Oral Antidiabetic Drugs Available In Indian Market Economics Essay

There exists a wide range of variation in the prices of drugs marketed in India and other countries of world. Very few studies have been conducted to reveal such price variations in the open market.

Aim & Objectives: To evaluate the cost of oral anti-diabetics of different generic classes and different brand names of one compound, To evaluate the difference in cost of different brands for same active drug by calculating percentage variation of cost.

Methods: Cost of a particular drug being manufactured by different companies, in the same strength, number and dosage form was compared. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and the percentage variation in price was calculated.

Results: In Single drug therapy, among sulfonylurea group of drugs, Glimepiride (1 mg) shows maximum price variation of 655.38%, while Glipizide (10mg) shows variation of 38.88%. In Biguanides & Thizolidinediones groups of drugs, Metformin (500 mg) & Pioglitazone (15 mg) show maximum price variation of 308.33% & 542% respectively. In α-glucosidases inhibitor group of drugs, Miglitol shows maximum price variation of 135.50 %. In combination therapies, Glipizide & Metformin combination shows maximum variation up to 399.04 %

Conclusion: The average percentage price variation of different brands of the same drug manufactured in India is very wide and the appraisal and management of marketed drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Keywords: Cost analysis, anti-diabetic drugs, brands, price evaluation

Introduction:

In the developing countries the cost of drugs is a major concern to both physician and patient; yet there are few data on prescribing patterns and expenditure1. Cost of drugs is an important factor influencing compliance with treatment.2 In the context of pharmaceutical and other health products, differential pricing (also called tiered pricing) is the adaptation of product prices to the purchasing power of consumers in different geographical or socio-economic segments. Differential pricing could potentially be a very effective strategy to improve access to essential medicines in low and middle-income countries where most patients pay for medicines out-of-pocket and therefore cannot afford prices comparable to high income markets.3  

Diabetes is the most common non communicable disease worldwide. The International Diabetes Federation (IDF) estimates the total number of diabetic subjects to be around 40.9 million in India and this is further set to rise to 69.9 million by the year 2025.4,5 Diabetes is a chronic disorder. It requires lifelong treatment. So the cost of antidiabetic drug is the major deciding factor for the patients’ compliance. Selection of oral antihyperglycaemic agents as first-line drug or combined therapy should be based on both the pharmacological properties of the compounds (efficacy and safety profile) and the clinical characteristics of the patient (stage of disease, bodyweight, etc.) 6. There exists a wide range of variation in the prices of drugs marketed in India and other countries of world.

In the Indian market various antidiabetic drugs of various brands are available. This creates a lot problem to physician to decide the drug of choice for individual patient. Also in the literature very less studies are available which compare the cost of drugs of different brands. Regarding oral hypoglycemic agents, with the best of our knowledge no study is available which compares the cost of drugs of different brands.

So, we decided to carry out the study which compares prices of different oral anti-diabetic drugs. This study also evaluates the cost of oral anti-diabetics of different brand names of one compound and difference in cost of different brands for same active drug by calculating percentage variation of cost.

Aim & Objectives: This Pharmacoeconomic study is designed with the aims & objectives of,

To find different anti-diabetics available either singly or in combination and the No. of brands available for each.

To evaluate the cost of oral anti-diabetics of different generic classes and different brand names of one compound.

To evaluate the difference in cost of different brands for same active drug by calculating percentage variation of cost.

Materials and Methods:

CIMS (current index of medical stores) & IDR (Indian drug review) [2011 issues] were reviewed for the prices of drugs used in the management of diabetes mellitus.

The retail cost of a particular drug being manufactured by different companies, in the same strength, number and dosage form was compared.

The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies was calculated.

The percentage variation in price was calculated.

The drugs being manufactured by only one company or being manufactured by different companies however, in different strengths were excluded.

The percentage variation in price was calculated using the following formula 2

Percentage = Price of most expensive brand – Price of least expensive brand X 100

  Price of least expensive brand

The drugs were classified into five categories depending on the percentage (%) range of price variation. These were as follows

1) 0-25% 2) 25.1-50%, 3) 50.1-75%, 4) 75.1-100% and 5) more than 100%

Findings of our observational study were expressed as absolute numbers as well as percentage.

