Published: 2016-12-28

Observational study to assess prescription cost and its relation to the socioeconomic status of the patients in psychiatry outpatient department in a tertiary care hospital

Sumit G. Goyal, Dnyaneshwar G. Kurle, Balwant D. Samant


Background: To analyse the cost of prescriptions and to determine the relationship between socioeconomic status of the patients and the cost of prescriptions.

Methods: A prospective, observational study was conducted in psychiatry OPD of a tertiary care hospital from August 2007 to January 2008. 300 patients of either sex and irrespective of age suffering from mental disorders were included. Information about the socioeconomic status of the patient was analysed on the basis of Kuppuswami’s socioeconomic status scale (updated for 2007). Cost analysis (calculated for 30 days) was done by calculating (a) average cost of the prescription borne by the hospital (b) average cost of the prescription borne by the patient and (c) average total cost of the prescription. The correlation between the socioeconomic score of the patients with the above three cost parameters was carried out using the Spearman rank correlation.

Results: In a cohort of 300 patients, 61.3% patients belong to upper lower class. Cost analysis showed that the average total cost of the prescription was 121.97 INR of which average cost of the prescription borne by the hospital and the patients was 18.43 INR and 103.54 INR respectively. The total cost of the prescription and cost of prescription borne by the patient had a positive correlation with the socioeconomic score of the patient, while the cost of prescription borne by the hospital was inversely correlated with the socioeconomic score of the patient.

Conclusions: It seems that the prescribing decision was influenced by the socioeconomic status of the patients. 


Drug Costs, Psychiatry, Tertiary healthcare, Socioeconomic status

Full Text:



World Health Organization: The World Health Report 2001: Mental health - new understanding, new hope Geneva: WHO. 2001.

Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry. 2012;200(5):393-8.

Exeter D, Robinson E, Wheeler A. Antidepressant dispensing trends in New Zealand between 2004 and 2007. Aust N Z J Psychiatry. 2009;43(12):1131-40.

Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848-56.

Chong MY, Tan CH, Fujii S, Yang SY, Ungvari GS, Si T, et al. Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change. Psychiatry Clin Neurosci. 2004;58(1):61-7.

WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacology. Introduction to Drug Utilization Research. Geneva: World Health Organization. 2003.

Grover S, Avasthi A. Antipsychotic prescription pattern: A preliminary survey of Psychiatrists in India. Indian J Psychiatry. 2010;52(3):257-9.

Grover S, Avasth A, Kalita K, Dalal PK, Rao GP, Chadda RK, et al. IPS multicentric study: Antidepressant prescription patterns. Indian J Psychiatry. 2013;55(1):41-5.

Trivedi JK, Dhyani M, Yadav VS, Rai SB. Antipsychotic drug prescription pattern for schizophrenia: Observation from a general hospital psychiatry unit. Indian J Psychiatry. 2010;52(3):279.

Thakkar KB, Jain MM, Billa G, Joshi A, Khobragade AA. A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital. J Clin Diagn Res. 2013;7(12):2759-64.

Sarkar P, Chakraborty K, Misra A, Shukla R, Swain SP. Pattern of psychotropic prescription in a tertiary care center: a critical analysis. Indian J Pharmacol. 2013;45(3):270-3.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric press. 2000.

Kumar N, Shekhar C, Kumar P, Kundu AS. Kuppuswamy's socioeconomic status scale updating for 2007. Indian J Pediatr. 2007;74(12):1131-2.

Cramer JA, Rosenheck R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998;49(2):196-201.

Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97.

Mitchell AJ, Selmes T. Why don’t patients take their medicine? Reasons and solutions in psychiatry. Advances in Psychiatric Treatment. 2007;13(5):336-46.

Thieda P, Beard S, Richter A, Kane J. An economic review of compliance with medication therapy in the treatment of schizophrenia. Psychiatr Serv. 2003;54(4):508-16.

Sharma P, Das SK, Deshpande SN. An estimate of the monthly cost of two major mental disorders in an Indian metropolis. Indian J Psychiatry. 2006;48(3):143-8.

Gupta N, Sharma D, Garg SK, Bhargava VK. Auditing of Prescriptions to study utilization of antimicrobials in a tertiary hospital. Indian Journal of Pharmacology. 1997;29(6):411-5.