A cost variation analysis study of various bisphosphonates preparations available in the Indian market

Background: Osteoporosis is a chronic disease leading to weakened and porous bones which increases the risk of fractures. It is a treatable condition using drugs like bisphosphonates. There is wide variation in the cost among various brands of bisphosphonates in the Indian market, so the objective of the study was to analyse cost of different brands of bisphosphonates.Methods: Cost of both oral and injectable bisphosphonates in the same strength and dosage forms was obtained from CIMS India (January-April 2019). For oral form of the drug, price was calculated per 10 tablets, for injectable form the price per ampoule or vial was calculated and cost ratio, percentage of cost variation was calculated.Results: 15 different formulations of bisphosphonates were analyzed and it was found that cost ratio is found to be highest with 60 mg of pamidronate injection and lowest with 10 mg alendronate tablet, also pamidronate 60 mg injection has highest percentage of cost variation (9632%) and lowest cost variation is seen with 10 mg alendronate (35%). Cost ratio of 11 formulations was found to be very high which was >2 while percentage of cost variation of 11 formulations was found to be more 100.Conclusions: This study concludes that there is wide variation in cost of various brands of bisphosphonates in India. The huge price variation creates unnecessary burden leading on the patients resulting in noncompliance which increases the risk of morbidity and mortality. Therefore, there is an urgent need to regulate the cost of various formulations of bisphosphonates which will reduce the financial burden on the patients.

Disparity in cost of oral hypoglycemic agents available in Indian market

Background: Diabetes is one of the most common non-communicable disease worldwide, of which India has been crowned with the title of “diabetes capital of the world”. On an average a person spends 20% of his or her income for the treatment of diabetes per year. So, it’s become very important to conduct a complete cost disparity study among oral hypoglycemic agent available in the market. Information generated from the current analysis, will be helpful to doctors in choosing the right drug for their patient and for the health sector in successfully utilizing the available resources.Methods: The study was conducted in the department of pharmacology AIIMS, Patna 2019. Price of the drugs per tablet/capsule/vial were reviewed from “Current Index of Medical Specialties” January-April 2019 and “Drug Today” October-December, 2018 for analysis of different formulations of oral hypoglycemic agents.Results: The cost of total 16 drugs belonging to 6 different classes, available in 38 different formulations were analyzed. Total 44 different pharmaceutical companies were involved in the manufacture of oral hypoglycemic agents. Overall glibenclamide (5 mg) and bromocriptine (2.5 mg) showed maximum % price variation of 422.79 and 586.27 respectively. Dapagliflozin and canagliflozin both belonging to sodium glucose cotransporter-2 inhibitors shows minimum price variation of 9.86 and 0.9 respectively.Conclusions: The current study shows that there is a huge price variation among oral hypoglycemic agents manufactured by different companies and government needs to take essential steps to bring about the uniformity in the price.

Drug price control order: the impact on pharmacoeconomics

Background: The objective of the present study was to analyze the prices of metformin, losartan, atorvastatin, paracetamol and aspirin for the doses which are included in the list of Drug Price Control Order (DPCO) 2013.Methods: Current index medical specialties India, 37th year, April-July 2015 issue was used for analysis. The retail prices of the drugs in INR were tabulated in Microsoft Office Excel 2013. The prices of the above listed drugs were compared with prices of DPCO 2013 for the same doses of drugs. The analysis of drugs costing more than the prices listed in the DPCO with the margin of the difference in percentage was carried out.Results: Out of 25 brands of metformin 500 mg tablet, 11 (44%) brands had price higher than listed in DPCO 2013. Similarly, prices for losartan 25 mg and 50 mg tablets, 8 (25%) out of 32 and 11 (31.42%) out of 35 were higher respectively. For atorvastatin 5 mg and 10 mg tablets, 2 (9.52%) out of 21 and 8 (13.55%) out of 59 brands had higher prices. For paracetamol 500 mg tablet, 12 (63.15%) out of 19 brands were priced higher than DPCO list. For aspirin 100 mg tablet and 325 mg tablet, 3 (100%) out of 3 brands and 1 (100%) out of 1 brand had higher prices.Conclusions: Many of the brand formulations have higher prices than the DPCO 2013 issued by government of India. The clinicians prescribing these drugs should be aware of these brand formulations to reduce the cost of the drug therapy.

Analysis of price variation of some commonly used antibacterial agents

Background: Antimicrobial resistance is a serious problem. Resistance may develop due to irrational use including poor patient compliance due to prescription of expensive drugs. In present study, the variation in the price of commonly used antibacterial was analysed.Methods: The price of commonly used antibacterial agents listed in recent issues of CIMS and MIMS was analysed in respect of number of brands available, price range (10 tablets or capsules) and 1 ampoule or vial (parenteral preparation) i.e. minimum, maximum and average price and price ratio (maximum/minimum). FDCs and formulation with only 1-2 brands were excluded.Results: The number of brands of oral antibacterial agents varied from 3 (faropenem 200 mg) to 90 (azithromycin 500 mg). The maximum price variation amongst different brands was 21.64 for levofloxacin 500 mg followed by 14.28 and 11.26 for linezolid 600 mg and moxifloxacin 400 mg respectively. For parenteral preparations, the number of brands varied from 2 (gentamicin 80 mg) to 57 (ceftriaxone 1 g). The maximum price variation was 5.05 for meropenem 1 g followed by 3.69 and 2.63 for meropenem 500 mg and ceftriaxone 1 g respectively.Conclusions: A very wide price variation was observed amongst different brands of both oral and parenteral formulations of antibacterial agents. Prescribing expensive brands may lead to resistance due to poor patient compliance.

