Cost variation analysis of ACE inhibitors in India


  • Prashant Wadagbalkar Department of Pharmacology, RKDF Medical College Bhopal, Madhya Pradesh, India
  • Poonam Patel Department of Pharmacology, Index Medical College, Indore, Madhya Pradesh, India
  • Swati V. Raipurkar Department of Paediatrics, Index Medical College, Indore, Madhya Pradesh, India



Adherence, Angiotension converting enzyme inhibitors, Angiotensin receptor blockers, Cost analysis, Compliance, Cost variation, Hypertension


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.


Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Comparative Risk. Assessment Collaborating G. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347-60.

Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet. 2011;377:413-28.

Sandozi T, Emani VK. Survey of prescription pattern of antihypertensive drugs in hypertensives and hypertension associated diabetics. International Journal of Pharma and Bio Sciences. 2010;1(4):P23-26.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden hypertension: analysis of worldwide data. Lancet. 2005;365:217-23.

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. The task force for the management of arterial hypertension of the European Society of H, The task force for the management of arterial hypertension of the European Society of C. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28:1462-536.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Joint National Committee on Prevention DE, Treatment of High Blood Pressure. National Heart L, Blood I, National High Blood Pressure Education Program Coordinating C. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.

Anti-Hypertensive drugs market- global industry analysis,size, share, growth, trends, and forecast, 2013-2019. Available from: http://www Available at: Accessed on 27/1/17

Meissner I, Whisnant JP, Sheps SG. Detection and controle of high blood pressure in the community: do we need a wakeup call? Hypertension. 1999;34:466-71.

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

Shankar PR, Subish P, Mishra P, Lalit M. Ambiguous pricing of Nepalese medicines. J Inst Med. 2006;28(3):35-8.

Van Vark LC, Bertrand M, Akkerhuis KM, Brugts JJ, Fox K, Mourad JJ, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients. Eur Heart J. 2012;33(16):2088-97.

Skeggs LT, Dorer FE, Kahn JR, Lentz KE, Levine M. The biochemistry of the renin-angiotensin system and its role in hypertension. Am J Med. 1976;60:737-48.

Unger T. Targeting cardiovascular protection: the concept of dual renin-angiotensin system control. Medscape J Med. 2008;10:S4.

Peny MJ. ACE Inhibitors- Analysis of marketing strategy. Available at: analysis of marketing strategy. Html. Accessed 5April 2017

Shrank WH, Hoang T, Ettner SL, Glassman PA, Nair K, DeLapp D, et al. The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med. 2006;166(3):332-7.

Akila L, Rani RJ. Cost analysis of different brands of antianginal drugs available in India. Int J Basic Clin Pharmacol. 2015;4:860-3.

Gagne JJ, Kesselheim AS, Choudhry NK, Polinski JM, Hutchins D, Matlin OS, et al. Comparative effectiveness of generic versus brand-name antiepileptic medications. Epilepsy Behav. 2015;52(Pt A):14-8.

Creese A, Kotwani A, Kutzin J, Pillay A. Evacuating pharmaceuticals for health policy in low and middle income country settings. In Freemantle N, Hill S, editors. Evaluating pharmaceuticals for health policy and reimbursement. Massachusetts, USA: Blackwell Publication; (in collaboration with WHO Geneva); 2004:227-43.




How to Cite

Wadagbalkar, P., Patel, P., & Raipurkar, S. V. (2017). Cost variation analysis of ACE inhibitors in India. International Journal of Basic & Clinical Pharmacology, 6(6), 1522–1525.



Original Research Articles