COST VARIATION ANALYSIS OF SOME SELECTED CATEGORY DRUGS AVAILABLE IN INDIA

DISSERTATION SUBMITTED

TO
JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY HYDERABAD
In partial fulfillment for the requirements for the award of degree of
BACHELOR OF PHARMACY
BY
K RITHIKA [15Z51ROO67]
MLD SAI KUMAR [15Z51ROO73]
M MANIKANTA [15Z51ROO74]
R CHANDRA SHEKAR [15Z51ROO80]

UNDER THE GUIDANCE OF

Dr. M. Srinivas
M.Tech., Ph.D.
PROFESSOR
DEPARTMENT OF PHARMACEUTICAL CHEMISTRY
GEETHANJALI COLLEGE OF PHARMACY
CHEERYAL (V), KEESARA (M), RANGA REDDY DISTRICT, TELANGANA STATE – 501301, INDIA
APRIL - 2019
 INTRODUCTION
• Although cancer remains a major health problems all over the
world ,its treatment is limited by affordability of patients in a
developing country like India .

• Pharmaceutical market in India has over 20,000 medicine

formulations and majority of them are sold under brand names
.Indian markets are flooded with a huge number of anti- cancer
drugs and the same drugs are sold under different brands which
puts the prescribing physicians in a difficult state to choose the best
drug for a given patient.
So, the present study was done to analyse the variation of cost
among different brands of anti-cancer drugs available in the
Indian market

AIM AND OBJECTIVE

Aim: The aim of present observational study was analyse the

price variations of anti-cancer drugs available in India.
 MATERIALS AND METHODS
The cost of a particular anti-cancer drug being manufactured by
different companies,in the same dose and dosage form, was obtained
from latest issue of “Current Index of Medical specialities”(CIMS)
January-April ,2016.The difference between the maximum and minimum
prices of various brands of the same drug was analysed and percentage
variation in the prices was calculated .The results of the study were
expressed as absolute numbers and percentages .
The cost ratio is calculated by
Price of the costliest brand
Price of the least costly brand
Percentage cost variation was calculated as follows:
Percent cost variation =(maximum cost-minimum cost/minimum cost)X
100
For example:

DRUG BRAND MANUFACTURER PRICE

METHOTREXATE Oncotrex Sun 82.00

(Tab.5mg)
Vibzi Cadila 67.00
Auratrex AHPL 32.00
Dermatrex East West 71.00
Folitrax IPCA 79.00
 PERCENTAGE COST VARIATION AND
COST RATIO OF VARIOUS DRUGS

DRUGS DOSE NO. OF MAXIMUM MINIMUM COST RATIO %COST

BRANDS PRICE (Rs.) PRICE (RS.) VARIATION

METHOTREXATE 21 480.00 14.91 32.1 0.349

Tab.2.5mg
Tab.5mg 07 670.00 32.00 20.9 19.93
Tab7.5mg 08 990.00 47.20 20.9 19.97
Tab.10mg 05 150.00 53.77 2.78 1.789
METHOTREXATE 07 69.25 31.75 2.18 1.181
Inj. 15mg/1ml
Inj. 50mg/1ml 09 79.96 56.00 1.42 0.0042
CHLORAMBUCIL Tab.250mg 03 1620.00 129.53 12.50 0.00115

Tab.5mg 03 2700.00 141.69 19.05 18.05

Cyclophosphamide Tab.250mg 05 116.50 30.00 3.88 2.883

Inj. 1g/1ml 12 145.80 105.00 1.38 0.388

Cyclophosphamide Inj. 500mg/1ml 14 89.80 58.00 1.54 0.548

Inj. 100mg/1ml 02 32.00 20.00 1.6 0.6

Inj. 200mg/1ml 12 46.15 26.00 1.77 0.775
Thio-TEPA Inj. 200mg/1ml 01 500.00 500.00 1.00 5.00

