HomeAboutusEditorial BoardCurrent issuearchivesSearch articlesInstructions for authorsSubscription detailsAdvertise

  Login  | Users online: 204

   Ahead of print articles    Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size  


 
 Table of Contents    
ORIGINAL ARTICLE  
Year : 2021  |  Volume : 46  |  Issue : 1  |  Page : 93-96
 

Cost analysis of different antibiotic brands available in indian market with reference to National List of Essential Medicines


Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission20-Apr-2029
Date of Acceptance20-Dec-2022
Date of Web Publication1-Mar-2021

Correspondence Address:
Dr. Mathaiyan Jayanthi
Department of Pharmacology. Institutional Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_296_20

Rights and Permissions

 

   Abstract 


Background: About 60%–90% of healthcare spending in India is on medicine which is mainly out of pocket. Almost all the drugs including antibiotics are available as brands with variable cost. Indian government formulated National List of Essential Medicines (NLEM) to ensure availability of affordable medicines to the population. Prescribing drugs from NLEM and considering the cost of drug, especially antibiotics in practice, can reduce cost of treatment and patient's out-of-pocket expenditure. Objective: The objective of the study is to analyze cost variation of different antibiotic brands available in Indian market with reference to NLEM. Materials and Methods: List of antibiotics listed in the NLEM 2015, India, was prepared. Percentage cost variation and cost ratio of different brands of these antibiotics were calculated and compared. Results: We found 17 antibiotics listed in NLEM 2015. The number of brands varied from 2 to 102. We found wide cost variations among different brands of same antibiotics. Minimum cost variation was 7.34% (for ciprofloxacin 200 mg/100 ml vial) while maximum 1049.82% (for azithromycin 500 mg tablet). Conclusion: There is wide cost variation in different brands of same antibiotics listed in the NLEM. Prescribers should prescribe cheaper brands of antibiotics to ensure that patients complete the course of treatment and thus reduce development of resistance to antibiotics.


Keywords: Branded antibiotics, cost variation, generic antibiotics, national list of essential medicines, out-of-pocket expenditure


How to cite this article:
Meena DK, Jayanthi M. Cost analysis of different antibiotic brands available in indian market with reference to National List of Essential Medicines. Indian J Community Med 2021;46:93-6

How to cite this URL:
Meena DK, Jayanthi M. Cost analysis of different antibiotic brands available in indian market with reference to National List of Essential Medicines. Indian J Community Med [serial online] 2021 [cited 2021 Apr 23];46:93-6. Available from: https://www.ijcm.org.in/text.asp?2021/46/1/93/310466





   Introduction Top


Out-of-pocket expenditure is the main source of health funding. About 58% of India's health expenditure is being spend out of pocket of the patient.[1] The Indian pharmaceutical market is flooded with more than 3000 pharmaceutical companies, 10,500 manufacturing units, and more than 60,000 generic brands across 60 therapeutic categories.[2] In India, antibiotic consumption became double between 2000 and 2015. Use of antibiotic in India increased from 3.2 billion defined daily dose (DDD) to 6.5 billion in 2015.[3] Of the total medicines sales worth USD 12.6 billion in India between 2013 and 2014, anti-infective contributed around 16.8% of the pharmaceutical market (USD 2.12 billion).[4] Misuse or overuse of antibiotics is commonly reported in India. In India, most of the drugs are available in brands. Prescribing of costly brands of antibiotics leads to increase treatment cost, and patient may not able to afford complete course of antibiotic treatment, which can contribute to the development of resistance to antibiotics. It has been observed that there is wide variation in the cost of different brands of same generic drug.[5],[6],[7],[8],[9] In 2013, India framed Drug Price Control Order which aims to ensure that essential drugs are available to all those who require them at affordable prices, under which prices of 814 scheduled formulations has revised and fixed by the National Pharmaceutical Pricing Authority.[10] National List of Essential Medicines (NLEM) in India has been formulated with the aim to promote rational use of medicines. The NLEM, 2015 comprises a total of 376 medicines including 17 different antibiotics.[11]

To the best of our knowledge, there is no study that compares the cost variations of different brands of NLEM-listed antibiotics available in the Indian market. This study was aim to find out the most economic and expensive brands of antibiotics available in the Indian market with reference of NLEM. Data from this study may be useful for prescribers and pharmacists to promote cost-effective use of antibiotics.


