Branded Drugs Research Articles

Dissolution rates of various brands of proton pump inhibitors in combination with domperidone: an in vitro study

Background: Drug solubility, bioavailability, and dissolution rates are important in establishing in vivo efficacy. Eight brands of domperidone proton pump inhibitor combination drugs were compared to enable physicians to take an informed decision regarding the dissolution rates of various domperidone-PPI combinations available in the Indian market to allow identification and prescription of the drug with better bioavailability. Methods: The in vitro dissolution rate of a combination of domperidone-PPI drugs was measured using the United States Pharmacopeia dissolution paddle apparatus. Each flask of the dissolving testing apparatus contained one tablet and 900 mL of the media, which was dissolved in pure water with 1% Tween® stored at 37.4°C. At regular intervals, aliquots were removed, filtered, and the amount of drug released was measured. The cumulative drug release was calculated using a standard formula. Results: P04 and P07 had the fastest and the slowest onsets of action, respectively. P01 (Omez DSR) and P08 exhibited the longest and the shortest durations of action, respectively. The P05, P06, and P08 formulations had greater particulate matter than the other formulations. Under in vitro conditions, the bioavailability of Omez DSR was nearly two-fold higher than P07 and five-fold higher than P08. Conclusions: Although P04 exhibited the fastest onset of action, Omez DSR had the longest duration of action, superior bioavailability, and ensured the rapid and continuous release of domperidone. Omez DSR demonstrated superior properties compared with other brands.

Settled: Patent characteristics and litigation outcomes in the pharmaceutical industry

A pharmaceutical company that seeks to produce a generic version of a brand drug before patent expiration can trigger a Paragraph IV litigation. However, generic and brand companies may avoid litigation through settlement, which sometimes involves payment to the generic company to delay generic entry. This behavior would be problematic if the settlement option was used to protect patents with low social value. This study explores the relationship between Paragraph IV litigation characteristics and the probability of a Paragraph IV settlement. Examining Paragraph IV settlements from 2003 to 2020, we find that the number of patents being litigated and the years of remaining market exclusivity are the strongest predictors of settlement. Moreover, we find no statistically significant relationship between active ingredient patents and settlement. This information may be helpful to regulators intending to promote the goals of the Hatch-Waxman Act.

The Comparative Effectiveness between Branded Generic Atorvastatin (Lipostat®) and Authorized Generic Atorvastatin (Xarator®): A Prospective Cohort Study

Background: An authorized generic drug has identical ingredients as the brand-name drug but marketed as a generic version by the innovator company with a lower cost. A branded generic drug is an imitation of the brand-name medication whose patent has expired. The active elements of a branded generic medicine are the same as those of the original drug, however the inactive ingredients may differ. Objective: To assess the effectiveness of the branded generic atorvastatin (Lipostat®), compared to the authorized generic atorvastatin (Xarator®) in decreasing low density lipoprotein cholesterol (LDL-C) levels. Materials and Methods: The present study was a prospective cohort study that included patients who had been taking the authorized generic atorvastatin (Xarator®) 40 mg once daily for at least three months. The authorized generic atorvastatin (Xarator®) was switched to branded generic atorvastatin (Lipostat®) 40 mg once daily for the next three months. Blood chemistry including lipid profile were evaluated before and three months after the transition from Xarator® to Lipostat®. Results: Of the 61 patients, mean age was 67.0±9.9 years, and 45 (73.7%) were male. The two most common comorbidities included coronary artery disease in 80.3% and hypertension in 60.7%. At three months after switching to branded generic atorvastatin, the mean total cholesterol changed from 133.6±28.8 to 130.0±25.8 mg/dL, the triglyceride changed from 123.3±78.3 to 115.6±70.1 mg/dL, and the LDL-C changed from 68.8±24.1 to 65.5±20.3 mg/dL, thus, they were not significantly different compared to the baseline. There were also no significant differences in adverse events between Lipostat® and Xarator®. Conclusion: Branded generic atorvastatin (Lipostat®) is as effective as the authorized generic atorvastatin (Xarator®) in lowering LDL-C levels. Keywords: Atorvastatin; Authorized generic drug; Branded generic atorvastatin; Low-density lipoprotein cholesterol; High-density lipoprotein cholesterol; Statin

