Cost analysis study of price variation among the various brands of antiepileptics available in India

Nagaraja Prasad Sai, Vedavathi H.


Background: One of the major cost that the patient has to bear during therapy is medication cost Different brands of the same mediations are available leading to considerable price variation. This can affect medication compliance by the patient. The present study was undertaken to evaluate the variation in costs of antiepileptic’s available in India.

Methods: Cost of all antiepileptics (tablets/capsules) available in India was obtained from CIMS July to Oct 2016 and from IDR Vol XXII issue No 3, 2016. The percentage cos ratio and percentage variation in cost were calculated and compared.

Results: The highest cost ratio and percentage price variation was found with carbamazepine 200mg (1:12 and 1100) followed by acetazolamide 250mg (1:11.38 and 1037.68). Other significant cost variations (>100%) were seen with carbamazepine 100mg, phenobarbital 30mg, divalproex sodium 25mg, lorazepam 1mg, clonazepam 1mg and valproic acid 500mg. Lowest percentage cost variation was seen with oxcarbazepine 450mg (1.09), lacosamide 50mg (2.56), pregabalin 50mg (3.51) and zonisamide 50mg (4.21).

Conclusions: The Government of India regulates prices of essential drugs through Drug Price Control Order (DPCO) and this is implemented by National Pharmaceutical Pricing Policy (NPPA). However nearly 80% of medications donot fall into this category. This leads to considerable economic burden on poor patients. There is still considerable price difference among various brands of antiepileptic available in India. The Government of India should take a firm decision and implement them with regard to pricing of medications so as to make them more affordable, especially for diseases which require long term treatment such as epilepsy.


Cost analysis, antiepileptics, Percentage cost variation, Pharmacoeconomics

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Thomas SV. Epilepsy. In: Munjal Y P Ed in Chief. API-Textbook of Medicine. The Association of Physicians of Medicine. 9th Ed Vol 2. API Mumbai; 2012:1371-1383.

Perkin GD. Epilepsy in later childhood and adulthood. In: Warrell D A, Cox T M, Firth J D ed. Oxford Textbook of Medicine. 5th Ed Vol 3. Oxford University Press, Oxford; 2010:4810.

Bope ET, Kellerman RD. Conn’s Current Therapy. Elsevier Saunders, Philadelphia; 2013:646-653.

Tripathi KD. Essentials of Medical Pharmacology. 7th ed. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi; 2013:412.

Planning Commission Report. Government of India 2014. Available at

Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Olendorf DA et al. Medication compliance and persistence: terminology and definitions. Value in Health. 2008;11:44-7.

Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: A literature review. P and T. 2012;37:45-55.

Kaiser Family Foundation. 2015. Available at https://

Kennedy J, Morgan S. Cost related prescription nonadherence in the United States and Canada: A system level comparison using the 2007 International Health Policy Survey in Seven Countries. Clin Ther 2009;31(1):213-9.

Cohen RA, Kirzinger WK, Gindi RM. Strategies used by adults to reduce their prescription costs. NCHS Data Brief. 2013;(119):1-8.

Ahuja J, Gupta M, Gupta AK, Kohli K. Pharmacoeconomics. Natl Med J India. 2004;17:80-3.

Sanchez LS. Pharmacoeconomics: Principles, methods and applications. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML Eds. Pharmacotherapy: A pathophysiological approach. 7th Ed. McGraw Hill; New York; 2008:1-2.

Das SC, Mandal M, Mandal SC. A critical study on availability and price variation between different brands: impact on access to medicines. Indian J Pharm Sci. 2007;69(1):160-3.

Chawan VS, Gawand KV, Badwane SV. Cost analysis of oral hypolipidaemic agents available in India. Int J Basic Pharmacol. 2014:3:954-7.

Rataboli PV, Garg A. Confusing brand names: Nightmare of medical profession. J Postgrad Med. 2005;51:13-6.

Gazette of India-Extraordinary Part II-Sec 3(ii).Drug Price Control Order. New Delhi, Ministry of Chemicals and Fertilizers. Department of Pharmaceuticals (National Pharmaceutical Pricing Authority) 2013:2:36-67. Available at 2013.pdf.

Compendium of notified ceiling prices of scheduled drugs. National Pharmaceutical Pricing Authority 2015. Available at

National List of Essential Medicines 2015. Available at 2015/recommendations.pdf.

Singal GL, Nanda A, Kotwani A. A comparative evaluation of price and quality of some branded versus branded-generic medicines of the same manufacturer in India. Indian J Pharmacol. 2011;43(2):131-6.

Wagh L, Swamy KM, Kempegowda MB. Cost variation of study of antiepileptic drugs available in India. Asian J Pharm Clin Res. 2016;9(2):64-8.

Frazier LM, Brown JJ, Divine GW. Can physician education lower the cost of prescription drugs? A prospective controlled trial. Ann Intern Med. 1991;115:116-21.

Schedule M. Good Manufacturing Practices and Requirements of premises, plant and equipment for pharmaceutical products. New Delhi. Available at M (GMP).pdf.

Nagarajan R. 80% of medicines not covered by price control order. Times of India; c2015. Available at

Atal S, Atal S, Deshmankar B, Nawaz SA. Cost analysis of commonly used drugs under price control in India: assessing the effect of drug price control order on brand price variation. International J of Pharmacy and Pharmaceutical Sciences. 2016;8(4):315-21.