Percentage Cost Variation Research Articles

A Cost Variation Analysis of Drugs Available in the Indian Market for the Management of Thromboembolic Disorders.

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 oral anti-dyslipidaemic drugs available in Indian pharmaceutical market

Background: Dyslipidaemia is one of major risk factor contributing to cardiovascular disease, which further causes mortality and morbidity, so requires a long course of treatment. Physicians should be aware of the cost of drugs.Methods: Cost of the oral anti-dyslipidaemic drug, either as single drug or in combination manufactured by different pharmaceutical companies in the same strength and dosage form was obtained from current index of medical specialities (CIMS) April-July 2019. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage cost variation per 10 tablets was calculated.Results: In this study, existing findings showed a wide cost variation among different brands of the same oral anti-dyslipidaemic drug. Percentage cost variation for individual oral anti-dyslipidaemic drug was found to be highest with atorvastatin (80 mg film coated (FC) tablet): 358.84% followed by atorvastatin (5 mg FC tablet): 247%, fenofibrate (200 mg FC tablet): 134.22%, lovastatin (10 mg FC tablet): 108.56%, rosuvastatin (10 mg FC tablet): 78.60%, while lowest cost variation is seen with rosuvastatin 40 mg FC Tb: 1.598%. Among fixed dose combination therapy percentage cost variation was found to be highest with atorvastatin and fenofibrate (10 mg and 160 mg, FC tablet): 256%, followed by atorvastatin and ezetimibe (10 mg and 10 mg, tablet): 132.39%, while minimum cost variation was for rosuvastatin and fenofibrate (10 mg and 67 mg, tablet): 22.6%.Conclusions: These study findings showed that there is a wide variation in the cost of the same oral anti-dyslipidaemic drug. So, it is very necessary for regulatory authorities to regulate the wide variation in the cost, as well as physicians, should be sensitized to be aware of their cost variations to reduce the economic burden of drug-therapy to the patients.

A pharmacoeconomic study on cost variation of antiplatelet drugs available in Indian market

Background: Expenditure spent on pharmaceutical products accounts for a significant percent of the total health-care expenses of any country. Hence, there is a need to prioritize different and sometimes competing health-care interventions or possibly different brands of a particular medicine, especially in case of chronic illnesses for countries with fixed resources. Pharmacoeconomics helps us to make such decisions. Since antiplatelet drugs are prescribed on long-term basis, they were included in this study. Aim and Objective: The aim of this study was to analyze the cost variation of the antiplatelet drugs available in the market under various brand names manufactured by different pharmaceutical industries. Materials and Methods: A cross-sectional study was conducted to analyze the cost variation of different antiplatelet drugs available in Indian market. Cost of each drug with respect to dosage and formulation was obtained from the “current index of medical specialties” website for India. Cost ratio and percentage cost variation were then calculated. Results: Among the injectable and oral and drugs included in this study, the percentage cost variation was observed to be maximum with eptifibatide 75 mg vial, prasugrel 5 mg film-coated tablets, and aspirin-clopidogrel (75 + 75 mg) capsules. Conclusion: Even though the cost variation is found to be wide among the antiplatelet drugs available in Indian market, getting a cost-effective drug is not building castles in the air for the beneficiaries. This could be rendered possible with the help of policy-makers, pharmaceutical companies, physicians, and pharmacists when they join hands together.

PDB38 COST OF ANTI-DIABETIC MEDICATIONS AMONG TYPE II DIABETES MELLITUS PATIENTS: A CROSS-SECTIONAL STUDY IN SOUTH INDIA

The study aimed to analyse the cost of anti-diabetic medications and its economic implications on patients with type II diabetes mellitus. A prospective, cross-sectional study was conducted in patients above 20 years of age and diagnosed with type II diabetes mellitus who attended the inpatient department of Endocrinology from October 2018 - April 2019. Patients were followed from the day of admission till their discharge. Relevant details were collected from medication charts, pharmacy bills and patient interviews and were recorded in a suitably designed data collection form. Microsoft Excel was used to describe data statistically. A total of 252 patients, who fulfilled criteria were recruited. Male predominance was found (61.9 %). The mean age of the patients was found to be 58.76±12.5. Cost of oral hypoglycemic agents were found to be INR 7.289±12.27 per day. Glimepiride showed highest percentage of cost variation with 493.33%. Diabetes imposes a large economic burden on individuals with diabetes and their families and to health systems and national economies through medication costs. Health care providers play a pivotal role in the betterment of patients’ health and lifelong management of the disease. Clinical pharmacist’s assistance can contribute to providing diabetes related services that focus on managing medications to positively impact health outcomes, reduce overall healthcare system costs, and empower patients and consumers to actively manage their health. Keywords: Type II diabetes mellitus, anti-diabetic medications, cost, percentage cost variation.

