Pharmacoeconomic Perspective Research Articles

Tumor-Homing Peptides as Crucial Component of Magnetic-Based Delivery Systems: Recent Developments and Pharmacoeconomical Perspective.

According to data from the World Health Organization (WHO), cancer is considered to be one of the leading causes of death worldwide, and new therapeutic approaches, especially improved novel cancer treatment regimens, are in high demand. Considering that many chemotherapeutic drugs tend to have poor pharmacokinetic profiles, including rapid clearance and limited on-site accumulation, a combined approach with tumor-homing peptide (THP)-functionalized magnetic nanoparticles could lead to remarkable improvements. This is confirmed by an increasing number of papers in this field, showing that the on-target peptide functionalization of magnetic nanoparticles improves their penetration properties and ensures tumor-specific binding, which results in an increased clinical response. This review aims to highlight the potential applications of THPs in combination with magnetic carriers across various fields, including a pharmacoeconomic perspective.

Insights into Prospects of Novel NSAID Prodrugs in the Management of Gastrointestinal Toxicity: A Perspective Review.

Non-steroidal anti-inflammatory drugs (NSAIDs) have a long history in the healthcare system due to their therapeutic potential. These NSAIDs cause ulcerogenicity, stomach pains, gastrointestinal hemorrhage, mucosa bleeding, and pancreatitis when used moderately and consistently. With researchers, managing the aforementioned adverse effects therapeutically is getting increasingly difficult. One method for creating NSAID moieties with low penetration as well as ulcerogenic properties is the prodrug technique. During the oral consumption of NSAID-prodrugs, ulcerations, intestinal hemorrhage, and mucosa hemorrhage have significantly decreased. Considering this background, this review focussed on NSAID prodrugs as well as their justifications, the pathogenesis of NSAIDs inducing gastrointestinal toxicity, and the role of different antioxidants and spacer groups. Prodrug moieties have more advantages over parent medicines concerning both solubility and lipophilicity. In general, NSAID-class prodrugs can successfully treat both acute and long-term inflammation and aches without causing ulcerotoxicity and related gastrointestinal side effects, which reduces their burden from the pharmacoeconomic perspective.

Imrecoxib: Advances in Pharmacology and Therapeutics.

Imrecoxib, a cyclooxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug (NSAID), was discovered via the balanced inhibition strategy of COX-1/COX-2. It is indicated for the relief of painful symptoms of osteoarthritis. There have been some pharmacological and therapeutic advances since the approval of imrecoxib in 2011. However, an update review in this aspect is not yet available. Relevant literature until January 2024 was identified by search of PubMed, Web of science, Embase and CNKI. From the perspective of efficacy, imrecoxib provides relief of osteoarthritis symptoms, and potential off-label use for treatment of idiopathic pulmonary fibrosis, perioperative pain, hand-foot syndrome, axial spondyloarthritis, COVID-19, cartilage injury, and malignancies such as lung and colon cancer. From a safety point of view, imrecoxib showed adverse effects common to NSAIDs; however, it has lower incidence of new-onset hypertension than other types of selective COX-2 inhibitors, less gastrointestinal toxicities than non-selective NSAIDs, weaker risk of drug interaction than celecoxib, and more suitable for elderly patients due to balanced inhibition of COX-1/COX-2. From a pharmacoeconomic perspective, imrecoxib is more cost-effective than celecoxib and diclofenac for osteoarthritis patients. With the deepening of the disease pathophysiology study of osteoarthritis, new therapeutic schemes and pharmacological mechanisms are constantly discovered. In the field of osteoarthritis treatment, mechanisms other than the analgesic and anti-inflammatory effects of COX-2 inhibitors are also being explored. Taken together, imrecoxib is a moderate selective COX-2 inhibitor with some advantages, and there would be more clinical applications and research opportunities in the future.

Clinical, organizational, and pharmacoeconomic perspectives of dalbavancin vs standard of care in the infectious disease network.