   Materials and Methods Top


The complete list of antibiotics included in NLEM, 2015, India, was prepared. Information regarding cost of different brands of antibiotics available in the Indian market was taken from latest edition of Current Index for Medical Specialties 41st Issue published in 2019. The price of antibiotics was measured in cost per DDD unit. The cost/DDD is calculated by multiplying the unit cost of suitable strength of the formulation with the number of units required to maintain the DDD. Percent cost variation and cost ratio were calculated for each antibiotic using the formula given below. Cost variation of an individual antibiotic of selected strength was compared.

Percent cost variation = (Maximum cost − Minimum cost/Minimum cost) × 100.

Cost ratio = Cost of most expensive brand/Cost of least expansive brand of same antibiotic.


   Results Top


A total of 17 antibiotics were found in NLEM, 2015, and all were included for analysis. Number of brands varied from 2 for ciprofloxacin 200 mg vial, gentamicin 80 mg vial, and cotrimoxazole (sulfamethoxazole 800 mg + trimethoprim 160 mg) to 102 for amoxicillin 500 mg + clavulanic acid 125 mg tablet. Wide cost variation was among different brands of antibiotics. The highest percent cost variation was found 1049.82 for azithromycin 500 mg tablet followed by 958.44 for doxycycline 100 mg tablet and 726 for nitrofurantoin 100 mg tablet, whereas the least percent cost variation was found as 7.34 for ciprofloxacin 200 mg vial followed by 8.83 for azithromycin 500 mg vial and 10.62 for cotrimoxazole (sulfamethoxazole 800 mg + trimethoprim 160 mg) tablet. On calculation of cost ratio between most and least expensive brand of individual antibiotic, we found the highest cost ratio as 11.4 for azithromycin 500 mg tablet followed by 10.5 for doxycycline 100 mg tablet and 8.3 for nitrofurantoin 100 mg tablet whereas the least cost ratio as 1.0 for ciprofloxacin 200 mg vial and azithromycin 500 mg vial followed by 1.1 for cotrimoxazole (sufamethoxazole 800 mg + trimethoprim 160 mg) tablet and 1.2 for cefadroxil 500 mg tablet. Price range between least and most expensive brand of individual antibiotic was found maximum as 775–1360 for ceftazidime 1000 mg vial followed by 69.24–183.20 for cefotaxime 500 mg vial and 100–196 for ceftriaxone 1000 mg vial. Minimum price range was found as 3.20–3.54 for cotrimoxazole (sulfamethoxazole 800 mg + trimethoprim 160 mg) tablet followed by 7.08–7.60 for ciprofloxacin 200 mg vial followed by 14.52–16.92 for cefadroxil 500 mg tablet. [Table 1] shows antibiotics that listed in NLEM, 2015 and have cost variation above 2%.
Table 1: ATC code and defined daily dose of antibiotics listed in national list of essential medicines 2015 and have cost variation above two percent

Click here to view



   Discussion Top


In 2000, India made a policy “Health for All” and one of the main objectives of this policy was to ensure the availability of quality medicines at a reasonable cost to the society.[12] An increased cost is related with decreased medication adherence, which ultimately results in poorer health outcomes.

We found wide cost variation between different brands of essential medicines. In our study, minimum percent cost variation was 7.34 and maximum percent cost variation was 1049.82. The minimum value is comparable with a previously published study from India done by Mir et al., where the minimum cost variation was nine for tigecylcine. Maximum cost variation in this study was 2000 for ciprofloxacin which was higher than our study.[7] Another study done by Srivastava and Kantharia reported maximum cost variation as 21.05 for levofloxacin which is lower than in our study.[8] In our study, we found the maximum cost ratio as 11.4 for azithromycin 500 mg tablet which was different from previous reported where the maximum cost ratio was 19.3 and 21.64, respectively.[7],[8] The difference in percent cost variation and cost ratio between current study and previously published study may be because our study mainly focused only on NLEM-listed antibiotics where previous studies included all the antibiotics available in Indian market.