Variation of cost among anti-malarial drugs available in Indian market

Background: There are numerous brands of antimalarial existent in the market. Expensive drugs could result in financial drain that causes reduced compliance or even non-compliance. Non-adherence to therapy could consequently cause partial treatment that leads to higher morbidity and in certain cases mortality too. Thus this evaluation was conducted to measure the cost disparity of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in Indian rupee rate was noted by using the latest edition of current index of medical specialities. The cost ratio and the percentage cost variation for individual drug brands were calculated.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Chloroquine DS 500 mg showed the highest cost ratio and cost variation (cost ratio=15.3 and % cost variation=1434). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents.Conclusions: The maximum variation shown by oral antimalarial was found to be for chloroquine DS 500 tablet. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment.

A study of the cost analysis of various oral antihypertensive drugs available in Indian market

Background: Hypertension is a serious global public health problem. It accounts for 10% of all deaths in India and is the leading non-communicable disease. Recent studies have shown that the prevalence of hypertension is 25% in urban and 10% in rural people in India. It exerts a substantial public health burden on cardiovascular health status and health care systems in India. Antihypertensive treatment effectively reduces hypertension related morbidity and mortality. The cost of medications has always been a barrier to effective treatment. The increasing prevalence of hypertension requires use of cost effective treatment for the effective management of the disease.Methods: Cost of a particular drug (cost per 10 tablets) in the same strength and dosage forms being manufactured by different companies was obtained from Current Index of Medical Specialties, Jan‑April 2019 and “Indian Drug Review” (IDR) September 2018. Difference between the maximum and minimum cost of the same drug manufactured by different pharmaceutical companies was calculated and percentage cost variation was calculated.Results: The prices of a total of 24 drugs (15 single and 9 combination preparations), available in 59 different formulations were analysed. These 62 formulations are manufactured by different pharmaceutical companies.Conclusions: The average percentage price variation of different brands of the same oral antihypertensive drug manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Cost analysis of various topical eye preparations currently available in Indian market

Background: topical eye preparations are very commonly used in India for different eye diseases hence their prices should not be much different in Indian pharmaceutical industry. The common man therefore has to shell out more money with medicine prices spinning out of his reach. Aim of this study was to compare the cost of drugs of the different brand of topical ophthalmic drugs.Methods: cost of various topical eye preparations was compared using “Current Index of Medical Specialties” (CIMS) January-April 2019 and cost variation was recorded. Drugs were categorized into anti-infective and antiseptics, topical corticosteroids, mydriatics, anti-glaucoma drugs, anti-inflammatory and lubricants.Results: That of the 26 drug formulations studied, the percentage cost variation of 10 drug formulations was more than 100%, out of which one formulation of moxifloxacin had more than 1000% variation. Cost ratio of 10 drug formulations were more than two. Moxifloxacin 0.5% eye drops had maximum percentage cost variation of 5610.66% and cost ratio of 57.11, followed by ofloxacin 0.30% eye drops (310.92%, 4.11), timolol 0.50% eye drops (263.64%, 3.64), ciprofloxacin 0.30% eye drops (142.42%, 2.42), tobramycin 0.30% eye drops (120.14%, 2.20).Conclusions: There is a significant variation in the price of various topical eye preparations. As most of the preparations being prescribed on an out-patient basis, which was not covered under most of the insurance program. Out of pocket expenditure adversely affects the drug compliance in the long run. There should be a comprehensive action from policymakers, regulatory authorities, government agencies, doctors, pharmacists, and the general public to solve this issue of cost variation of drugs.

Cost analysis of various branded versus generic chemotherapeutic agents used for the treatment of early breast cancer- a deep insight from India

