Study of price variation among the different brands of anti-tubercular drugs available in India

Abstract

Background: India is one of the largest Tuberculosis (TB) burden countries in the world. Although Revised National Tuberculosis Control Programme provides free cost of therapy, sometimes patient get treated by private practioners. This can sometimes lead to irregular course of treatment due to decreased patient compliance. This in turn may lead to multi drug resistance among TB bacilli. One of the reasons for decreased patient compliance is cost of therapy. The present study was undertaken to evaluate the cost of therapy of various anti-TB drugs and their combinations available in India.Methods: The maximum and minimum cost in rupees (INR) of all anti-TB drugs manufactured by various pharmaceutical companies was noted. The cost of 10 tablets/capsules or their fixed dose combinations (FDCs) was calculated. The cost ratio and percentage price variation were calculated for each brand and compared.Results: Percentage variation in cost of oral anti-TB drugs marketed in India was highest in ethambutol 400mg (474.51), cycloserine 250mg (384.61), ethambutol 800mg (321.84) and rifampin 450mg (258.45). The lowest percentage cost variation was seen with pyrazinamide 225mg (10.04), ethambutol 1000mg (18.82) and rifampin 100mg (22.78). Among the FDCs lowest percentage cost variation seen with rifampin 150mg +isoniazid 75mg+pyrazinamide 400mg (0.16) and highest percentage cost variation is seen with rifampin 450mg+isoniazid 300mg+pyrazinamide 750mg+ethambutol 800mg (232.73).Conclusions: There is a significant variation in the cost of different brands of oral anti-TB drugs and their FDCs available in India. The National Pharmaceutical Pricing Authority (NPPA) should take more proactive steps for bringing down the prices of first line anti-TB drugs and the clinicians prescribing them should be aware of the price variation among the various brands of anti-TB drugs available in India.