Heavy Metal Analysis in Some Common Foods and Drugs Available in Nigeria

Table Sugar, Milo, Antibiotic–Metronidazole, Antimalaria–Artemether & Lumefanthrine are among the most commonly used Foods and Drugs in Nigeria. In this study, analysis of four heavy metals: Cr, Cu, Cd, and Pb were done by FAAS technique in the Food and Drug samples. Cr was detected in the Sugar sample only with mean concentration of 0.295 ppm. Similarly, only the antibiotic–Metronidazole sample had about 0.022 ppm concentration of Cd with none in the other three samples. These concentrations of Cr and Cd in Sugar and Antibiotic were found to be below the maximum permissible limits set by WHO/FAO and NAFDAC. Both Cu and Pb were not detected in any of the samples. This is good information because Pb is potentially toxic. The overall outcome of the study has indicated that the analyzed food and drug brands are safe for utilization.

The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis

BackgroundIn September 2019, the “4 + 7” centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion.MethodA single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured.ResultsAfter the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a “carry-over”.ConclusionsThese findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The “patent cliff” for branded drugs has gradually emerged. Besides, a short-term “spillover effect” of the volume of alternative drugs was observed, requiring special attention and vigilance.

Economic Advantages of Domestic Production of Biosimilar Medicines in Iran

Background: Biosimilars can be considered generic versions of branded biologic medicines. Substituting branded biologic medicines with biosimilars is important to reduce medication costs. In addition to reducing drug costs, the domestic production of biosimilars can provide many other economic benefits. Therefore, this study aimed to investigate the economic benefits of producing biosimilar medicines in Iran.&#x0D; Methods: This study was done in 2021 through 2 qualitative and quantitative steps. In the first step, after literature review, the interview guide was designed and semi-structured interviews with experts continued until reaching the saturation point, after interviewing 9 experts from different fields (imports, production, and policy making). The data were coded and analyzed by thematic analysis using MaxQDA software and the economic benefits of producing the biosimilars in Iran were extracted. In the quantitative step, the price advantage of producing domestic biosimilars was analyzed as one of their most important economic advantages compared to its equivalent in reference countries. In addition, the same comparison was done for the main imported branded medicines.&#x0D; Results: From the experts’ viewpoints, the most important economic effect of the domestic production of biosimilars was the reduction of medication costs through access to lower-priced medicines. The employment of professionals, development of new technologies, expansion of the pharmaceutical market, the reduction of foreign currency outflows, increased affordability and access to drugs, and ultimately the improvement of the health level of the society were the other economic aspects of these medicines. In the quantitative step, after comparing the prices of 23 domestic biosimilars with the prices of the equivalent medicines in reference countries, the prices of 21 medicines were lower than the average prices of equivalent biosimilars and the prices of 18 medicines were even lower than the minimum price of the equivalent biosimilars in the reference countries. In addition, the production of these drugs in the country is indirectly effective in reducing the price of the main branded drugs in the country, so that in the case of imported branded biologic medicines, out of 28 medicines, the prices of 26 medicines were lower than the average prices in the reference countries and the prices of 23 medicines were even lower than the minimum of prices in the reference countries. &#x0D; Conclusion: Based on the results of the study, it was concluded that the domestic production of biosimilar medicines in Iran, in addition to increasing access to biological drugs and promoting public health, provides many economic benefits, including saving drug costs.

Pharmacists’ approach to oncology medicine shortages: results of a cross-sectional survey in Pakistan

ObjectivesThe study estimated the shortages of oncology medicines in Pakistan, their causes, impacts, mitigation strategies, and possible interventions.DesignCross-sectional survey.SettingOncology pharmacists working at 43 oncology settings (out of 80) from five...

Overcoming Barriers to Generic Drug Adoption: Insights from Global Studies

Objective: This review paper aims to provide insights into the awareness of generic drugs among consumers, challenges in the adoption of generic drugs identified in various studies conducted in different countries, and proposed remedies to make generic drugs more available, accessible, and affordable to consumers. Generic drugs, produced and marketed by entities other than the original innovators, are often priced significantly lower than branded drugs. However, patients sometimes exhibit reluctance towards generic versions. This article reviews findings, challenges, and potential solutions recorded in past research from sources like PubMed and Google Scholar. Data: Generic drugs are a vital component of healthcare affordability and accessibility, aligning with the United Nations' Sustainable Development Goals. We explore historical and evolving concepts of generic drugs, challenges posed by patenting, and the overarching issue of catastrophic medical expenditures. Study Selection: This review compiles information from diverse online sources, research articles, and review papers related to generic drugs. Conclusion: While generic drugs are equally effective and more affordable, consumers' awareness and perceptions often present barriers to adoption. Factors such as age, education level, health literacy, income, and trust in prescribers influence willingness to accept generic drugs. Country-specific healthcare policies, prescription regulatory frameworks, and reimbursement mechanisms also affect adoption. Addressing the perception of generic drugs, increasing knowledge, and improving educational interventions can enhance adoption. Making the prescription guidelines more binding and updating legal frameworks for generic substitution are essential steps. Generic drugs are a powerful tool for making healthcare more accessible and affordable, but these challenges must be overcome to realize their full potential.

