Quantitative analysis, cost comparison, physician, and patient perceptions on generic versus branded clopidogrel bisulfate tablets marketed in Kerala, India

Abstract

Background: Clopidogrel bisulfate is sold in more than 60 advertised brand names (trade names) in the Indian market. Government health sector in India emphasizes on prescribing clopidogrel in its generic form, which refers to the chemical makeup of the drug, rather than to the advertised brand name, to reduce the economic burden. Preference for branded drugs and cost difference with generics are already well established, however physicians are apprehensive regarding the quality of generic drugs and have concerns about their reliability. Objective: We studied perspective of physicians and patients regarding generic versus branded medicines among hospitals in our locality. Cost difference incurred while prescribing various brands and generic clopidogrel tablets were calculated. Percentage purity of generic and branded clopidogrel tablets were analyzed to find if any difference really exists between them. Methodology: Perspective of 150 physicians and patients were studied using questionnaire method. Using ultraviolet spectrophotometer, generic and most commonly prescribed brands of clopidogrel were analyzed for percentage purity. Once analyzed, their costs were compared. Results: Eighty- six percent (n = 129) of physicians and 81% (n = 122) of patients surveyed, preferred branded medicines over generic ones. Among 10 branded clopidogrel tablets, only three complied with the Indian Pharmacopoeia standards of drug percentage purity. Pricing pattern of various brands of clopidogrel ranged from $1.4 to $3.13 per month. Generic clopidogrel tablets are available free of cost for patients from government-run hospitals but did not meet recommended percentage purity standards. Conclusion: Both branded and generic versions of clopidogrel have their merits and demerits. The general notion and doubt regarding difference in quality of generic versus branded version of medicines as evidenced by our perspective evaluation of physician and patients is appropriate in the present scenario. More large scale studies of different cardiovascular drugs are required to ensure their quality. Improved quality of generic medicines has to be ensured prior to marketing in India.