Rational use and cost variation analysis of antitussive-expectorants available in the Indian market: a pharmacoeconomic study

Background: Antitussive-expectorants are among the most frequently prescribed drugs by physicians in clinical practice. Upper respiratory tract infections, such as common cold, acute pharyngitis and acute trachea-bronchitis, are the most common of all communicable diseases and significantly increase OPD burden. This study aimed to assess the rational use, cost ratio, and percentage cost variations in different brands of the commonly prescribed antitussive-expectorants available in the Indian market.Methods: The cost of antitussive-expectorant manufactured by different pharmaceutical companies was obtained by using drug today Jan-April 2021 vol 2. The maximum and minimum price was noted down, cost ratio and percentage cost variation of the individual formulation were analysed. Results: Analysis of cost ratio and percentage cost variation for each formulation of the antitussive-expectorants drug, syrup (100 ml) chlorpheniramine (2 mg), dextromethorphan (10 mg), phenylephrine (5 mg) combinations show the highest cost ratio and percentage cost variation as 5.30 and 430.25 respectively, and syrup (100 ml) dextromethorphan (10 mg), guaifenesin (100 mg), phenylephrine (25 mg), chlorpheniramine (4 mg) combinations show lowest cost ratio and percentage cost variation as 1.17 and 17.69 respectively.Conclusions: There was a wide variation in the cost of different brands of antitussive-expectorant drugs available in the Indian market. So, clinicians should be aware of rational use and variations in cost to reduce the treatment cost and increase patient compliance.

Pharmacoeconomic Study on the Application of Magnetic Resonance Imaging with Gadoxetic Acid in Addition to Contrast-Enhanced Computed Tomography in Diagnosis of Hepatocellular Carcinoma

Objective: to evaluate pharmacoeconomic advantages of the application of magnetic resonance imaging (MRI) with hepatobiliary-specific contrast agent – gadoxetic acid in addition to contrast-enhanced computed tomography (CT) in the diagnosis of hepatocellular carcinoma (HCC).Material and methods. We performed the modeling and obtained the results of the pharmacoeconomic study: effectiveness analysis, cost analysis, and cost-effectiveness analysis. The cost analysis included only direct medical costs (the cost of contrast-enhanced CT, gadolinium-based contrast agent (GBCA) for MRI, and therapy per a patient with verified HCC diagnosis after diagnostic procedures). The financing was performed from the Compulsary Health Insurance Fund. The calculations were made per 1 patient.Results. The effectiveness analysis showed that the diagnostic scheme CT + MRI with gadoxetic acid was the most effective complex for the diagnosis of HCC because its application provided 50% of patients with 5-year overall survival (4.8 years), which was significantly higher than in patients who were diagnosed HCC with CT + MRI with extracellular GBCA (2.3 years) or CT (3.7 years). The cost-effectiveness analysis showed that the diagnostic scheme with gadoxetic acid was dominant because each disability-adjusted life year required fewer costs (14 862 rubles) in comparison with CT + MRI with extracellular GBCA (25 293 rubles) or CT (46 540 rubles). According to the results of the incremental cost-effectiveness ratio analysis, the application of the diagnostic complex with gadoxetic acid was characterized by the lowest rate of additional costs per 1 disability-adjusted life year.Conclusion. The pharmacoeconomic study showed that the application of MRI with a hepatospecific contrasting agent – gadoxetic acid in addition to contrast-enhanced CT was an effective and economically beneficial method of early HCC diagnosis.

Interdisciplinary Pharmacoeconomic Study of Pharmacotherapy of Cupping of Drunk Forms of Alcohol Dependence: Clinical and Pharmacological, Organizational, Legal and Marketing Experiment

An interdisciplinary pharmacoeconomic study of pharmacotherapy for the relief of alcoholic dependence on the basis of experimental clinical and pharmacological, organizational, legal and marketing studies. The scheme of basic pharmacotherapy of relief of drunken forms of alcohol dependence developed by the authors for the interdisciplinary study was used. Thirteen international nonproprietary names of drugs from Ukrainian (92.3%) and foreign (7.7%) manufacturers were selected. It was established that for pharmacotherapy of support of relief of drunken forms of alcohol dependence tablets occupy 23,1% of appointments of doctors, solutions – 76,9%. The scheme of pharmacotherapy in the relief of intoxicated forms of alcohol dependence includes 38.5% of international nonproprietary names of drugs with ATC code "A" - drugs that affect the digestive system and metabolism; 30.7% with ATC code "B" - drugs that affect the blood system and hematopoiesis; 15.4% with ATC codes of classification "C" – drugs that affect the cardiovascular system and "N" – drugs that affect the nervous system. Nomenclature and legal analysis showed that 92.3% of the studied drugs belong to prescription nomenclature and legal group; the share of OTC drugs is 7.69% (international nonproprietary name Antral).

