DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20161566

Cost-minimization analysis of proton pump inhibitors in India

Mukunda Bharat Bargade, Mohini Sachin Mahatme, Sachin Hiware, Pallavi D. Admane

Abstract


Background: Peptic ulcer disease significantly lowers quality of life. The proton pump inhibitors (PPIs) are the most potent suppressors of gastric acid secretion. Although similar in terms of efficacy and safety, PPIs have important differences in their costs. Prescription of costly brands adversely affects expenditure on health care system by patients. Therefore, we conducted this cost-minimization study of all available PPIs to help doctors in selecting the cheapest available option.

Methods: Cost-minimization analysis (CMA) compares the cost of equally effective therapeutic options for the given condition. The cost of all PPIs brands available was collected from CIMS (July 2015) and Drug Today (July 2015). Cost range, cost ratio and mean cost of the generic drug was calculated.

Results: 1122 PPI brands are available in India. Pantoprazole is most commonly available with 494 brands and dexrabeprazole has only 6 brands. All the PPIs are available in oral and injectable formulations except ilaprazole and dexrabeprazole which are available in oral formulations only. Omeprazole 20 mg and 40 mg is the cheapest in both oral and injectable form respectively while ilaprazole 10 mg is the costliest amongst all oral formulations and rabeprazole 40 mg is the costliest in injectable preparations. Highest cost ratio for oral PPIs is for omeprazole 20 mg and lowest is for omeprazole 10 mg. This variation is mostly due to large numbers of brands available for omeprazole.

Conclusions: Prescription of costly brands adversely affects patient’s economy and thereby health seeking behaviour. Therefore knowledge of the doctor about drug cost and its application in practice would be an added benefit to the patient and society.


Keywords


PPIs, CMA, Acid peptic diseases, Cross-sectional study

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References


Moore M, Gould P, Keary BS. Global urbanization and impact on health. Int J Hyg Environ Health. 2003;206:269-78.

Ibrahim H, Awadalla. Health effect of slums: A consequence of urbanization. Serbian Journal of Management. 2013;3:7-14.

Mohammed KM, Suman C, Bogadi V, Prabhakar B, Rao KPR, Devi S, et al. Epidemic trends of upper gastrointestinal tract abnormalities: hospital-based study on endoscopic data evaluation. Asian Pac J Cancer Prev. 2015;16(14):5741-7.

Sharma PK, Ahuja V, Madan K, Gupta S, Raizada A, Sharma MP. Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in Northern India. Indian J Gastroenterol. 2011;30(3):128-34.

Goh KL. Changing epidemiology of gastro-oesophageal reflux disease in the Asia-Pacific region: an overview. J Gastroenterol Hepatol. 2004;19:22-5.

Ho KY, Lim LS, Goh WT, Lee JMJ. The prevalence of gastrooesophageal reflux has increased in Asia: a longitudinal study in the community. J Gastroenterol Hepatol. 2002;16:132.

Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med. 2010;123(4):358-66.

Wallace JL, Sharkey KA. Pharmacotherapy of gastric acidity, peptic ulcers and gastroesophageal reflux disease. In: Bruxton LI, Chabner BA, Knollman BC. Goodman and Gilman’s The Pharmacological basis of therapeutics. 12th ed. New York, NY: McGraw-Hill; 2012:1311-1133.

CIMS India. Monthly index of medical specialties. c 2015 (3). Available at https://www.mims.com/. Accessed 27 October 2015.

Drug Today India. Ready reckoner of current medical formulations. 2015 (3). Available at https://www.drugtodayonline.com/drugdirectory/pharmacological-index.html. Accessed 22 October 2015.

Eisenberg JM. Clinical economics: a guide to economic analysis of clinical practices. J Am Med Asso. 1989;262(20):2879-86.

Sharma HL, Sharma KK. Treatment of gastric acidity, peptic ulcer and gastroesophageal reflux disease. In: Principles of Pharmacology. 2nd ed. Hyderabad, Paras publications; 2011:389-90.

Villamanan BE. Reasons for initiation of proton pump inhibitor therapy for hospitalized patients and its impact on outpatient prescription in primary care. Rev Esp Enferm Dig 2015.

Solis GPJ, Perez PM, Fernandez JP, Maranes AI. Inappropriate use of proton pump inhibitors, guidelines and clinical research. Rev Esp Enferm Dig. 2013;105:373.

Ralph SW, Henning B. Pharmacokinetic drug interaction profiles of proton pump inhibitors: an update. Drug Safety. 2014;37:201-11.

Patil R, Aithal S, Hooli T, Varun HV. Drug utilisation study of proton pumps inhibitors in inpatients of a tertiary care hospital: a cross-sectional study. Natl J Integr Res Med. 2015;6(5):62-5.