Inj. 6mg/1ml 01 5100.00 5100.00 01 5100.00

Busulfan Tab.2mg 05 325.00 60.00 5.41 4.416

Powder.100mg 01 4285.00 4285.00 01 4285

Carmustine CombinationTa 05 220.00 38.20 5.75 4.759
b. 500mg
Inj. 500mg/1ml 03 220.00 38.20 5.75 4.759
Inj. 250mg/1ml 02 30.00 27.00 1.11 0.11
Tab.50mg/75m 03 120 17.00 7.05 6.058
g
Mercaptopurine Tab.50mg 05 765.00 69.70 10.9 9.975
Inj.200mg/2ml 01 83.00 83.00 01 83.00

Azathioprine Tab.50mg 11 750.00 55.00 13.63 12.63

Inj.250mg/1ml 14 172.00 10.50 16.38 15.38
Inj.500mg/1ml 07 228.00 19.50 11.69 10.69
5-Fluorouracil Inj.50mg/1ml 06 228.00 7.07 32.24 31.25
Tab.100mg 02 5320.25 800.00 6.65 5.650

Inj.500mg/1ml 18 907.82 170.00 5.34 4.340

Cytarabine Inj.1g/1ml 08 990.00 550.0 1.8 0.8
Inj.100mg/1ml 12 1003.00 180.00 5.57 4.572
Inj.500mg/1ml 08 907.80 170.00 5.34 4.34
Inj1000mg/1m 02 1634.07 775.00 2.10 1.108
l
VINBLASTINE Inj10mg/1ml 04 375.00 225.00 1.66 0.666
Vincristine Inj.1g/1ml 01 65.00 65.00 01 65.00
Vincristine Inj.1mg/1ml 09 63.00 48.00 1.31 0.3125
 Inj.900mg/1ml 01 16640.00 1664.00 01 09
Paclitaxel
Inj.300mg/1ml 07 14990.00 9360.00 1.60 0.601