Cost Analysis of Haemodialysis Patients in Government Tertiary Care Centre – A Pharmacoeconomic Study

The progression of chronic kidney disease (CKD) to End-Stage Renal Disease (ESRD) in India is rapidly increasing. Over 25 million of people suffering from ESRD, especially in rural areas. Many of these patients are not undergoing dialysis due to the factors such as lack of awareness, fewer treatment options, unaffordability prices due to low income, and minor reimbursement for chronic illness. The cost of hemodialysis in private hospitals is around 12.000 INR (Indian Rupee) per person monthly and 140.000 INR per year, which seem too expensive for middle and lower-middle-class of patients. Hence our study was aimed to analyze the healthcare cost of hemodialysis in government tertiary health care centers by analyzing the direct and indirect cost from the patient perspective. Sixty patients who underwent dialysis in Hassan Institute of Medical Sciences Teaching Hospital were included in this study. The demographic details, past and present medical history, cost per session of dialysis, laboratory examination, money spent on travel, and the working days lost were calculated. Out of 60 patient (male: 47; female: 17), 53 patients aged 18-65 years old. They belonged to lower-middle (38.33%), middle (23.33%), lower (21.66%), and upper-middle-class (8%). The average direct medical cost of each patient in one session of dialysis was 481.5 INR and indirect medical costs were 557.33 INR. Based on our observation, we conclude that the patients are having satisfactory outcomes, comparatively at low cost in our government dialysis unit. Government should encourage and also cover the mobile dialysis centers under government health schemes, by which the indirect medical cost can be reduced.

A pharmacoeconomic study: cost-utility analysis of modern wound dressings vs conventional wound dressings in patients with diabetic foot ulcer

Introduction: Duration of treatment and outcome of therapy of diabetic foot ulcers are some of the factors that affect the quality of life and will require higher medical costs. Objectives: This study aimed to choose an alternative wound dressing that provides the best utility at the most cost-efficient. Methods: The research method used was pharmacoeconomics with a patient’s perspective. Results: The results showed the mean cost of modern wound dressings per visit was IDR 347,131, while that of conventional wound dressings was IDR 47,140. The quality of life with modern vs conventional wound dressing was significantly different (p < 0.05). The incremental cost utility ratio (ICUR) value was IDR 22,813 per quality of life (QoL). Conclusions: This study showed that modern wound dressings provide a higher quality of life at a higher cost. Indeed, it cost more than IDR 22,813 to change from conventional to modern wound dressings and increase 1 unit of quality of life, but patients obtained an additional 13.15 quality of life.

A pharmacoeconomic study of different brands of commonly prescribed antihypertensive drugs

Background: The hypertension is the most common chronic disease, therefore treatment should be affordable. The antihypertensive drugs of same strength are available in market at different costs. This study was undertaken to create awareness among health care workers and patients, about cost difference among different brands of same antihypertensive drug. So that whenever possible, a cheaper effective brand can be prescribed to ensure better patient adherence.Methods: Maximum retail price (MRP) of various antihypertensive drugs of same strength, manufactured by different pharmaceutical companies was obtained from various offline and online sources. The minimum and maximum cost of 10 tablets/capsules noted. The cost ratio and percentage cost variation was calculated for single drug and fixed dose combinations. The ceiling price (as per DPCO) of essential antihypertensives (as per national list of essential medicines) was compared with their maximum cost.Results: The formulations of single antihypertensive drugs (41) and fixed dose combinations of two drugs (19) and three drugs (9) were included in the study. Among the single antihypertensives analyzed the highest cost difference was of eplerenone (50 mg) and high cost ratio and cost variation percentage was of amlodipine (5 mg). Among fixed dose combination of two drugs analyzed highest cost difference was found that of hydrochlorothazide (12.5 mg)+olmesartan (40 mg) combination and highest cost ratio and percentage cost variation was of amlodipine (5 mg)+telmisartan (40 mg).Conclusions: There was a huge price variation among the antihypertensive drugs manufactured by various companies. Some measures must be taken by the government to bring the uniformity in the price that will help to reduce the economic burden on the patients.