The therapeutic approach to the patient with acute bacterial skin and skin structure infection (ABSSSI) and complicated infections often involves the early transition from intravenous to oral therapy (early switch) or early discharge. Our study aimed to evaluate sustainable and innovative care models that can be transferred to community healthcare and the economic impact of dalbavancin therapy vs Standard of Care (SoC) therapy for the treatment of ABSSSI and other Gram-positive infections including those by multidrug-resistant organisms. We also described the organization of an infectious disease network that allows optimizing the treatment of ABSSSI and other complex infections with dalbavancin. We retrospectively studied all patients treated with dalbavancin in the University Hospital "S. Anna" of Ferrara, Italy, between November 2016 and December 2022. The clinical information of each patient was collected from the hospital's SAP database and used to evaluate the impact of dalbavancin in early discharge with reduction of length of stay promoting dehospitalization and in improving adherence to antibiotic therapy. A total of 287 patients (165 males and 122 females) were included in the study of which 62 were treated with dalbavancin. In 13/62 patients dalbavancin was administered in a single dose at the completion of therapy to facilitate early discharge. Assuming a 12-day hospitalization required for the treatment of ABSSSI or to complete the treatment of osteomyelitis or spondilodiscitis, the treatment with dalbavancin results in a cost reduction of more than €3,200 per single patient compared to SoC (dancomycin, linezolid or vancomycin). Dalbavancin has proven to be a valid therapeutic aid in the organization of a territorial infectious disease network given its prolonged action, which allows the dehospitalization with management of even patients with complex infections in outpatient parenteral antimicrobial therapy.

Cost Variation Analysis of Branded Generics Used for Initial Treatment of Type 2 Diabetes, Hypertension and Dyslipidemia in India: A Pharmacoeconomic Perspective

Background: Branded generics are off-patent medications with proprietary names which are bioequivalent to the innovator medications. Cardiovascular diseases, driven by diabetes, hypertension, and dyslipidemia, are major health concerns, where patient compliance is crucial for long-term management. This analysis investigates cost variations of first-line branded generics for these conditions in Indian primary care settings.
 Methods: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia were identified through an online survey of prescribers. Data from 1mg.com, an Indian online pharmacy, was used to compile a list of available brands for each medication. The study compared the prices of the five most prescribed brands, the three lowest-cost and one highest-cost brand per medication, and calculated the percentage cost difference.
 Results: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia in India include Metformin 500mg, Enalapril 5mg, Telmisartan 40mg, Amlodipine 5 mg, and Atorvastatin 20mg. The analysis reveals significant cost disparities among commonly prescribed brands, with Metformin, Enalapril, Telmisartan, and Atorvastatin being notably more expensive (up to 1177%) than lower-cost alternatives, potentially placing a financial burden on patients. Amlodipine, however, exhibits modest cost variation (26-113%), with commonly prescribed brands leaning toward lower-cost options.
 Conclusion: Cost disparities among commonly prescribed brands could harm patient compliance and outcomes, emphasizing the need for cost-effective medication selection. This study offers crucial insights into cost variations in India's treatment of Type 2 Diabetes, Hypertension, and Dyslipidemia, underscoring the importance of cost awareness for improved patient compliance and healthcare system sustainability.

Cost variation analysis of commonly prescribed oral antipsychotic drugs available in India-a pharmacoeconomic perspective

Background: Antipsychotics are commonly prescribed for a variety of psychiatric disorders which require prolonged treatment. If a costly brand is prescribed, it reduces patient compliance, especially in the lower socio-economic groups. Awareness about the cost variation among different brands will guide an economically effective prescription by the treating physician.Methods: The cost of different brands of commonly used oral antipsychotic drugs available in the Indian market manufactured by different companies, in the same strength, number and dosage form was obtained from the latest CIMS, MIMS, and India drug Index. The cost ratio and percentage cost variation were calculated for each. The cost for the same drugs was also noted from the Jan Aushadhi generic medicines portal and a comparison was made. Results: The percentage variation in the cost was above 100% with most of the commonly used antipsychotic drugs like haloperidol (517%), trifluoperazine (504.12%), risperidone (485.27%), chlorpromazine (436.35%), aripiprazole (340.34%), flupenthixol (293.12%), olanzapine (245%), ziprasidone (176.02%), amisulpride (169.44%), quetiapine (163.16%). Percentage cost variation between branded and generic drugs ranged from 400-1050%.Conclusions: There is substantial cost variation among the various brands of antipsychotic drugs. Stigma surrounding generic prescription needs to be addressed. More psychiatric drugs need to be included under National list of essential medicines and DPCO (Drug price control order) so that there can be a ceiling on the maximum price.

