiviral drug sofosbuvir cost 4.9 times more than JA. The final analysis suggests that antibiotics had the highest, while antivirals and antiprotozoals had more consistent CD values. Conclusion: The cost-minimization study, which is the first in this field of infectious diseases, indicates the usefulness of JA drugs in reducing financial costs for the patient.

<p style="text-align: justify;"><strong>Introduction:</strong> A generic drug is a pharmaceutical product that is commonly used in place of branded medicine. Generic medications have the same therapeutic effect as their branded counterparts. The utilisation of generic drugs is critical for lowering rising health-care costs, and pharmacy students must have a thorough understanding of generic medications. <strong>Methodology:</strong> The present study was performed to assess the awareness about generic medicines among first-year and fourth-year bachelor of pharmacy students at a college in Coastal Karnataka, India. An awareness questionnaire was prepared and validated, and distributed to the students. Simple descriptive statistics were used to produce frequencies, percentages, and proportions. Microsoft Excel was used to analyze the data. During the study, 200 students were enrolled. 10 questions were asked out of that students&rsquo; answers were validated, and they showed comparatively good knowledge about generic medicines.<strong> Results:</strong> Out of 200 students, 181 students answered that Generic drugs are available in Jan-Aushadi, 183 students think that there is a price variation between generic drugs and branded drugs, 123 students approved that generic medicines are equivalent to branded drugs, 156 students have agreed that there is no difference in the effectiveness of generic drugs and branded drugs, 114 students not agreed that generic drugs have long duration of action than branded drugs, 87 students have the opinion that both branded and generic drugs are made in same manufacturing facilities.<strong> Conclusion:</strong> The study confirmed that fourth-year students had better awareness about generic drugs compared to first-year students. There was a significant gap concerning the knowledge about generic medicines. Studies among pharmacy students in the institution are required. More work is required on how interventions for pharmacy students and the community can result in an increase in the awareness and acceptability of generic medicines. Awareness gaps about the use of generic medicines exist, and they must be corrected through suitable education. Deficiencies were noted, and we have to strengthen learning about generic medicines during the coming years. <p style="text-align: justify;"><strong>Key words:</strong> Generic drugs, Jan-Aushadi, Branded drugs, Awareness, Effectiveness.

Background: Most fungal infections require long-term therapy significantly increasing cost of therapy. High medical care cost should be of concern for policy makers and service providers. Hence, a study was planned to analyze cost ratio and percentage (%) cost variations of antifungal drugs available in India. Aim and Objectives: The aim of the study was to evaluate cost of different brands of antifungal drugs available in India and to analyze cost ratio and cost variations of different brands of antifungal drugs. Materials and Methods: Maximum and minimum price of each drug was noted in Indian Rupee, using “CIMS” April to July 2021; “Drug Today” April to July 2021 Vol - 1 and 2; and “Indian Drug Review” 2021. Percentage cost variation and cost ratio for individual drugs were compared. Results: Among oral antifungal drugs, Terbinafine 250 mg has highest cost ratio 89.071 and 8807.1% price variation. Griseofulvin 250 mg has lowest cost ratio 1.169 and 16.98% price variation. Among parenteral antifungal drugs, Amphotericin B 50 mg has highest cost ratio 17.088 and 1608.83% price variation. Caspofungin (50 and 70 mg) has least cost ratio and % price variation. Among single drug topical preparations, Clotrimazole 1% powder formulation has highest cost ratio and % price variation 22.48 and 2144.89%, respectively. Ketoconazole 2% solution formulation has least cost ratio and % price variation 1.233 and 23.33%, respectively. Conclusions: Long-term antifungal therapy requires patient compliance and thereby increased adherence to treatment which is achieved by switching to cost-effective regimen and by making Pharmacoeconomics an integral part of Undergraduate and Postgraduate Curriculum.