A COST VARIATION ANALYSIS STUDY OF DRUGS USED IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA AVAILABLE IN THE INDIAN MARKET

Objectives: The objectives of the study are to evaluate the cost variation and cost ratio of different brands of the drugs used in the treatment of benign prostatic hyperplasia (BPH). Methods: The cost of alpha-blockers and 5 alpha-reductase inhibitors used in the treatment of BPH was noted from CIMS (Oct 2019–Jan 2020), Drugs Update, and Medline. The differences between the maximum and minimum cost of various brands of the same drug were analyzed and percentage variation in the cost was calculated. The results of the study were expressed in absolute numbers and percentages. Results: All the drugs used in the treatment of BPH are only available in tablet and capsule forms, in 10 different dosages and in 242 different brand names, of which 10 mg alfuzosin and 2.5 mg finasteride have the highest (518) and lowest (14) percentage of cost variation, while 0.4 mg tablet form of tamsulosin is available in the maximum number of brands-41. Conclusion: This pharmacoeconomic study reveals that there is wide variation in the cost of most of the drugs used in the treatment of BPH. Therefore, it is very much essential for both government and pharmaceutical companies to make combined efforts to reduce the cost of these drugs, which will reduce the economic burden on the patients and also reduce the overall health care costs.

Cost of Venous Thromboembolic Disease in Patients with Lung Cancer: Costecat Study

Background: Patients with lung cancer (LC) are at significantly higher risk of developing venous thromboembolism (VTE), which may lead to increased use of health resources and the cost of management. The main aim of the study was to determine the cost of the management of VTE events in patients with LC treated with Low Molecular Weight Heparins (LMWH) in Spain. Methods: Costecat was an, observational, ambispective pharmacoeconomic study. Patients with LC, with a first episode of VTE (symptomatic or incidental) in treatment with LMWH, were recruited from six third-level hospitals and followed up for six months. Sociodemographic, clinical and resource use variables of VTE-related implications and its treatment were collected. Direct healthcare costs and direct non-healthcare costs were recorded. Data collection was documented in an electronic case report. Unit costs were obtained from national databases. Costs (€2018) were estimated from the healthcare perspective. Statistical analysis was performed using the statistical program R 3.4.3 version (30 November 2017). Results: Forty-seven patients were included. Mean age was 65.4 years, 66.0% were male. The percentage of patients with LC who had metastatic disease was 78.7%. Twenty-three patients (48.9%) needed hospital admissions due to thromboembolic episode. Total average cost of patients with cancer associated VTE (CAT) was €109,696.6 per patient/semester. The hospitalizations represent 65.8% of total costs (7207.3 € SD 13,996.9 €), followed by LMWH therapy which represents 18.6% (2033.8 € SD:630.5 €). Conclusions: Venous thromboembolism episodes induce an economic impact on patients and healthcare systems. Direct healthcare costs are the major burden of the total cost, in which hospitalizations are the main drivers of cost.

Results of a pharmacoeconomic analysis of the rationality of the use of acute myeloid leukemia chemotherapy regimens with the use of various doses of cytarabine

A pharmacoeconomic study of the rationality of the use of various chemotherapy regimens (“7 + 3” scheme) in the treatment of patients with acute forms of myeloid leukemia has been carried out. The use of the chemotherapy regimen “7 + 3” with 200 mg / m2 / per day dosage of cytarabine on 1-7 days allows to achieve a unit of treatment efficacy at a lower cost (CEA = 19.22 US $ / per unit of efficacy), compared with another dosage of cytarabine that was two times less, i.e., 100 mg / m² / day at the same period (CEA = US $ 20.18 / unit of effectiveness). The presented research results can be used in the formation of programs for the rational use of limited resources in the purchase of anticancer drugs for hematological cancer patients, as well as in the development of schemes for providing them with effective medical care in a hospital setting.