Safety and efficacy of ranibizumab biosimilar (Razumab®) as a cost-effective alternative to the innovator molecule for macular disorders in real-world

: To report the clinical efficacy and safety of the intravitreal ranibizumab biosimilar molecule, Razumab® (IVRz) as an economic alternative to the innovator molecule (Lucentis) in macular diseases under real-world conditions.: A single‑ center, prospective study of 100 consecutive eyes undergoing three-monthly IVRz between April 2020 to March 2021 for a variety of macular disorders including diabetic macular edema (DME), neovascular age‑related macular degeneration (nAMD), retinal vein occlusion (RVO), and myopic choroidal neovascular membrane (mCNVM). The main outcome measures were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), intraretinal-fluid (IRF), and subretinal-fluid (SRF) along with a safety analysis at weeks 4, 8, and 12 respectively. : Of the 100 eyes of 100 patients undergoing IVRz, a majority had DME (39 eyes; 39%) followed by RVO (34 eyes; 34%), nAMD (21 eyes; 21%), and mCNVM (6 eyes; 6%). Mean BCVA improved from baseline to weeks 4, 8, and 12 (P&amp;#60;0.001). A significant reduction in CST from the baseline was also noted at all the visits (P&amp;#60;0.001). On qualitative analysis, resolution of SRF and IRF was observed in 61.47% and 61.71% of eyes respectively. No serious ocular or systemic adverse events were noted.: Our real-world data suggests that IVRz therapy is safe and efficacious for the management of varied macular pathologies. The cost-effectiveness and systemic and ocular safety of this regulatory-approved biosimilar makes it a suitable alternative to the branded drug. Further comparative studies into the benefit-cost analysis of these biosimilar and branded agents are warranted to better understand the health economics of anti-vascular endothelial growth factor (anti-VEGF) therapy in chorioretinal disorders.

Spending on and Use of Clinician-Administered Drugs in Medicare

Medicare Part B drug expenditures have increased in recent years. This trend is likely to persist given the increased use and availability of biologics. To assess the extent to which Medicare Part B spending growth was associated with changes in price vs quantity, and how these trends interacted with entry of new drugs into the marketplace. This cross-sectional study quantified the degree of spending concentration and the association between price and use of Part B drugs among fee-for-service Medicare beneficiaries. Data on use and spending for separately payable Part B drugs were included. Source data were aggregated to the drug-year level and reported from 2016 to 2020. Descriptive decomposition and index analyses quantified the relative association of price and use changes separately for existing single-source drugs, existing drugs that faced competition, and new drugs that entered the market. Data analysis was performed from June to December 2022. Part B drug spending by the fee-for-service Medicare program and beneficiaries, as well as use, defined as dosage units and beneficiaries using the drugs. The study included 535 unique Part B drug products. From 2016 to 2020, 15 or fewer products comprised half of all Part B drug expenditures. The set of 7 drugs that comprised the top 25% of spending was very consistent over time, and all were biologics. Part B drug products that cost $1.85 or less per administration accounted for more than half of the doses administered in 2020. Spending on Part B drugs increased by $15 billion from 2016 to 2020. The entry of new, nonbiosimilar drugs during this period accounted for $12 billion of this increased spending (80%), while shifts in use and price increases among existing single-source brand drugs accounted for the remaining increase in spending. Part B spending decreased among the subset of existing drugs facing generic or biosimilar competition. Among single-source drugs on the market in 2016, the index that varied dosage units exceeded the index that varied price in all years, confirming that changes in use were associated more with spending growth for those drugs. In this cross-sectional study of Medicare Part B drug expenditures, spending was found to be concentrated among a small number of drugs. The entry of new products was a key factor associated with recent increases in Part B drug spending. These findings suggest that policies targeting top-selling drugs may have greater potential to curb Part B drug spending than those targeting price growth.