ABSTRACT Background Breast cancer (BC) stands first with high incidence and mortality in India. Most of the oncologists are unaware of cost savings by utilising generic drugs. Aim To perform a cost minimization analysis of generic versus branded chemotherapeutic regimen for treatment of BC. Methodology CIMS (current index of medical stores) was referred for the cost of branded drugs and the generic cost was taken from Jan Aushadhi scheme. The percentage cost variation and potential cost-saving particular to BC regimens on substituting available generic drug was calculated using standard formula and costs were presented in Indian Rupees and US Dollars (as of 2019). Results Among the branded agents considered, a range of 25% to 606.11% cost variation was observed with cyclophosphamide and 5-Fluorouracil respectively. Gemcitabine proposed the highest cost variation (373.68%-990.78%) and cyclophosphamide (71.42%-114.28%) with the lowest variation when compared to generic drugs. The highest level of cost-saving (₹60,807.3 to ₹1,31,864.1) with TAC regimen and the lowest range (₹12,15.84 to ₹15,667.2) with AC regimen was observed among adjuvant therapy regimens. Conclusion Our evaluation inferred that substituting generic chemotherapeutic drugs can bring potential cost savings. Healthcare professionals and patients should aware and opt generic drugs to achieve goals of BC therapy.

Analysis of cost variation among various statin preparations available in India

Introduction: Hyperlipidemias are recognized as one of the major risk factors for the development of Coronary Artery Disease (CAD). Statins are the most potent lipid lowering agents currently available that significantly lower the morbidity and mortality associated with CAD. Aim: To compare the cost of various statins of different brands by calculating the percentage variation of cost. Materials and Methods: Prices of different statin preparations per 10 tablets/ capsules in rupees were reviewed from Drug today April-June 2018 issue and www.drugsupdate.com for analysis. Maximum and minimum price difference of the same drug manufactured by different pharmaceutical companies was calculated. Percentage variation was calculated as per the following formula Drug formulations manufactured by only one company and those whose price could not be obtained from the sources were excluded from analysis. Results: Maximum companies are manufacturing single drug atorvastatin 10mg (192) and atorvastatin 5 mg + ezetimibe 10mg (40). Highest percentage variation in cost is found with atorvastatin 5 mg (900%) and in atorvastatin 10mg + amlodipine 5 mg (1488%). Conclusion: There is wide variation in the cost of various statins available in India, which increases the economic burden on patients. Government of India should take more consumer friendly steps to control the cost of drugs. Physicians should maintain a P-drug list and prescribe low cost and effective drugs to improve compliance to drug therapy and ensure effective treatment of the disease. Keywords: Statins, Cost variation, Hyperlipidemias.

Price variation in different brands of anticancer drugs available in Indian pharmaceutical market: a cost analysis study

Background: Cancer is one of the most expensive and lethal noncommunicable diseases globally. Availability and affordability of anticancer drugs are the most important factors on which management of cancer depends. The objective of the study was to evaluate the variation of cost among different brands of anti-cancer drugs available in the Indian market.Methods: “Current Index of Medical Specialties” July-October 2018 and “Drug Update” Sept - 2018 were used to obtain cost in INR* (Indian National Rupees) of anticancer drugs manufactured by different pharmaceutical companies in India, in the same strength and dosage form. Percentage cost variations were calculated by minimum and maximum costs of anticancer drug of different brands.Results: Percentage variation in cost was analyzed for 41 different formulations of 27 anticancer drugs. Highest cost variability seen with Alkylating agent Carboplatin 150 mg injection (1100%) and lowest with Antimetabolite anticancer agent Cytarabine 500 mg injection (6.56%). Three formulations showed more than 500% cost variation, largest with Carboplatin 150 mg injection (1100%) followed by Anastrozole 1 mg tablet (870%) and Letrozole 1 mg tablet (508.42%).Conclusions: Present study finding showed significant cost variation in different brand of many anticancer drugs in India. These results indicated that greater price transparencies required. This price variation issue requires a much more in-depth analysis of the health care system.

Cost variation analysis of various brands of anticoagulants, fibrinolytics, and antiplatelet drugs currently available in Indian pharmaceutical market

Background: Cardiovascular disease is both highly prevalent and expensive to treat. Many novel anticoagulants, fibrinolytics, and antiplatelet agents have been found to be effective in decreasing the morbidity and mortality associated with cardiovascular disease. In the Indian market, there is large variation in the prices of anticoagulants, fibrinolytics, and antiplatelet drugs marketed in India. Aims and Objectives: Thus, a study was conducted to find out the variation in cost in the anticoagulants, fibrinolytics, and antiplatelet drugs available in India and to evaluate the difference in cost of various brands of the same anticoagulants, fibrinolytics, and antiplatelet drugs by calculating percentage variation in cost. Materials and Methods: Cost of a particular drug in the same strength and dosage forms being manufactured by different companies was obtained from “current index of medical specialties” January to April 2017 edition. Minimum and maximum price of anticoagulants, fibrinolytics, and antiplatelet drugs manufactured by different pharmaceutical companies, and percentage cost variation was calculated. Results: The cost of anticoagulants, fibrinolytics, and antiplatelet drugs by different companies was different. The highest percentage of cost variation was for tablet clopidogrel (75 mg) 394.61%, followed by tablet acenocoumarol (3 mg) 171.70%, injection enoxaparin sodium (60 mg/0.6 ml) 143.68%, tablet aspirin (75 mg) 51.55%, and lowest percentage cost variation was observed for injection streptokinase (1.5 MIU) 1.31%. Conclusion: There is lot of variation in the prices of different brands of the same anticoagulants, fibrinolytics, and antiplatelet drugs currently available in Indian market. Despite the implementation of price control, brand price variations still exist widely for commonly used drugs. Reassessment of pricing policy and implementation of quality norms is required.