IDF21-0306 Clinical efficacy of an economically favorable new generic dapagliflozin in the management of Type II Diabetes mellitus

Background: Regulatory bodies across the globe give approval to a generic equivalent when the innovator brand comes off-patent. The generic equivalent should have a robust evidence for its chemical and bio equivalence for such an approval. This approval entitles the prescribing physician to switch the prescription from the innovator brand to a generic brand or generic equivalent formulation. While such a shift offers economic advantage, there is no easy way for the physician to be extremely sure of their therapeutic equivalence unless the physician has a follow-up data for over several months. Aim: Therefore, a clinical trial establishing therapeutic equivalence will give greater confidence for the physician to shift and to provide pharmacoeconomic benefit to the patients. Dapagliflozin, a sodium/glucose cotransporter-2 inhibitor (SGLT2i) recently went off patent. A new generic formulation was introduced in India by October 20201. Although a pharmacokinetic study has already established the bioequivalence of the generic product compared to the innovator brand, 2 we evaluated the clinical efficacy of the new generic in the management of T2DM (Type 2 Diabetes Mellitus). Method: A single center study included 50 diabetic patients with good glycemic control, stabilized on the innovator Dapagliflozin for a period of at least 6 months prior to the switch. Mean age, BMI, baseline HbA1c levels were 54 ± 9.4 years, 26 ±2.2 kg/m2 and 6.68 ± 0.51, respectively. The generic equivalent (UDAPA) was administered at a similar dose of 10 mg and the patients were followed up for a period of 12 weeks with no other changes to the treatment regime. Primary outcome measures were changes in HbA1c, fasting blood sugar (FBS), and secondary outcome measures were BMI and serum creatinine. The null hypothesis was that UDAPA is therapeutically equivalent to the innovator brand of Dapagliflozin. Difference in means was assessed using paired t-test at 5% level of significance. Results: There were no significant changes in the levels of HbA1c (P = 0.9541), FBS (P = 0.8907), BMI (P = 0.3852), serum creatine (P = 0.9571) and the incidence of genital mycotic infections (6.8% versus 7.4%) and urinary tract infections (4.1% versus 3.9%) after the switch to generic UDAPA. From a pharmacoeconomic perspective, prior to change over to this generic, patients have spent a price of 60 INR per dose (translates to a price of 290 USD annually) and post-shift, the patient’s expenditure was 14.5 INR per dose (translates to a price of 70 USD annually). The original innovator molecule in recent times has been reduced to 30 INR. Overall, the study findings demonstrate the therapeutic equivalence of generic Dapagliflozin brand of UDAPA to the innovator brand with potential benefits of compliance to treatment and a pharmacoeconomic value. Moreover, the authors believe that the UDAPA once daily composition could offer an enhanced compliance benefit compared to twice daily formulations available in the market. Therefore, the authors recommend such measures of providing a comprehensive equivalence data and economic value for most of the antidiabetic medications to help diabetic patients in a developing economy.

Perception of castration value over cost in the metastatic prostate cancer scenario: a contemporary pharmacoeconomic perspective

Perception of castration value over cost in the metastatic prostate cancer scenario: a contemporary pharmacoeconomic perspective

DRUG PROVISION MANAGEMENT TO PROVIDE BETTER ACCESS TO THE HIGH COST TREATMENT AND IMPROVE OUTCOMES — EXAMPLE OF MUCOPOLYSACCHARIDOSIS TYPE II