Introduction: In breast cancer care, chemotherapy is an important modality, and this study evaluated the cost-minimization analysis (CMA) considering the price of the most and the least expensive branded drugs by taking body surface area (BSA) relevant to the Indian context. Objectives: The objective of this study was to conduct CMA comparing the costliest and cheapest cytotoxic drugs used to treat breast cancer in India by focusing on the direct comparison of cost. Materials and Methods: The current index of medical stores was used to identify the most and least expensive brand-name medications. Based on this, the cost difference, cost ratio, and percentage variation in cost were calculated for both individual drugs and treatment regimens. The cost of the drugs is presented in both Indian rupees and American dollars. Results: The anthracycline–taxane chemotherapy regimen with four cycles of adriamycin–cyclophosphamide + four cycles of paclitaxel had the biggest cost variation. Using a less expensive brand of trastuzumab instead of the most costly version resulted in an annual cost savings of approximately ₹715,065 ($9,608.51). Similar observations were seen for other regimens. Conclusions: A huge difference in the cost was observed between the costliest and the cheapest brands suggesting a judicious selection can reduce financial toxicity for breast cancer patients.

Background: Dyslipidemic drugs are widely prescribed drugs in atherosclerosis, as it is a chronic illness the long term need of this medication creates a financial burden on the patient, especially with patients of low socioeconomic status. Considering this government of India established Jan Aushadhi medical store with a view to provide cheaper generic medicines, so that a good patient compliance is achieved. Aims and Objectives: The aim of the study was to analyze the cost variation of the dyslipidemic drugs available in Indian market under generic and various brand names manufactured by different pharmaceutical industries. Materials and Methods: This was a cross-sectional study conducted to analyze the cost variation of dyslipidemic drugs available in different formulations in our Indian market. The information on cost of each drug with its dosage and formulation was obtained from “Current index of medical specialties” October. 2021–January. 2022 India and from Jan Aushadhi Price list W.E.F October 2015. Cost ratio and percentage variation among different strength and formulation in dyslipidemic drugs were calculated. Results: The cost difference was highest seen between the minimum cost brand of simvastatin 20 mg tab with its generic drug cost (142.8). Lowest difference between minimum brand cost and generic drug was observed for atorvastatin 10 mg tab (17.48). Conclusion: Knowledge about wide cost difference between branded and Jan Aushadhi dyslipidemic drugs helps clinicians to select budget friendly drugs for patients with low socioeconomic status.

Introduction: Heart failure, a global health concern affecting millions, has varying prevalence, classifications, and treatments. Standard therapy includes ACE inhibitors, beta blockers, and diuretics. Newer options like ARNIs and sinoatrial node modulators are recommended. There is no previous research on cost disparity in heart failure medication in India. The objective of this research, which aims at reducing treatment costs, increasing adherence to therapy and using medicines more carefully, is to assess the differences in cost between various medicinal products. Methods: The maximum and minimum price of each brand of the drugs given in Indian rupees (INR) was noted by using ‘Drug Today’ (January to April 2023, volume II). The cost range, cost ratio, and the percentage cost variation for individual drug brands were calculated. The cost of tablets/capsule was calculated and the cost ratio and percentage cost variation of various brands was compared. Results: After calculation of cost ratio and percentage cost variation for each brands of drug used in the management of Heart failure, tab Propranolol (40 mg) had a maximum percentage cost variation of 678% and a cost ratio of 7.78 while tab Candesartan (8 mg) had a minimum percentage cost variation of 006% and cost ratio of 1.06. Ideally we use the drug which cost ratio less than 2 and percentage cost variation less than 100. Conclusions: There is a wide variation in the price of different brands of drug used in the management of Heart failure available in India. The clinicians prescribing these drugs should be aware of these variations to reduce the financial burden of drug therapy and improve compliance.

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.

Background: While generic drugs and branded drugs are supposed to be bioequivalent, generic drugs have the additional benefit of being available at a lower cost which can be important in patients with chronic diseases such as hypertension. However, there are some concerns among clinicians that generic drugs may not be as effective as the branded counterparts. Hence, there is a need to generate comparative data between the branded and the generic drugs. Aims and Objectives: The objective of the study was to compare the pharmaceutical parameters and costs of four generic antihypertensive drugs with their branded counterparts. Materials and Methods: Four antihypertensive drugs, namely, Ramipril, atenolol, enalapril, and amlodipine were considered for evaluation for which their generic and branded samples were taken. All the drugs were in tablet form. The costs of these drugs were recorded, and various in vitro tests were conducted to assess and compare their characteristics, including disintegration, dissolution, hardness, weight variation, friability, thickness, diameter, and quantitative analysis using high-performance liquid chromatography and ultraviolet spectrophotometry. These tests were done in accordance with the specifications outlined in the Indian pharmacopoeia 2018. Results: All the branded drugs were more expensive than the generic counterparts. Quantitative assay of the generic sample of ramipril tablets showed a lower amount of the active ingredient than the stated value. Apart from the hardness values of the tablets, all the generic and branded samples fell within the specified normal range for most of the other important parameters. Conclusion: Generic antihypertensive tablets, were less costly than their branded counterparts and generally met the specified standards in in vitro testing. However, there were instances of subpar hardness results and a deficiency in the stated drug amount in the generic (less ramipril content in sample). These findings suggest the importance of rigorous quality control measures for generic medications particularly for those formulations liable for degradation.