Cost variation analysis of various brands of topical eye preparations currently available in Indian pharmaceutical market

Background: Ocular drug delivery is a complex drug delivery system, and topical administration being the most frequently employed route of drug delivery in eye diseases. Many topical eye preparations are sold under brand names. The variation in the costs of the same drug and inadequate information on quality and bio-equivalence makes it difficult for the physician to prescribe the most cost-effective treatment. The objective of this study was to analyse the cost variation in different brands of commonly used topical eye preparations in India.Methods: The minimum and the maximum cost in Rupees (INR) of particular topical eye preparations manufactured by various pharmaceutical companies in the same strength were noted. The percentage cost variation and cost ratio were calculated for each brand.Results: The costs of the total of 19 topical eye preparations available in 26 different formulations in India were analysed and a substantial variation in cost was observed. Of 19 drug formulations studied, the percentage cost variation of 10 drug formulations was more than 100% out of which one had more than 1000% variation. Cost ratio was also observed to be very high and 10 drug formulations had this ratio more than two.Conclusions: There is a wide variation in the prices of different brands, so there is an urgent need to raise the awareness of physicians about cost variation to lower the financial burden on patients.

Cost variation analysis of oral anti-diabetic drugs

Background: Diabetes Mellitus is a chronic metabolic disorder, one of the major causes of morbidity, mortality and needs lifelong treatment. There are large numbers of oral anti-diabetic drugs available for the treatment of type 2 diabetes mellitus. There are numerous brands available for each of the individual oral anti-diabetic drug. Thus, a study was planned to find out cost variation among different brands of same active oral anti-diabetic drug.Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from the price list provided by the pharmaceutical companies in Current Index of Medical Specialities (CIMS) (October 2017- January 2018). The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was analyzed.Results: Percentage cost variation of the commonly used drugs found was seen highest with Sulfonylureas (Glimepiride - 562%) followed by Metformin (492%) which was followed by Pioglitazone (488%), DPP-4 inhibitor Teneligliptin (231%), α- glucosidase inhibitors (Voglibose 284%), Meglitinides (Repaglinide 0.5mg 154%) and lowest was seen with Repaglinide 2mg (15%).Conclusions: There is very wide cost variation among different brands of the same oral anti-diabetic drugs manufactured in India. The average percentage cost variation of different brands of the same oral anti diabetic drugs manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Cost variation analysis of proton pump inhibitors available in Indian market

Background: In now days proton pump inhibitors are prescribing more and more by Indian physicians not only in peptic ulcer,gastroesophageal reflux disease, gastritis but also along with non steroidal anti-inflammatory drugs to overcome the side effects as gastric irritation and discomfort by non steroidal anti inflammatory drugs.There are many brands of PPI drugs available in Indian market. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non –compliance leads to incomplete treatment which tends to increase morbidity.Increase in the patient medication cost was found to associated with decreased adherence to prescription medication.Hence this study was done to assess the cost variation of proton pump inhibitors [PPI] 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 10 tablets/capsules was calculated in case of oral drug and the cost of one 1 vial or ampoule was noted in case of injectable drug. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for proton pump inhibitors marketed in india was found to be tablet/capsule Esomeprazole [20mg]:141.17, tablet/capsule Esomeprazole [40mg]:196.29, capsule/tablet Omeprazole[20mg]: 569.53, Tablet/capsule Pantoprazole[40mg]: 248.8, tablet /capsule Rabeprazole[20mg]: 815.78, capsule/tablet Lansoprazole[30mg]: 173.33, Inj. Esomeprazole [40mg] 1 vial: 81.81, Inj. Omeprazole[40mg] 1vial: 47.95, Inj. Pantoprazole[40mg] 1vial: 66.66, Inj.Rabeprazole [20mg] 1vial: 176.625.Conclusions: Tablet Rabeprazole[20mg] shows highest cost ratio and percentage cost variation as 9.15 and 815.78. While Inj. Omeprazole[40mg] 1 vial shows lowest cost ratio and percentage cost variation as 1.47 and 47.95.