The concept of essential medicines was first launched in 1977 by the WHO, and it was one of the eight pillars of WHO's primary healthcare plan. Although the main objective of NLEM is to ensure a regular availability and access of affordable medicines to the Indian population, physicians do not follow NLEM in practice which results in an increased financial burden to patients. One of the major impacts of the NLEM is that, currently, it has become the reference point for price regulation.

The present study compared the cost variation of drugs without considering the quality, which is a limitation. Quality data on individual brands of drugs are not readily available on public domain which makes it difficult to find this information. The government, during policy-making, should carefully study these price variations among antibiotic brands and take steps to ensure price regulation. Prescribers should prescribe medicines from NLEM and consider the cost of drug in practice to reduce drug-related financial burden on patients.


   Conclusions Top


There is wide cost variation in different brands of same antibiotics listed in NLEM. Following NLEM concept and considering cost of antibiotics during practice can reduce health-related patient's out-of-pocket expenditure. Prescribing cheaper brands of antibiotics can help to ensure that patients complete the course of treatment and thus reduce development of resistance to antibiotics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
WHO Global Health Expenditure Atlas; 2014. Available from: http://www.who.int/health-accounts/atlas2014.pdf. [Last accessed on 2019 Nov 04].  Back to cited text no. 1
    
2.
Pharmaceuticals. India Brand Equity Foundation. Available from: https://www.ibef.org/download/PharmaceuticalMay2017.pdf. [Last accessed on 2019 Nov 19].  Back to cited text no. 2
    
3.
Million Death Study Collaborators; Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet 2010;376:1853-60.  Back to cited text no. 3
    
4.
India the Antibiotic Capital of World. Available from: https://www.downtoearth.org.in/blog/health/india-the-antibiotic-capital-of-the-world-63097 5/13. [ Last accessed on 2019 Nov 21].  Back to cited text no. 4
    
5.
Mehta A, Hasan Farooqui H, Selvaraj S. A critical analysis of concentration and competition in the Indian pharmaceutical market. PLoS One 2016;11:e0148951.  Back to cited text no. 5
    
6.
Gupta RK, Reddy PS. A calm look on cost analysis of different brands of anti-epileptic drug. J Mahatma Gandhi Inst Med Sci 2011;16:64-6.  Back to cited text no. 6
    
7.
Mir SA. Cost analysis of different brands of antimicrobial agents available in India. Int J Basic Clin Pharmacol 2016;5:85-9.  Back to cited text no. 7
    
8.
Srivastava R, Kantharia ND. Analysis of price variation of some commonly used antibacterial agents. Int J Basic Clin Pharmacol 2019;8:1567-71.  Back to cited text no. 8
    
9.
Karve AV, Paul KB. Economic analysis of oral cephalosporins in the Indian market. Int J Res Med Sci 2019;4:4143-9.  Back to cited text no. 9
    
10.
NPPA Fixes Ceiling Prices of 814 Scheduled Formulations. Available from: https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmacyeuticals/nppa-fixes-ceilingprices-of-814-scheduled-formulations/articleshow/59402801.cms. [Last accessed on 2019 Dec 15].  Back to cited text no. 10
    
11.
Report of the Core-Committee for Revision of National List of Essential Medicines. November, 2015. Available from: http://cdsco.nic.in/WriteReadData/NLEM-2015/Recommendations.pdf. [Last accessed on 2019 Dec 24].  Back to cited text no. 11
    
12.
Gurbani N. Access to quality medicines and health products in Rajasthan. J Healthc Commun 2017;2:1-7.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
           

    

 
   Search
 
  
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Article in PDF (327 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusions
    References
    Article Tables

 Article Access Statistics
    Viewed320    
    Printed2    
    Emailed0    
    PDF Downloaded31    
    Comments [Add]    

Recommend this journal

  Sitemap | What's New | Feedback | Copyright and Disclaimer
  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007