Results:

The prices of a total of 20 drugs (11 single and 9 combination preparations), available in 54 different formulations were analysed. These 54 formulations are manufactured by different pharmaceutical companies.

Single drug therapy:

In single drug therapy, Table I shows the price variation between sulfonylurea group of drugs. In this group, Glimepiride (1 mg) shows maximum price variation of 655.38%, while Glipizide (10mg) shows variation of 38.88%.

Table II shows price variation in Biguanides (Metformin) & Thizolidinediones (Pioglitazones) groups of drugs. In these groups, Metformin (500 mg) & Pioglitazone (15 mg) show maximum price variation of 308.33% & 542% respectively.

Table III shows price variation between α-glucosidases inhibitor group of drugs. In this group, Miglitol shows maximum price variation of 135.50 %.

Table IV shows price variation between Meglitinides group of drugs. In this group, Rapaglinide (0.5 mg) shows maximum price variation of 90.95 %

Combination therapy:

In Combination therapy, total 7 combination therapies were analysed. In this, Glipizide & Metformin combination shows maximum variation up to 399.04 %. Table V shows price variation in combination drug therapy

Relationship between percent price variation & no. of Manufacturing Companies:

When we draw a graph showing relationship between manufacturing companies and % price variation, it was noted that there is linear relationship in between these two variables. As the no. of manufacturing companies increases, the percent price variation also increases. (As shown in figure no.1)

Discussion:

The Indian market has over 100,000 formulations and there is no system of registration of medicines2. The drugs are mainly sold under brand names7.

A study in the United States found drug prices to be high and that price discrimination occurred across the industry7. But very less studies are available in our scenarios which compare the cost of drugs of different brands. Therefore we decided to carry out the study which compares the cost of different brands of drug of common disorder.

The drug prices available in CIIMS & IDR were compared, as they are readily available source of drug information and are updated regularly. Drugs used in the management of diabetes mellitus were selected as it is one of the major cause of morbidity and mortality & the treatment requires continuous prescription drug use.

It is observed from our results that there is a wide (up to 836.20%) variation in prices of drugs manufactured by different pharmaceutical companies. The reasons for this price variation could be as follows8-14:

The existing market structure of the pharmaceutical industry

Asymmetry of information or imperfect information

Industry costs

Government regulations and pricing policies

From our study it is also clear that, price variation was directly related to the number of companies manufacturing a particular drug. So it can be concluded that price variation increases because of increase in competition among the manufacturing companies.

Pharmacists do not dispense the same brand as prescribed by the doctor and try to substitute it with other alternatives, quoting the reason of nonavailability. This is often done with vested interest for economic gains as some brands have a higher profit margin.

It is felt that physicians could provide better services and reduce costs of drugs if information about drug prices was readily available. Studies have shown that providing a manual of comparative drug prices annotated with prescribing advice to physicians reduced their patients’ drug expense15.

Due to long term treatment duration, diabetes patients usually have higher than average monthly out-of-pocket expenses and high out-of-pocket expenses can be a barrier to adherence to prescription drug regimen. Many chronically ill adults cut back on medications due to high prescription cost. Inadequate prescription coverage and out of pocket expenses are one of the strong predictors of their medication adherence problems.

Market structure and subsequent market segmentation provide basis for prescription agent pricing policies leading to wide variation in prices of drugs. In the absence of information on comparative drug prices and quality, it is difficult for doctors to prescribe the most economical prescription.

Conclusion:

The average percentage price variation of different brands of the same drug manufactured in India is very wide. So it is recommended that the appraisal and management of marketed drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Recommendations:

There is a need for concerted action from regulatory authorities, doctors, pharmacists and general public at large to address this issue of oral antidiabetic drugs price variation.

At the hospital level authorities and concerned committees have to frame policies on these aspects.

The situation can be improved by incorporating analysis of prescription costs in medical curriculum and by providing updated and complete information regarding bioequivalence, quality and cost of the pharmaceutical preparation to the doctors.

Wherever possible a cheapest brand should be prescribed because the superiority of any particular brand over the others has never been proved scientifically.

Currently, very few medicines are under drug prices control order16. Hence it is desired that the Government should bring all lifesaving and essential medicines under price control