Cost analysis and price variation of commonly used drugs in obstetrics and gynecology in Jhalawar district of Rajasthan, India

Background: Drugs used in obstetrics and gynecology are strong selling drugs in pharmaceutical market but they are the least studied drugs in terms of cost analysis and price variation.Methods: Cost of most commonly used Obstetrics and Gynecology drugs in Jhalwar district manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from Drug Today (January-March 2018). 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/10 capsule/1 injection/1 protein packet/1 sachet were analysed.Results: In Obstetrics drugs, the highest cost ratio (1:9.5) and percentage price variation (848) was found for Ferrous Salt + Folic acid combination followed by Cefixime (1:4.3, 330), Nifedipine (1:3.7, 270), Folic acid (1:3.67, 266), Paracetamol. Amoxicillin was having least cost ratio (1:1.4) and percentage price variation (37). Maximum number of brand available for Ferrous Salt + Folic acid combination (41) followed by Paracetamol, Calcium Salt + Vitamin D3 combination. In Gynecological drugs, the highest cost ratio (1:35) and percentage price variation (3433) was found for Ethinylestradiol + Levonorgetral combination followed by Doxycycline (1:8.9, 793), Fluconazole. Metronidazole was having least cost ratio (1:1.3) and percentage price variation (27). Maximum number of brand available for Omeperazole (27) followed by Ethamsylate (22).Conclusions: This study shows that the average percentage price variation of different brands of the same drugs were very wide. Improved adherence to the drug treatment can be ensured by decreasing the cost of therapy, which can be done by changes in the government policies and regulations, integrating pharmacoeconomics as part of medical education curriculum, and creating awareness among treating physicians for switching to cost effective therapy.

Drug usage pattern of anti-hypertensive drugs in elderly diabetic, hypertensive in-patients with or without impaired renal function in a tertiary care hospital

Background: Hypertension (HTN) and Diabetes mellitus (DM) are the leading contributors to the cardiovascular mortality and morbidity. Drug utilisation studies (DUS) are potential tools in the evaluation in health care systems. Objectives was to analyse the drug usage pattern of anti-hypertensives in elderly hypertensive diabetic in-patients in a tertiary hospital. To analyse drug usage pattern of anti-hypertensives in elderly hypertensive, diabetic in-patients with renal impairment in a tertiary hospital.Methods: The study population consisted of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based study was conducted and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Our study revealed that angiotensin receptor blockers (ARBs) were the most commonly prescribed (42.4%) class of anti-hypertensive drugs. In patients with impaired renal function also ARBs were the most common class prescribed (22.0%). Out of 35 anti-hypertensive fixed drug combinations (FDCs) prescribed the most frequent combination was combination with an ARBs (85.7%). There was a significant increase in the number of anti-hypertensive drugs prescribed in patients with impaired renal function when compared to patients without impaired renal function (p <0.05). The cost index was high, and the percentage cost variation was more than 100% in most of the anti-hypertensive drugs prescribed.Conclusions: This study shows that the most commonly prescribed anti-hypertensive drug class was ARBs in patients with and in patients without impaired renal function.

Cost analysis study of neuropsychiatric drugs: Role of National List of Essential Medicines, India.

This study investigated the cost variation among neuropsychiatric drugs prevalent in the Indian market with reference to the National List of Essential Medicines (NLEM, 2015). To promote the rational use of medicines through cost variation analysis among drugs for neuropsychiatric disorders enlisted in NLEM and those not included in NLEM (NNLEM). This study included drugs used for epilepsy, migraine, psychosis, depression, generalized anxiety disorder (GAD), bipolar disorder, and obsessive-compulsive disorder (OCD). The unit drug cost for the selected strengths of different manufacturers mentioned in the Current Index of Medical Specialities 2016 was used for calculating cost/defined daily dose (DDD). Comparison was done among individual drugs and groups (NLEM and NNLEM) by cost/DDD in terms of interquartile range, percentage cost variation, and cost ratio. The cost variation is wide for neuropsychiatric drugs (maximum, 1724.3% for risperidone in NLEM, and 1780% for olanzapine in NNLEM). The drug-to-cost ratio is the highest (168.8 times) for bipolar disorder and the lowest (9.7 times) for GAD. The NLEM drugs were found to be more economical than the NNLEM drugs among antiepileptic drugs, antidepressants, and drugs for bipolar disorder; however, the reverse was noted for antimigraine drugs and drugs for GAD. Antipsychotic medications and drugs for OCD in the NLEM group have a wider range than in the NNLEM group. The NLEM group has economical drugs in some disease categories; there is a need to consider the cost effectiveness of all drug categories while revising the NLEM next time and attention should focus on drug price regulation policies to accomplish the goal of rational use of medicines.