Aim: to conduct a comparative assessment of the efficacy and safety of ERT drugs in MPS II type patients and analyze drug provision organization for pa- tients with this nosology. Methods: to conduct a comparative assessment of the efficacy and safety of ERT drugs, clinical trials data and real clinical practice data, including data from the Hunter outcomes survey register, were used. To assess the drug pro- vision organization were analyzed the current legal framework of the Russian Federation and public procurement data. Results and discussions: provision of pathogenetic therapy to the patients with orphan diseases is attributed to a number of administrative, clinical and eco- nomic constraints. The best example of the management of provision of this patients in Russia is a so-called Federal Program of High-cost nosologies (HCN) that has clear and transparent state regulation and the patient register that is essential for budget planning. The example of mucopolysaccharidosis type II (MPS II) that was included in HCN in 2019 shows noticeable increase in pa- tients’ access to therapy when transferring from regional budgets. Two medical products – idursulfase and idursulfase beta – are available in Russia for life-time pathogenetic treatment of this nosology. These products are produced using different cell lines; they have different INNs and are not interchangeable. Both drugs have registration clinical research, however, unique real world evidence is available for idursulfase only and show the survival rate of the patients with MPS II collected during 15 years of maintaining the international patient register cov- ering more than 1,000 patients from 129 countries, including Russia. According to the analysis, mortality risk in the patients treated with idursulfase is lower by 54% than in those who received no treatment (HR 0.46, 95% CI: 0.29; 0.72). This evidence can be used by health care decision makers to prioritize value of this medicinal product from both clinical and pharmacoeconomic perspectives. Predictability of therapy outcomes and higher prescription frequency according to current standards of care justifies idursulfase as a first choice treatment.

Adherence to Treatment in Myelofibrosis Patients: Preliminary Results from Italian Romei Observational Study

Adherence to Treatment in Myelofibrosis Patients: Preliminary Results from Italian Romei Observational Study

The MYRACLE protocol study: a multicentric observational prospective cohort study of patients with multiple myeloma

BackgroundDespite recent advances in the treatment of multiple myeloma, the disease constantly relapses and is still considered as incurable. The current knowledge about the biological mechanisms underlying resistance to the different class of drugs in multiple myeloma remains poor. The primary objective of the MYRACLE (Myeloma Resistance And Clonal Evolution) cohort, a multicenter prospective cohort of patients with multiple myeloma, is to address this limitation. We here describe the study background, design and methods used for this cohort.Methods/designAll patients (> 18 year old) diagnosed with de novo or relapsed multiple myeloma and treated in two hematology department from west of France are included in the MYRACLE cohort. Patients provide a signed informed to be included in the study. All subjects are followed until refusal to participate in the study or death. The MYRACLE cohort prospectively collects data on socio-economic status, medical status, imaging, prognosis factors, MM therapies and associated events (resistance, safety issues). Patients also complete standardized quality of life questionnaires. In addition, bone marrow samples will be collected at time of diagnosis and relapses to perform biomarkers analysis and functional assays exploring mechanisms underlying drug resistance.DiscussionThe “real-life” MYRACLE cohort offers the opportunity to prospectively collect epidemiological, medical, QoL and biological data from MM patients during the course of the disease (at time of diagnosis and subsequent relapses). At mid-tem, this integrative cohort will be unique at producing a large variety of data that can be used to conceive the most effective personalized therapy for MM patients. Additionally, the MYRACLE cohort will allow integrating the medical care of MM patients in a health and pharmacoeconomic perspective.

New drugs in early-stage clinical trials for allergic rhinitis

ABSTRACTIntroduction: Allergic rhinitis (AR) is the most common allergic disease, and it has a relevant impact on the quality of life of the patient. Treatment of AR includes a combination of strategies of proven efficacy and effectiveness; however, a relevant proportion of patients remain uncontrolled.Areas covered: This review article summarizes emerging therapeutic approaches to AR; these approaches include nasal sprays, oral drugs, alternative allergen immunotherapy administration routes, and biologic agents.Expert opinion: The agents discussed require further clinical trials to prove their efficacy in the treatment of AR. Some of these agents, in particular, allergen immunotherapies and biologics, have the potential to form crucial precision medicine approaches to AR. Those that prove their efficacy in clinical trials must also be evaluated from a pharmacoeconomic perspective, possibly in real-life studies; this will define which therapeutic strategies achieve the most convenient and cost-effective ratio, thus yielding a novel opportunity for the most severe and previously treatment-resistant allergic patients.