To study the cost variation analysis of oral H2 receptor blockers available in different brands in Indian pharmaceutical market

Background: Aim of the study was to study percentage price variations among different brands of the commonly prescribed H2 receptor blockers.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 price ratio and the percentage price variation for individual drug brands was calculated. The price of 10 tablets/capsules were calculated. At last the price ratio and percentage price variation of various brands were compared.Results: Percentage variation in price for H2 receptor blockers marketed in India was found to be tablet cimetidine 200mg:81.89, tablet cimetidine 400mg:91.27, tablet ranitidine 150mg:295.64, tablet ranitidine 300mg:123.19, tablet famotidine 20mg:939.62, tablet famotidine 40mg:1110.09, tablet roxatidine 75mg:38.65, tablet roxatidine 150mg:21.85.Conclusions: H2 receptor blocker is the most common drug prescribed for prolonged period in case of gastritis, Gastro-Esophageal Reflux Disease (GERD), peptic ulcer. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The doctors prescribing these drugs should be aware of these variations in price to reduce the price of drug therapy.

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.

The extent of price variation amongst branded antihypertensive drugs and its association with number of pharmaceutical companies.

Background: The study was performed to analyze the extent of price variation amongst branded antihypertensive drugs in India and the relation of this price variation to number of pharmaceutical companies manufacturing/marketing these drugs. Methods: Price of different brands of antihypertensive drugs was collected from authentic sources. The data were segregated and the percentage price variation was calculated applying suitable statistical tools. Results: A total of 116 formulations from different companies representing 38 antihypertensive drugs were analyzed. Maximum price variation (3233.33%) was seen with 10 mg dose of propranolol. In general the price variations are proportionally correlated to the number of pharmaceutical companies. Conclusions: Price variation of great extent was found among many formulations. Physicians should be aware of these variations for choosing the appropriate brand for rational therapeutics. This will reduce the burden on patients and family.

Antidepressant drugs: evaluation of price variation.

Background: 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. If the cost of a drug is high patient has to pay more money for complete treatment. It can result in noncompliance and treatment failure. This study was aimed to evaluate the cost of antidepressant drugs of different classes and to analyze price variation in various antidepressant drugs available in India. Hence, we decided to do the study of price variations of antidepressant drugs. Methods: We had evaluated the cost of a different class of antidepressant drugs. Current Index of Medical Specialties October-December 2014 and Indian Drug Review 2015 issue 1 drug manuals were used to derive the cost of antidepressant drugs. Data about the cost of antidepressant drugs were collected for all the strength and dosage forms. The maximum price and minimum price for the different antidepressant drugs were identified, and calculation for the percentage of price variation was done. Results: Maximum percentage of price variation in different groups were 900% in reboxetine 2 mg (tricyclic antidepressants group), 495.23% in escitalopram 10 mg (selective serotonin reuptake inhibitors group), 318.66% in duloxetine 20 mg capsules (serotonin and noradrenaline reuptake inhibitors group), 243.58% in moclobemide 150 mg tablet (reversible monoamine oxidase-A inhibitor), 84.93% in bupropion 150 mg sustained-release tablet (atypical antidepressants group). In combination escitalopram 10 mg + clonazepam 0.5 mg shows maximum price variation of 1101.92%. Conclusion: Price variation was wide for antidepressant drugs. Generic drug prescribing can decrease the expenditure of patient on the drug. Prescribers should be provided updated knowledge of the cost of different drugs. Modifications in pharmaceutical policy are required, and prices of the drug should be controlled in effective way for all the drugs.

Study of variation in price of various antidiabetic drugs available in Indian market.

Background: Diabetes mellitus in early age is on the alarming rise in India, requiring lifelong treatment. There is a wide range of variation in the prices of antidiabetic drugs marketed in India. Hence, we decided to study price variations in the oral antidiabetic drugs available, either singly or in combination, and number of manufacturing companies for each, and to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: 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 2014 and “Indian Drug Review” July 2014. The difference in the maximum and minimum price of the same drug, manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation among different group of drugs was found to be as follows: in sulfonylureas, it was highest in glimepiride 2 mg 836.44%, among biguanides - metformin 500 mg 245.55%, among thiazolidionedionespioglitazone 15 mg 600%, among α glucosidase inhibitors - voglibose 284.61% and meglitinides - repaglinide 0.5 mg 181.40%. Among combination therapy glimepiride 1 mg + metformin 500 mg 366.66%, pioglitazone + metformin 207.51%, pioglitazone + glimepiride 268.42% showed maximum variation in price. Conclusion: The average percentage price variation of different brands of the same oral antidiabetic drug manufactured in India is very wide. The appropriate changes in the government policy, sensitizing the prescribers about cost of therapy and proper management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative economic consequences.

Cost analysis study of oral antihypertensive agents available in Indian market.

Background: Hypertension is one of the major causes of morbidity, mortality and needs lifelong treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out price variations in the oral antihypertensive drugs available either singly or in combination and number of manufacturing companies for each, also to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: 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 2013 and “Indian Drug Review” September 2013. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation of the commonly used drugs found was amlodipine (5 mg): 1128.57%, atenolol (12.5 mg): 683.53%, enalapril (10 mg): 394.67%, telmisartan (20 mg): 288.33%. Among the combination therapy, amlodipine + atenolol (5 + 50 mg): 673.79%, amlodipine + losartan (5 + 50 mg): 284.61%, telmisartan + hydrochlorothiazide (40 + 12.5 mg): 293.85%, losartan + hydrochlorothiazide (50 + 12.5 mg): 384.62% variation. Conclusion: 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.