Trade Implications on Active Pharmaceutical Ingredients (APIS) Due to COVID-19 Pandemic and India China Altercation

ABSTRACT: India's pharmaceutical sector has been one of the largest manufacturers of generic drugs globally. During the pandemic, most countries were dependent on imports of generic drugs from India. However, India has been relying on resources from China for Active Pharmaceutical Ingredients (APIs) which are the raw material for preparing generic drugs. We considered, in our analysis, branded product groups of Paracetamol and Amoxicillin due to their extensive use in the treatment of COVID-19. From a thorough market analysis of both the drugs, we conclude that firms have a monopoly over their brands but compete within the same product group and operate in their respective market under varying prices within certain bandwidths which resembles the feature of monopolistic competitive market. We have introduced compensating function a la Helpman (1981) in the pharmaceutical goods market with the assumption that an 'ideal product' exists among the pharmaceutical goods. Given the framework, this paper explores a general equilibrium model set in a monopolistic competitive product market for branded drugs. We concluded through our propositions that expanding the pharmaceutical sector will increase the employment of unskilled labor under no capacity constraint. We will observe an increase in wages of unskilled labor only under full employment conditions wherein we would observe that the expansion of pharmaceutical good will increase wages in the unskilled labor market. However we obtain an intriguing result wherein we obtain that despite instances of limiting trade dependence on China through implementation of policies like 'Aatmanirbhar Bharat' and 'profit linked incentive schemes', yet to maintain the status quo in the global market for generic drugs, India's dependence on China would increase, owing to API imports due to the pandemic crisis. While India can grab the opportunity in the form of increased demand for pharmaceutical goods to increase the employment level of the economy but this improvement in welfare is also dependent on the degree of dependency of API India has on China. The Indian government has recognized the same through the incorporation of 'Covid-Suraksha' and PLI schemes to minimize import dependency, and accelerate the development of APIs and the production of indigenous drugs.

A Cost Variation Analysis of Oral Contraceptive Pills Available in the Indian Market

Background: Oral Contraceptive Pills (OCPs) are highly effective contraceptives if used regularly and adequately, and they also have added non-contraceptive benefits. This gives way to their increasing use in recent years, which has led to the introduction of numerous brands of drugs with different costs in the Indian market. Hence the current study was conducted to analyze the cost ratio and cost variation of different brands of OCPs available in the Indian market and to compare the cost of branded and generic drugs.&#x0D; Materials and Methods: The cost of the drugs was obtained from the Current Index of Medical Specialties (CIMS) - 44th Year April – July 2022 and from the website https://www.mims.com/india/. The Cost Ratio (CR) and Percentage Cost Variation (CV) was calculated. The cost of generic drugs was obtained from the website http://janaushadhi.gov.in/SortingView.aspx.&#x0D; Results: 124 brands of various OCPs were available in the Indian market. Among all the regular OCPs available, the CR and CV were highest for Ormeloxifene 30mg at 10.19 and 919.4%, respectively, and they were lowest for Dienogest +Ethinylestradiol which comes under combined OCPs with the results of 1.007 and 0.73% respectively. The cost of all generic OCPs was lesser when compared with brand OCPs, and the difference in cost was maximum for Ulipristal.&#x0D; Conclusion: There is wide variation in the cost of Oral Contraceptive Pills available in the Indian market, and the cost of brand drugs is higher than their generic counterparts. Physicians have to be made aware of this price difference so that they can prescribe drugs that are more affordable to the patients to improve their adherence to the regimen.

Pharmacoeconomic analysis of Oral &amp; Injectable Proton Pump Inhibitors available in India

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.&#x0D; 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.&#x0D; 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%).&#x0D; 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&#x0D;

The Effect of Inventory Control on Patients with Acute and Chronic Illness during Pre, Peri and Post COVID-19 Pandemic in India