PUB002 Nivolumab in Second-Line Treatment for Advanced Non-Small Cell Lung Cancer with Squamous Cell Histology: A Cost-Effective Choice

The introduction of active new agents, such as nivolumab, for the second-line treatment of advanced non-small cell lung cancer (NSCLC) with squamous cell histology is associated with a relevant increase of costs and it is therefore important to make a balance between the costs of treatment and the added value represented by the improvement of the clinical parameters of interest such as progression free survival (PFS) and overall survival (OS). The analysis was conducted to assess the effect of front-line chemotherapy on the PFS and OS on each arm of the evaluated trials. Only phase III randomized controlled trials (RCTs) were considered. We calculated the pharmacological costs necessary to get the benefit in PFS and OS, for each trial. We have also applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above pivotal phase III RCTs We evaluated the 2 pivotal phase III RCTs, including 815 patients. The application of ESMO-MCBS reached high scores for the two pivotal phase III RCTs (grade 5 for Brahmer et al Trial and grade 4 for Broghaei et al Trial). Concerning both PFS and OS, the most relevant increase of costs was associated with the use of nivolumab, with the highest costs for month of PFS-gained (31 294 €), but with the lowest cost for month of OS-gain (from 5856 € to 6846 €). Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, nivolumab is a cost-effective second-line treatment for patients with advanced NSCLC with squamous cell histology. The lack of correlation between PFS and OS is a well-known phenomenon with the clinical use of check point inhibitors and reinforces the importance of the evaluation of OS as a strong end-point, even on a pharmaco-economic perspective.

Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit.

AimTo evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post‐partum hemorrhage (PPH) during cesarean deliveries.MethodsA systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period.ResultsSeven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70.ConclusionReduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

Cost-effectiveness of anti-angiogenic agents in second-line treatment for metastatic colorectal cancer. Integrating the EUROPEAN Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) with the costs of drugs

Background: In western Countries, colorectal cancer (CRC) is the second most common cause of death from cancer. In particular, the introduction of active new anti-angiogenic agents for the second-line treatment of metastatic CRC (mCRC) is associated with a relevant increase of costs and it is therefore important to make a balance between the costs of treatment and the added value represented by the improvement of the clinical parameters of interest such as progression free survival (PFS). Materials and methods: The analysis was conducted to assess the effect of second-line therapy with anti-angiogenic agents on the PFS and was restricted to pivotal phase III randomized controlled trials (RCTs). We calculated the pharmacological costs necessary to get the benefit in PFS, for each trial. Calculations were based on an “ideal patient” (BSA 1.8 sqm; weight 70 Kg). The costs of drugs are at the Pharmacy of our Hospital and are expressed in euros (€). We have subsequently applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above pivotal phase III RCTs. Results: The present analysis evaluated 4 phase III RCTs, including 3938 patients. PFS ranged from 2.7 months of bevacizumab alone in the E3200 trial to 7.3 months of the combination of FOLFOX and bevacizumab in the same trial. ESMO-MCBS reached medium score for VELOUR trial and low grade scores (grade 1 and 2) for RAISE, TML and E3200 trials, respectively. Dividing the costs of therapy by the measure of efficacy represented by PFS we found out that the lowest cost per month of PFS gained (4581 €) was associated with the use of FOLFIRI plus aflibercept; the highest cost per month of PFS gained (23 827 €) was associated with the use of FOLFIRI plus ramucirumab. Conclusions: Combining pharmacological costs of drugs with the measure of efficacy represented by the PFS, aflibercept in combination with FOLFIRI is a cost-effective second-line treatment for patients with mCRC. The lack of correlation between PFS and OS is a well known phenomenon with the clinical use of anti-angiogenic treatment and reinforces the importance of the evaluation of PFS as a strong end-point, even on a pharmaco-economic perspective.

The cessation of anti-PD-1 antibodies of complete responders in metastatic melanoma.

The optimal duration of PD-1 antibodies for metastatic melanoma is unknown. In previous trials, there has been the potential to cease therapy if the patient achieves a complete response (CR). We aimed to assess the outcomes of patients who had ceased anti-PD-1 antibodies in this setting. A retrospective review was carried out of CR to PD-1-based therapy across two institutions. Patients were from the Pembrolizumab Named Patient Program (PEM NPP), Nivolumab monotherapy (NIVO), and reimbursed Pembrolizumab (r PEM). Patients had to have experienced a CR to PD-1-based therapy and ceased therapy because of this. Disease recurrence was the primary outcome measured. Twenty-nine patients (PEM NPP, N=20; Nivo, N=3; r PEM, N=6) ceased anti-PD-1 therapy after CR for observation. The median age was 64 (27-83) years. All patients had treatment discontinued for observation. The median time to CR was 10.5 months in the PEM NPP, 7.5 months on r PEM groups, and 17 months in the NIVO group. The median time off therapy in PEM NPP was 10 months, NIVO was 9 months, and r PEM was 4.5 months. To date, three patients have shown a relapse at a median follow-up off treatment of 8 months. This is the first report of patients who have intentionally ceased PD-1-based therapy because of CR. With a follow-up of 8 months off treatment, the risk of relapse was low. Data such as these are clinically relevant as we need to be able to discuss cessation of therapy and relevant from a pharmacoeconomic perspective, given the cost of PD-1 antibodies to society.