Background: Dyslipidemia is the most common cause of premature coronary atherosclerosis manifesting as ischemic heart disease. Hyperlipidemia has a major role in the causation of atherosclerosis and atherosclerosis-induced conditions, such as ischemic cerebrovascular disease, coronary heart disease (CHD) and peripheral vascular disease.Methods: The prices of 07 antidyslipidemic drugs, available in 19 different formulations marketed in 260 brands and 03 fixed dose combinations available in 11 different formulations marketed in 75 brands were analyzed. Costs of different brands of a particular generic antidyslipidemic drug being manufactured by different companies, in the same strength and dosage forms were used to calculate cost ratio and percentage cost variation.Results: In this study, it was found that there exists a wide cost variation among the different brands of same antidyslipidemic drugs in Indian market. Among individual antidyslipidemic drugs, highest cost ratio and percent cost variation was found for atorvastatin 20 mg, followed by atorvastatin 10 mg and atorvastatin 5 mg. Among fixed dose combinations for antidyslipidemic drugs, highest cost ratio and percent cost variation was found for atorvastatin 20 mg+fenofibrate 160 mg, followed by atorvastatin 10 mg+ezetimibe 10 mg and atorvastatin 20 mg+ezetimibe 10 mg. Highest number of brands of antidyslipidemic drugs available in Indian market are for atorvastatin 10 mg followed by atorvastatin 20 mg and rosuvastatin 10 mg. Highest number of brands of fixed dose combinations of antidyslipidemic drugs available in Indian market are for atorvastatin 10 mg+ezetimibe 10 mg and atorvastatin 10 mg+fenofibrate 160 mg.Conclusions: In Indian market, there is very wide price variation of different brands of the same generic antidyslipidemic drug. Treatment of dyslipidemia has long course of treatment. For long term adherence to the treatment, cost of a drug plays an important role for successful drug treatment. Various steps are needed to reduce this wide price variation of different brands of the same generic antidyslipidemic drug.

Combination therapy with three classes of drug, antiplatelet, cholesterol and blood pressure lowering treatment markedly reduce the risk of recurrent cardiovascular events in patients with coronary heart disease (CHD). Within each class, generic and branded (patented) drugs are available which have similar efficacy but differ in cost. (i) To assess the extent to which preventive medical drugs are prescribed in patients with CHD and to examine the reasons for drug omissions and (ii) to assess the relative use of branded and generic drugs and the reasons for drug selection. The medication charts and hospital notes of consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) at a large cardiothoracic centre were reviewed over a 3-month period. Interviews with patients, attending cardiologists and general practitioners were undertaken to establish why drugs were and were not prescribed. Among 1008 patients (755 who had PCI and 253 who had CABG) the use of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), beta blockers and calcium channel blockers were, respectively, 97, 98, 81, 76 and 18%. The combination of any 4 classes of drug were used in 65% of patients. Almost all patients who did not receive aspirin or a statin had clinical contraindications and were on alternative drugs. In about 12% of patients without an ACE inhibitor (or ARB) and 7% of patients without a beta blocker, no reason to withhold such treatment was identified. Branded drugs were used in 52% of patients; the most commonly prescribed being atorvastatin in 33%. Clinical reasons for using branded rather than generic drugs were identified in 13% of cases. Our results show a high rate of use of secondary preventive cardiac medications in patients undergoing coronary revascularization procedures, but the use of ACE inhibitors or beta blockers is still overlooked in about 1 in 10 patients. Branded drugs are prescribed in about half of all patients undergoing PCI and CABG, but in almost 90% of cases, a generic equivalent could have been used to achieve similar risk reduction. If our results reflect wider practice, an estimated 11 million pounds a year would be saved by the National Health Service by switching to generic alternative drugs.