Aim: To determine the effect of inventory control protocols on patient's health management systems during the pre; peri and post COVID – 19 pandemic in India.&#x0D; Study Design: An analytical observation type of study.&#x0D; Place and Duration of Study: A tertiary care hospital, between June 2020 to November 2022.&#x0D; Methodology: We collected the stock movement data of 10 brand drugs that include Acute disease medications and Chronic condition medication, from hospital pharmacy, at pre, peri &amp; post-COVID times. These drugs were selected for their common usage. The study of inventory based on data collected, will show how the pharmacy managed its inventory during the pandemic era. The pharmacy practised the collaborative method of ABC – FSN inventory method to meet demands and the same has continued during COVID-19.&#x0D; Results: Data collected on 5 drugs for acute diseases showed an average percentage increase of 62.33% in drug consumption between the pre and post-COVID period whereas the 5 drugs for chronic conditions show an increase of 86.39%. The hospital pharmacy managed the high range of demand with the successful model of inventory control. It is evidence of the successful use of ABC – FSN analysis in the hospital sector during the pandemic (COVID-19).&#x0D; Conclusion: The study concluded that the ABC – FSN inventory approach was helpful during the pandemic and concentrates mainly on the effect of inventory control on patients with chronic and acute diseases.

Spectrometric Assessment of Generic and Brand Drug Quality for a Sentinel Screening Network.

The U.S. Food and Drug Administration (FDA) is a worldwide leader among analogous regulatory organizations in other countries. The FDA uses current good manufacturing practices to regulate the processes that produce drugs. Nevertheless, investigative journalists have pointed out problems in the drug supply, and pharmacies are not required to test the drugs they receive. The University of Kentucky Drug Quality Study does perform screening on the sterile injectable drugs that it receives and regularly reports new findings to FDA, practitioners, and the public. A Sentinel Screening Network of academic health systems could provide independent data on drug quality to FDA not available through manufacturers.

Generic Aversion and Observational Learning in the Over-the-Counter Drug Market

Through a labeling intervention at a national retailer, we test three hypotheses for consumer aversion to generic over-the-counter drugs: lack of information on the comparability of generic and brand drugs, inattention to their price differences, and uncertainty about generic quality that can be reduced with information on peer purchase rates. With a difference-in-differences strategy, we find that posted information on the purchases of other customers increases generic purchase shares significantly, while other treatments have mixed results. Consumers without prior generic purchases appear particularly responsive to this information. These findings have policy implications for promoting evidence-based, cost-effective choices. (JEL D12, D83, L65, L81, M37)

Study of Knowledge, Attitude, and Practice of Prescribing Generic Medicines by Resident Doctors at a Tertiary Care Teaching Hospital

ABSTRACT Context: In this era of rapidly rising health-care costs, generic medications offer a more cost-effective alternative to branded medications. Aims: The main objective of this study is to evaluate junior (resident) doctors’ knowledge, attitude, and practice regarding the prescription of generic medications in a tertiary care teaching hospital. Settings and Design: It is an observational, cross-sectional study held at a tertiary care teaching hospital. Materials and Methods: An online, prevalidated questionnaire was used for this study. Results: A total response of 102 resident doctors was recorded. 75.70% (78) of the participants responded positively that generic medicines are cheaper than branded medicines. 68.90% (71) of participants had knowledge regarding Jan Aushadhi Yojana and generic medicine stores. About 90.30% (93) of participants positively suggested conducting a training program to increase the awareness regarding generic medicines and 86.40% (89) of participants suggested promoting the use of generic medicines. However, 26.20% (27) of participants had not read any article on generic medicines and 30.10% (31) participants disagreed with the substitution of a branded drug with a generic medicine by pharmacists. Sixty-five percent (67) of the participants preferred to prescribe generic medicines and 79.60% (82) of participants suggested that they are willing to encourage the patients to use generic medicines. Conclusions: Our study found that the resident doctors were well-versed in the idea of generic medications and their advantages. However, promoting training initiatives, setting up workshops, running journal club meetings, continuing medical education, etc., need to be planned to boost the number of prescriptions for generic drugs.

Pharmaco-ecomonic study of oral anti-hypertensive drugs available in Indian pharmaceutical market

Background: Hypertension is a global public health problem. To decrease its morbidity and mortality it needs life-long treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: The cost of different brands of commonly used anti-hypertensive drugs was sorted out by referring latest CIMS, MIMS and drug today. The cost of 10 dosage forms (tablets/capsules) in INR of each brand, cost ratio and percentage cost variation were calculated and evaluated. Results: The cost of different anti-hypertensive drugs were analysed and minimum and maximum cost of the drugs in a particular dosage are tabulated. The cost variation is analysed with SPSS software 2.0 version with tools of median and interquartile range. The variation in cost of most of the anti-hypertensive drugs is more than 100%. It’s found maximum in amlodipine (5 mg) with cost variation of 625%, atenolol 100 mg with cost variation of 413%. Conclusions: The average percentage cost variation of the same molecules of antihypertensive drugs manufactured by different pharmaceuticals company in India is very wide. So, government, pharmaceutical company, marketing manager and prescribing doctors should think about variation of cost and do needful for providing maximum benefits to the patients receiving antihypertensive drugs.