The REFRACT-LYMA cohort study: a French observational prospective cohort study of patients with mantle cell lymphoma.

BackgroundMantle Cell Lymphoma (MCL) is often associated with progression, temporary response to therapy and a high relapse rate over time resulting in a poor long-term prognosis. Because MCL is classified as an incurable disease, therapeutic resistance is of great interest. However, knowledge about the biological mechanisms underlying resistance associated with MCL therapies and about associated predictors remains poor. The REFRACT-LYMA Cohort, a multicenter prospective cohort of patients with MCL, is set up to address this limitation. We here describe the study background, design and methods used for this cohort.Methods/DesignThe REFRACT-LYMA Cohort Study aims at including all patients (>18 years old) who are diagnosed with MCL in any stage of the disease and treated in specialized oncology centers in three public hospitals in Northwestern France. Any such patient providing a signed informed consent is included. All subjects are followed up indefinitely, until refusal to participate in the study, emigration or death. The REFRACT-LYMA follow-up is continuous and collects data on socio-economic status, medical status, MCL therapies and associated events (resistance, side effects). Participants also complete standardized quality of life (QOL) questionnaires. In addition, participants are asked to donate blood samples that will support ex vivo analysis of expression and functional assays required to uncover predictive biomarkers and companion diagnostics. If diagnostic biopsies are performed during the course of the disease, extracted biological samples are kept in a dedicated biobank.DiscussionTo our knowledge, the REFRACT-LYMA Cohort Study is the first prospective cohort of patients with MCL for whom “real-life” medical, epidemiological and QOL data is repeatedly collected together with biological samples during the course of the disease. The integrative cohort at mid-term will be unique at producing a large variety of data that can be used to conceive the most effective personalized therapy for MCL patients. Additionally, the REFRACT-LYMA Cohort puts the medical care of MCL patients in a health and pharmacoeconomic perspective.

The diagnosis and therapy of colorectal cancer from a pharmacoeconomic perspective

The diagnosis and therapy of colorectal cancer from a pharmacoeconomic perspective

Pharmaceutical Pricing in India: A Pharmacoeconomic Perspective

India, during the last two decades is fast becoming the “Pharmacy to the World”. India is a world destination of affordable drugs. India’s prowess is in making patented drugs more affordable. Though the prices of patented drugs are lower in India, the retail markets are highly stratified and price sensitive. Hence, even though a large number of manufacturers exist; substantial price differences exist between different brands of the same drug. In marked departure from the world pharmaceutical buying paradigm; In India medicines are bought are paid by the people themselves without social security or through health insurance. Because of limited social healthy schemes often out of reach insurance facilities, access to medicines has been low in India. But substantial populations of people are acquiring a fair degree of affluence of late. The government policy controls pricing of drugs in various forms since 1963. But its approach is selective prone to imperfections —while some drugs are under control, competing drugs have been kept out of control. This has provided the manufacturer to alter the to more profitable product portfolios out of DPCO’s purview. In a significant change in the government policy after 2005, India has re-introduced product patent protection. MNCs have started selling new patented drugs at exorbitant prices but these are yet to be included under price control. India has been able to restrict product patents by exempting grant of patents under certain conditions,invoking certain sections of the Patents Act. In a pharmacoeconomic perspective the Indian Pharmaceutical pricing is a state of flux and needs a course correction.

Role of Pharmacists in Cancer Care: Medication Safety and Pharmacoeconomic Perspective

Role of Pharmacists in Cancer Care: Medication Safety and Pharmacoeconomic Perspective