Cost-analysis study of second generation antihistamines used in the treatment of allergic rhinitis in India
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20162218Keywords:
Second generation antihistamines, Allergic rhinitis, Cost-analysis, Partial pharmacoeconomic studyAbstract
Background: Second-generation antihistamines (SGAs) are the most commonly used drugs for AR nowadays. The cost of medicines is very important determinant in drug compliance; selection of low cost quality drugs would thus be helpful in improving compliance. Literature search revealed no such study done in India and the current study was thus planned to compare the variation in the cost of different SGAs used for the treatment of allergic rhinitis in India. The study results would help doctors, pharmacists in selecting the least costly options among the available SGAs.
Methods: The costs in Indian rupee (INR) of different generic and branded SGAs available in Indian market were referred from CIMS, drug today and the website www.medindiaguide.com. The dose for each drug was taken as per WHO defined daily dose (DDD) for allergic rhinitis. The highest and lowest price for ten tablets/capsules of each SGA manufactured by different pharmaceutical companies was noted. The percentage cost variation and cost ratio were then calculated for each drug.
Results: Eight oral SGAs with a total of 1050 oral tablets or capsules manufactured by different companies are available for use in AR in India. The highest number of manufacturers were for levocetirizine (483), and lowest for mizolastine (2). Fexofenadine (INR 123.56) was the costliest and levocetirizine the cheapest (INR 2.3) SGA. Maximum variation in price was seen with cetirizine (4300%). The cost ratio was highest for cetirizine (44), and lowest for mizolastine (1.1). Cetirizine is the only SGA from the National List of Essential Medicines (NLEM) 2015 of India; also the only SGA in the DPCO 2013 list of controlled drugs and formulations.
Conclusions: There is huge variation in the price of same SGA being manufactured by different companies. Between the least expensive and the most expensive cetirizine, there is a huge cost variation of 4300%.
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References
WAO White Book on Allergy 2011-2012: Executive Summary. Available at: http:// www. worldallergy. org /publications/ wao_white_book.pdf. Accessed on 21 April 2016.
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization. Allergy. 2008;63(86):8-160.
Hansen J, Klimek L, Hormann K. Pharmacological management of allergic rhinitis in the elderly: safety issues with oral antihistamines. Drugs Aging. 2005;22:289-96.
Ramirez JF, Pavon RG, Juarez MLL, Teran LM. Allergic Rhinitis. J Aller Ther. 2012;5:6.
Drugs Prices Control Order. 2013. Available at: http:// www. nppaindia. nic. in/ DPCO 2013.pdf. Accessed on 9 May 2016.
Srinivasan S, Srikrishna T, Aisola M. Pharma price control policy: unrealistic and unfair. Economic Political Weekly. 2014;49(34):13-5.
Haycox A, Boland A, Walley T. Basics of economics, health economics and pharmacoeconomics. In: Walley T, Haycox A, Boland A, eds. Pharmacoeconomics. Edinburgh: Churchill Livingstone;2004:1-16.
Townsend RH. Post marketing drug research and development. Drug Intell Clin Pharm. 1987;21:134-6.
Trask LS. Pharmacoeconomics: principles, methods, and applications. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill Global Education Holdings;2011. Available at: http://accesspharmacy.mhmedical.com/content.aspx?bookid=462&Sectionid=41100767. Accessed on 26 April 2016.
Kulkarni U, Dalvi K, Moghe VV, Deshmukh YA. Pharmacoeconomics: An emerging branch in heath science for decision making. Afr J Pharm Pharmacol. 2009;3(8):362-8.
Current index of medical specialities. UBM Medica India Private Limited, Bangalore. 2016:132;479-87.
Mishra L. Drug today: Ready reckoner of current medical formulations. Lorina Publications (India) Inc., New Delhi. Oct-Dec 2015.
Defined daily dose. Available at http://www.whocc.no/ddd/definition_and_general_considera/. Accessed on 11 Dec 2015.