Inj.30mg/1ml 11 2500.00 1400.00 1.78 0.785

Inj.100mg/1ml 15 1664.00 3400.00 4.89 0.00038

Topotecan Inj.2.5mg/1ml 02 5960.00 4935.00 1.20 0.207

Inj.1mg/1ml 01 4500.00 4500.00 01 4500.00

Cisplatin Inj.10mg/1ml 10 511.98 77.00 6.64 5.649

Tab.120mg 01 163.00 163.00 01 163.00

Fosfestrol
Tab.300mg 01 48.87 48.87 01 48.87

Tamoxifen Tab.10mg 18 249.00 11.50 21.65 20.65

Tab.20mg 17 429.00 18.00 23.83 22.83

Anastrozole Tab.1mg 12 3272.00 49.50 66.1 65.10

 Flutamide Tab.250mg 07 2210.90 100.58 21.98 20.98

Triptorelin Inj.0.1mg/1ml 01 305.00 305.00 01 305.00

Inj.3.75mg/1ml 01 6045.00 6045.00 01 6045.00

Imatinib Tab.100mg 08 1028.00 850.00 1.209 0.209

Tab.400mg 06 4115.20 1800.00 2.286 1.286

Rituximab Inj.100mg/1ml 03 16000.00 7500.00 2.13 1.133

Inj.500mg/1ml 03 16000.00 7500.00 2.13 1.133

Mitotane Tab.500mg 01 486.00 486.000 01 486

L-Asparaginase Inj.5000mg/1ml 07 1251.00 825.00 1.57 5.236

Inj.10000mg/1 07 1251.00 1385.00 1.59 0.595

ml
 RESULTS
The prices of a total of 23 anti-cancer drugs belonging to 6
different categories available in 52 different formulations were analysed.
With regard to various categories of anti-cancer drugs analysed in our
study, the maximum price variability was found to be highest with
hormonal drugs (714.24%)
In relation to anti-cancer anti-metabolites, methotrexate showed
the maximum price variation . With regard to naturally obtained anti-
cancer drugs, paclitaxel showed maximum price variation while epirubicin
showed the minimum price variation .Among hormonal anti-cancer drugs,
maximum price variation was seen with flutamide and minimum price
variation was seen with anastrazole .
 DISCUSSION
To the best of our knowledge, there was no study
done to evaluate the variability of prices of anti-cancer drugs
in India. Our study for the first time analysed the variation of
cost among different brands of anti-cancer drugs available in
the Indian market. Our findings revealed that the prices of
various anti-cancer drug formulations showed great
variation.
 CONCLUSION
This study shows that there is a wide variation in the prices of
most of the anti-cancer drugs available in India. Health care
providers must be aware of availability of low cost brands or
generics available among anti-cancer drugs and prescribe
accordingly based on the economic status of the patient for
successful treatment of cancers. There is an urgent need to
decrease the cost of anti-cancer drugs by the government in
order to save many lives due to cancer related mortality.
 REFERENCE
1. CIMS Oct, 2018-Jan. 2019.

2. Drugsupdate.com
http://www.drugsupdate.com

3. Media India
https://www.medindia.net
 CHAPTER 2
COST VARIATION ANALYSIS OF
ANTIVIRAL DRUGS
 INTRODUCTION
Pricing of drugs plays a very important role in country like India
majorly in management of chronic conditions. There exists a huge price
variation among different brands of same drug. Hence this study was
planned to find out variation in prices of antiviral drugs marketed in
India.
viral diseases such as HIV and hepatitis B virus (HBV) afflict millions
of people worldwide. A key public health challenge in managing such
diseases is identifying infected, individuals so that they can receive
antiviral treatment. Such treatment can benefit both the treated individual
and the population as a whole.
 AIM AND OBJECTIVE
AIM:- This study was planned to find out variation in

prices of antiviral drugs marketed in India.

OBJECTIVE:- The objective was to compare the percentage price

variation and cost ratio of various formulations of oral and parental
antiviral drugs available in Indian market.
 MATERIALS AND METHODS
1. Prices of various Antiviral drugs were obtained from various offline and
online sources. Offline sources utilized were CIMS October 2018 to
January 2019 edition. DRUG TODAY January 2019 to March 2019
edition VOL-1. Online sources were CIMS official website, Drugs update
website, Drug today online, India mart drugs website.
2. The cost ratio and the percentage cost individual drug brands were
calculated. The cost of 3,10,30,60 tablets was calculated in case of oral
drug. The cost of 1 ampoule or vial was noted in case of Injectable drug.
The cost of 5gm of cream or ointment is calculated in case of topical
preparations and the cost of 5g of ophthalmic drug was calculated.
 MATERIALS AND METHODS
3. At last the cost ratio and % cost variation of various brands was
compared.

% COST VARIATION ═ maximum cost-minimum cost/minimum

cost×100

4. COST RATIO= Cost ratio = Price of the costliest brand /Price of

the least costly brand.
EXAMPLE:-

DRUG BRAND MANUFACTURER PRICE

ACIVIR INJ CIPLA 361.10
ACYCLOVIR ACLOVIR MEDICON 426.00
powd for inj
AUTIC ALNA H&I 345.00
250mg×10ml×1
AXOVIR SAMARTH 271.90
HERZOVIR CHANDRA 465.00
BHAGAT PHARMA
OVIR OSPER 290.00
UNIVIR UNITED BIOTECH 361.05
VAZOVIR VHB 358.00
VIR INJ TROIKAA 471.20
ZOYLEX VHB 355.00
ACV INJ GEO PHARMA 240.45
COST VARIATION ANALYSIS OF VARIOUS ANTIVIRAL
DRUGS:-
DRUG DOSE NO.OF MAXIMUM MINIMUM COST % COST
BRANDS PRICE (RS.) PRICE (RS.) RATIO VARIATION

