Cost analysis and price variation of commonly used drugs in obstetrics and gynecology in Jhalawar district of Rajasthan, India
Keywords:Adherence, Cost analysis, Compliance, Price variation, Pharmacoeconomics
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.
Supriya S, Deshmukh YA, Mandavi R, Urmila S. Study of drug utilization pattern in the gynecology opd of a tertiary care centre. World J Phar and Pharmaceuti Scienc. 2014;3(12):916-23.
Shankar PR, Subish P, Mishra P, Lalit M. Ambiguous pricing of Nepalese medicines. J Inst Med. 2006;28(3):35-8.
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.
Gupta SK. Proposed Pharmacoeconomics Guidelines for India (PEG-I). IPSOR India Chapter; 2013:79-100.
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); 2004:227-243.
Shrank WH, Hoang T, Ettner SL. The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med. 2006;166(3):332-7.
Of India’s healthcare spend, 2/3 out of patients’ pockets: Study. Available at: http://indianexpress.com/article/india/of-indias-healthcare-spend-23-out-of-patients-pockets-study. Accessed 10th February 2018.
Morbidity, Health Care and the Condition of the Aged NSS 60th round (January - June 2004) National Sample Survey Organisation Ministry of Statistics and Programme Implementation.
Atal S, Drug Prescribing Pattern and Cost Analysis of Antipsychotics at a Tertiary Care Hospital. Int J Pharm Sci Res. 2016;7(6):2611-14.
Compendium of notified ceiling prices of scheduled drugs. National Pharmaceutical Pricing Authority; 2015. Available at: http://www.nppaindia.nic.in. [Last accessed on 27 Jul 2015].
Shrivastava SK. In: Essential drug concept, P-drugs, rational drug therapy, compliance, drug information and pharmacoeconomics. A complete textbook of medical pharmacology. 1st Ed. Sirmour HP. Avichal publishing company; 2012:117.
Kumar V, Gupta NV, Kumar AK. A comparison between old and latest systems in DPCO. Int J Pharm Pharm Sci. 2014;6:19-20.
Order (Published in Part II, Section 3, Sub-section (ii) of the Gazette of India, Extraordinary). New Delhi. Available at: http://www.nppaindia.nic.in/ceiling/press24aug15/so2308e-24-8-15.html. [Last accessed on 01 Aug 2015].
Drug pricing policy irrational re-examine it, Supreme Court tells Centre. [Homepage on the Internet]. New Delhi. The Times of India. Available at: http://timesofindia.indiatimes.com/india/Drug-pricing-policy-irrational-re-examine-it-Supreme-Court-tells-Centre/articleshow/48092107.cms. [Last accessed on 02 Aug 2015].
Kumar PS, Balmuralidhara V, Kumar TP. Need for Drug Price Control in India. Advan J Phar Life Sci Resear. 2013;1(1):22-30. Available at: http://ajplronline.org/uploadfile/635.pdf
Rathore A, Mantry P. Impact of DPCO 2013 on availability of essential medicines in market. Int J Eco Comm Manageme. 2013;1(1):1-3. Available at: http://ijecm.co.uk/wp-content/uploads/2014/01/117.pdf
Shankar PR, Subish P, Bhandari RB, Mishra P, Saha AC. Ambiguous pricing of topical dermatological products: a survey of brands from two South Asian countries. J Pak Assoc Dermatol. 2006;16:134-40.
Price Notifications. Order (Published in Part II, Section 3, Sub-Section (ii) of the Gazette of India, Extraordinary). New Delhi. Available at: http://www.nppaindia.nic.in/paragraph19/press10july14/so1735e-10-7-14.html. [Last accessed on 29 Jul 2015].
Ahuja J, Gupta M, Gupta AK, Kohli K. Pharmacoeconomics. Natl Med J India. 2004;17:80-3.
Trask L. Pharmacoeconomics: Principles, methods, and applications. In: Di Piro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: a pathophysiologic approach. 8ed. New York, NY: McGraw-Hill; 2011. Available at: http://accesspharmacy.mhmedical.com/ content.aspx? bookid=462andSectionid=411007. [Last accessed on 13 Sep 2015].
Haider BA, Spiegelman D, Ezzati M. Anaemia, prenatal iron use and risk of adverse pregnancy outcomes: Systematic review and meta-analysis. BMJ. 2013:346.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Grantham-McGregor, S.; Katz, J.; Martorell, R.; et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427-51.
Parveen K, Momen A, Begum AA, Begum M. Prevalence of urinary tract infection during pregnancy. J Dhaka Nat Med Colle & Hospit. 2011;17(2):8-12.
Prescrire R. Paracetamol during pregnancy: no particular danger for the child. Prescrire Int. 2012;21:186-7,190.
Frazier LM, Brown JT, Divine GW, Fleming GR, Philips NM, Siegal WC, et al. Can physician education lower the cost of prescription drugs? A prospective, controlled trial. Ann Intern Med. 1991;115:116-21.
Medical council of India; 2016. Available at: http://www.ipgmer.gov.in /Pharmacovigilance Committee/MCI_CircularUseofGenericNames20170421.pdf. Accessed 10th February 2018.
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;43:131-6.
Raju K, Elumalai A, Sridhar E. Irrational drug combinations. Int J Experim Pharmacol. 2013;3(2):52-6.