Comparison: Percent Difference. Available at http://www.oracle.com/webfolder/technetwork/data-quality/edqhelp/Content/processor_library/matching/comparisons/percent_difference.htm. Accessed on 19 April 2016.
Shankar PR, Subish P, Mishra P, Lalit M. Ambiguous pricing of Nepalese medicines. J Institute Med. 2006;28:35-8.
Lal A, Sharma ML. A calm look at the cost of drugs in psychiatric practice. Indian J Psychiat. 1992,34(1),18-20.
WHO Model List of Essential Medicines. Available at http:// www. who. int/ medicines/ publications/ essentialmedicines/en/index.html. Accessed on 13 March 2016.
National List of Essential Medicines of India, 2015. Available at: http: //cdsco.nic.in/ WriteReadData /NLEM-2015/NLEM,%202015.pdf. Accessed on 13 March 2016.
Date AP, Mahajan HM, Dashputra AV, Bhosale RR. Study of variation in price of various antidiabetic drugs available in Indian market. Int J Basic Clin Pharmacol. 2015;4:36-40.
Wagle L, Kumaraswammy M, Kempegowda MB. Cost variation study of antiepileptic drugs available in India. Asian J Pharm Clin Res. 2016;9(2):64-8.
Akila L, Rani J. Cost analysis of different brands of antianginal drugs available in India. Int J Basic Clin Pharmacol. 2015;4(5):860-3.
Karve AV, Chattar KB. Cost analysis study of oral antihypertensive agents available in Indian market. Int J Basic Clin Pharmacol. 2014;3:479-83.
Phatak A, Hotwani J, Deshmukh K, Panchal S, Naik M. Cost analysis of long established and newer oral antiepileptic drugs available in the Indian market. Int J Med Res Health Sci. 2015;4(4):744-8.
World health statistics 2012. Available at http://apps.who.int/iris/bitstream/10665/44844/1/9789241564441_eng.pdf?ua=1. Accessed on 27 March 2016.
Kumar AKS, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A, et al. Financing health care for all: challenges and opportunities. Lancet. 2011;377:668-79.
Draft National Health Policy. Available at: http://www.thehinducentre.com/multimedia/archive/02263/Draft_National_Hea_2263179a.pdf. Accessed on 28 April 2016.
Boston Consulting Group. The hidden epidemic: finding a cure for unfilled prescriptions and missed doses. 2003. Available at http:// www.bcg.com /documents/file14265.pdf. Accessed on 10 May 2016.
Kennedy J, Tuleu I, Mackay K. Unfilled prescriptions of medicare beneficiaries: prevalence, reasons, and types of medicines prescribed. J Manag Care Pharm. 2008;14(6):553-60.
Srinivasan S, Bhargava A. Impoverishing the poor: pharmaceuticals and drug pricing in India. Low Cost Standard Therapeutics (LOCOST). Vadodara/Bilaspur,India.2004. Available at http: //www. Jssbilaspur .org /wordpress /wp-content /uploads /2015 /10 /Impoverishing –the -poor-Pharmaceuticals-and-drug-pricing-in-India.pdf. Accessed on 27 March 2016.
World Health Organization and Health Action International. Measuring medicine prices, availability, affordability and price components. 2008. Available at: http: //www.who.int /medicines /areas /access/ OMS_Medicine_prices.pdf. Accessed on 27 March 2016.
Jan aushadhi. Available at: http:// janaushadhi.gov.in /about_jan_aushadhi.html. Accessed on 17 March 2016.
Niramaya Arvi. Available at https:// niramayaarvi. wordpress.com. Accessed on 17 March 2016.
Low cost standard therapeutics (LOCOST). Available at: http:// www. locostindia. com/. Accessed 17 March 2016.
Life Line drug store. Available at: http://www.rmsc.nic.in/llds.html. Accessed 11 June 2016.
Adis international limited. Second-generation antihistamines have similar efficacy in allergic rhinitis, but their tolerability and metabolism differ. Drug Ther Perspect. 2007;23:17-9.