Cost Variation Analysis of Various Brands of Anti-Depressants Agents Currently Available in Indian Markets

Depression is a mental, psychiatric medical condition or disorder in which individuals manifest some clinical syndrome characterized by sadness, mood swings, societal withdrawal, lack of interest, family issues, and education problems which affect the daily student life in which the individual does not participate in daily activities. Sometimes individual commits suicide due to exam stress and that swings the mood upon the condition of the individual. The cost of brand-name medications prescribed in such circumstances exacerbates the disease burden and may even result in noncompliance with therapy. IDR (Indian Depository Receipt) was used to calculate the cost of various antidepressant drug brands. Using the percentage cost ratio, one can ascertain the price of each brand’s 10 tablets in INR (Indian Rupees), the cost ratio, and the percentage cost variance. The difference between the greatest and lowest prices of the same drug produced by Indian pharmaceutical industries was calculated. There is a greater price disparity between agents on the market. The greatest expense variance was found to be amitriptyline 25 mg (195%), fluoxetine 50 mg (95%), sertraline 50 mg (83%) and the lowest % cost variation was of fluvoxamine 20 mg (13.8 mg), duloxetine 20 mg (16%) and escitalopram 10 mg (38%). On the Indian market, the average price disparity between antidepressant medications of various brands is quite high. If a pricey brand is prescribed, patients will incur additional costs.

Oncologists’ receipt of pharmaceutical industry payments and use of non-recommended and low-value cancer care services.

6639 Background: Personal payments from the pharmaceutical industry to US physicians are common and influence physician practice. Prior studies have found that industry payments sway physicians’ selection among effective, medically appropriate treatments. However, whether industry payments may be associated with non-recommended and low-value care has not been assessed. The objective of this study was to estimate the association between oncologists’ receipt of industry payments and use of non-recommended and/or low-value (NR/LV) interventions. Methods: Population-based cohort study using fee-for-service Medicare claims and Open Payments records of industry payments. We identified four NR/LV cancer interventions: 1) denosumab for castrate-sensitive prostate cancer; 2) GCSF for patients at low risk for neutropenic fever; 3) nab-paclitaxel instead of paclitaxel for breast and lung cancer 4) branded drug instead of a generic or biosimilar. Study sample: Medicare beneficiaries with an incident cancer diagnosis (identified by new occurrence of a cancer diagnosis code in proximity to claims for cancer treatment) from 2014-2019. We applied additional requirements as appropriate to identify four sub-cohorts, corresponding to patients at risk for each of the NR/LV treatments, and identified the treating oncologist using claims. The primary exposure was receipt, by a patient’s oncologist, of any industry payments for the corresponding NR/LV treatment of interest, within 365 days before the patient’s index cancer date. The primary outcome was receipt of the corresponding NR/LV treatment. We fit general linear models controlling for patient characteristics and calendar year. To assess robustness, we also accounted for physician-level fixed effects in separate models. Results: Cohort sizes were: denosumab N = 9,799; GCSF N = 271,485; nab-paclitaxel N = 86,394; branded drug N = 13,386. Controlling for patient characteristics and calendar year, industry payment was associated with an increase in the absolute prevalence of denosumab (+17.5% [95%CI:15.3 to 19.7%]), GCSF (+5.8% [95%CI:5.4 to 6.1%]), and nab-paclitaxel (+7.6% [95%CI:7.1 to 8.1%]) use, but lower branded drug use (-4.6 [95%CI:-5.8 to -3.3]). In physician-level fixed effects models, industry payment was associated with increased denosumab (+7.4% [95%CI:2.5 to 12.2%]) and nab-paclitaxel (+1.7% [95%CI:0.9 to 2.5%]) use, but not with GCSF (+0.4% [95%CI:-0.3 to 1.1%]) or branded drugs (+1.2% [95%CI:-5.8 to 8.3%]). Conclusions: Recent receipt of industry payments by physicians was associated with increased use of several forms of NR/LV cancer treatment. These findings raise quality-of-care concerns regarding physician-industry financial relationships. Additional work is needed to further explore the causal relationship between payments and non-recommended treatments, and between payments and patient outcomes.