DNA TAB 200mg×10s 26 195.00 25.00 7.8 680

POLYMERASE
INHIBITORS :- TAB 400mg×10s 31 510.00 49.00 10.40 940
ACYCLOVIR
TAB 800mg×10s 28 371.00 95.00 3.90 290.5

POWD FOR INJ 11 471.20 240.45 1.95 95.96

250mg×10ml×1

POWD FOR INJ 11 670.00 455.25 1.47 47.17

500mg×10ml×1
SKIN CREAM 20 70.00 25.00 2.8 180
5% w/w×5g
OPTHALMIC 6 54.70 24.58 2.22 122.53
OINTMENT
3%w/w×5g
VALACYCLOVIR 500mg×3s
TAB 6 5,510.00 123.00 44.79 4379
1g×3s
TAB 6 546.00 325.00 1.68 68
FAMCICLOVIR 250mg×10s
TAB 5 290.00 198.00 1.46 46.4
500mg×3s
TAB 4 1,735.00 943.55 1.83 1037.6
GANCICLOVIR 250mg×10s
TAB 2 2,650.00 1,687.00 1.57 57.0
500mg×10s
POWD FOR INJ 5 2025.00 1650.00 1.22 22.72
500mg×1

INHIBITORS OF PENETRATION OF INFLUENZA VIRUS

DRUG DOSE NO.OF MAXIMUM MINIMU COS % COST
BRANDS PRICE (RS.) M PRICE T VARIATION
(RS.) RATI
O
AMANTADINE TAB 3 183.70 32.57 5.64 464
HYDROCHLORIDE 100mg×
15s
 INHIBITORS OF HIV PROTEASES

DRUG DOSE NO.OF MAXIMUM MINIMUM COST RATIO % COST

BRANDS PRICE (RS.) PRICE (RS.) VARIATION

INDINAVIR TAB 5 1155.00 540.00 2.13 113.88

400mg×30s
SEQUINAVI TAB 2 3086.00 3000.00 1.02 2.86
R 500mg×60s
RITONAVIR TAB 5 1800.00 1200.00 1.50 50
100mg×60s
LOPINAVIR TAB 5 921.00 483.55 1.90 90.46
+ 200mg:30m
RITONAVIR g×10s
 RESULT
1. The prices of a total of 19 antiviral drugs available in the Indian market
in 41 different formulations were analyzed. These formulations are
manufactured by different pharmaceutical companies.
2. Percentage cost variation of Antiviral drugs found was seen highest
with Purine nucleosides Tab Valacyclovir 1g showing maximum price
variation of 4379% and cost ratio is about 44.79. Followed by
Inhibition of HIV reverse transcriptase Zidovudine 1161.98% a cost
ratio of 12.61 .The lowest percentage cost variation is seen in Inhibition
of HIV protease Tab Sequinavir 500mg showing price variation of
2.86% and cost ratio of 1.02
DISCUSSION
This study was carried out with the main objective of computing
the cost and percentage price variation among the different
Antiviral drugs across the different brands available in the Indian
market.
Our study findings showed a high fluctuation in the minimum
and maximum price of Antiviral drugs which are being
manufactured by several companies.
The cost of many of the Antiviral formulations has a percentage
price variation above 100% reaching a maximum of 4379%.
DISCUSSION
Possible reasons for this could be due to companies offering
incentives to the physician for prescribing a particular brand. Also
at times, pharmacist does not dispense the same brand as
prescribed by the doctor and substitute it with some other brand,
quoting the reason as non-availability. This is done for the
economic gains as some brands have a higher profit margin.
When drug cost is affordable, patient compliance will improve.
 DISCUSSION
 The doctors should be encouraged to write the generic names of
the drug and a cheaper brand should be prescribed whenever possible
because the superiority of one particular brand over the others has not
been scientifically proved.
 These steps can help in providing cost effective therapy to the
patients thereby improving the compliance.
 CONCLUSION
Selling costs of drugs are fixed by national pharmaceutical
pricing authority (NPPA) government of India in accordance with
DPCO 2013. Despite this there exists a wide variation of drug
costs within one drug with the availability of various brands.
Also, the national pharmaceutical pricing authority (NPPA)
should act strictly to ensure that the prices of Antiviral drugs and
their combinations are brought under control so that all patients
irrespective of the economical class should be able to afford these
medicines and get treated completely.
 REFERENCES
1. CIMS October2018 to January 2019 edition.
2. Kd-Tripathi-Essentials-Of-Medical-Pharmacology Rang & Dale’s Pharmacology-
7th Edition Pharmacology: Lippincott’s Illustrated Reviews
3. www.drugupdate.in Antivirals in Indian market
4. Approved Antiviral Drugs over the Past 50 Years
5. https://cmr.asm.org/content/29/3/695
6. Antiviral Drugs - Antiviral Medicine Latest Price, Manufacturers
7. https://dir.indiamart.com/impcat/antiviral-drugs.html
8. http://nasi.org.in/nasi_journal/media/pdf/proceedings/89/EmergingViralInfectioni
nIndia8215-21.pdf
9. Kumar V, Gupta NV, Kumar AK. A Comparison between old and latest systems in
DPCO. Int J Pharm Pharm Sci. 2014
 INTRODUCTION
• Malaria has been a problem in India for centuries. Details of this disease
can be found even in the ancient Indian medical literature like the
Atharva Veda and Charaka Samhita.