Cost variation analysis of ACE inhibitors in India

Background: Cardiovascular diseases are the most prevalent cause of death and disability in developed and developing countries. There is a wide variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out variation in cost in the ACE Inhibitors available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same ACE Inhibitors and ARBs by calculating percentage variation in cost in Indian rupees.Methods: Minimum and maximum costs in rupees (INR) of antihypertensive agents manufactured by different companies, in the same strength and dosage forms were obtained from “current index of medical specialties” January April 2016 and Drug Today October-December 2016. The cost ratio and percentage cost variation were calculated for each generic antihypertensive agent (ACE Inhibitors and ARBs).Results: This study shows that there is a wide variation in the prices of different brands of same ACE Inhibitors and ARBs in Indian market.Highest cost variation 400% is for Lisinopril (2.5mg), followed by Enalapril (10mg) 394.16%, Telmisartan (20mg) 322.22%.Conclusions: There is a wide difference in the cost of different brands of ACE Inhibitors and ARBs available in India. They have important role in management of hypertension particularly if associated with other morbidities like diabetes. The clinicians prescribing these drugs should be aware of these variations in cost so as to reduce the cost of drug therapy and increase the patient adherence to the therapy.

Cost variation analysis of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation

Background: Several brands of antihypertensive drugs are available in the Indian market with huge price variations. This study was undertaken to find out the percentage cost variation and cost ratio of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation.Methods: Costs of different brands of renin angiotensin aldosterone axis modulatory drugs with antihypertensive action for the same dosage form and strength were found out using current index of medical specialties-134, July-October 2016. The maximum and minimum price of different brands of each drug was noted. Data was entered in Microsoft excel 2010. Percentage cost variation and cost ratio was calculated for each drug.Results: 16 antihypertensive drugs were analysed. Most of them were tablets. Ramipril and Valsartan were available as capsules also. Among tablets, percentage cost variation was highest for Atenolol 12.5 mg (683.93%) and least for Bisoprolol 2.5 mg (3.6538%). Valsartan capsules (160 mg) had no difference in the costs between the available 2 brands. Cost ratio ranged from 1.04 to 7.84 among the tablet form of drugs.Conclusions: There is a huge difference in the cost of antihypertensive drugs manufactured by different companies in the same strength and dosage form. To promote rational drug use and cost effective therapy, it is essential to create an awareness among clinicians regarding the availability of multiple brands for these drugs and the discrepancies in their costs.

Cost variation analysis study of oral anti-depressant drugs available in India

Background: Depression is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity and economic burden. In India, the overall prevalence of depression is reported to be 15.9%. Antidepressant drugs are available in many different brands and costs of all brands are different. Patients of depression have to take the antidepressant drug for a long duration, so cost of the antidepressant drug influence the patient adherence to treatment and it is one of the important part of rational prescription.Methods: The cost of a particular drug being manufactured by different companies in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October, 2015, and “DrugsUpadate.com”. The cost ratio and percentage cost variation was calculated.Results: The prices of a total of 28 drugs (22 single and 6 combination preparations) available in 64 different formulations were analyzed. In single drug therapy, among Tri cyclic antidepressants (TCAs), Reboxetine (2 mg) showed the maximum price variation of 900%. In SSRIs, Dapoxetine (30 mg) showed the maximum price variation of 2360%. In SNRIs, Venlafaxine (75 mg) showed the maximum price variation of 109%. In Atypical antidepressants, Bupropion (150 mg) showed the maximum price variation of 515.38%. In RIMAs, Moclobemide (150 mg) showed the maximum price variation of 246.15% and in combination therapies, Amitriptyline with Chlordiazepoxide showed the maximum price variation of 129.35%.Conclusions: This study shows a wide variation in the prices of oral Anti-depressant drugs available in India. Psychiatrist/ Physician should consider the cost while prescribing antidepressant drugs. India being developing country most of the people belong to poor socioeconomic status, so prescribing same generic drug with low cost reduces economic burden and improves patient adherence to treatment which results in better outcome.