• India’s population suffered from malaria, particularly in the states like

Punjab and Bengal. The government of India launched the national
malaria control programme in April 1953. Initially the programme was a
success as the number of malaria cases significantly declined.

• Among the 11 nations with 70% of the world’s burden of malaria, only
India has managed to reduce its disease burden, registering a 24%
decrease between 2016 and 2017.

• In 2017, there were an estimated 219 million cases of malaria, compared

to 217 million the year before.
 AIM AND OBJECTIVE
• Aim and Objectives: To evaluate the cost of different brands
of anti-malarial drugs available in India, and to analyze the
variations in cost of same dosage of different brands of the
same active drug.
 METHODS
Prices of various Antimalarial drugs were obtained from various
offline and online sources. Offline sources utilized were CIMS October
2018 to January 2019 edition. DRUG TODAY January 2019 to March
2019 edition VOL-1. Online sources were CIMS official website,
Drugs update website, Drug today online, India mart drugs website.
Price in Indian rupees (INR) of antimalarial drugs manufactured by
different pharmaceutical companies in India, in the same strength were
obtained from Current index of medical specialties (CIMS) Oct, 2018-
Jan. 2019 and from Drug Today January to March 2019, Vol (1). The
cost of 10 tablets/injections was calculated.
 METHODS

The cost ratio, calculated as the ratio of the costliest brand to that
of the cheapest brand of the same drug, calculated as follows:

Cost ratio = Price of the costliest brand /Price of the least costly
brand.

Percentage cost variation was calculated as follows:

Percent cost variation = (maximum cost - minimum cost/

minimum cost) X 100.
 DRUG BRANDS MANUFACTURER PRICE

ARTEMETHER Aarnet Alpha Aromatic Pvt.Ltd 90.00

(Inj. 150mg/2ml-2ml)

AB safe American BioCare 80.00

AB-ther SOSELABS HEALTHCARE PVT.LTD 34.00

Abther AB Mac Organics 92.00

Alfadin 150 Odin Health Care Pvt.Ltd 225.00

Alfamal 150 Altius Life Sciences 30.00

Alither Allenge India 78.00

Alphabetas Shrestha Formulations 240.00

Alpharid Mint Life Sciences 3.00

Amether Ampus Life Science Ltd 99.00

Artee NITFIT REMEDIES PVT.LTD 72.00

Arteema Pharma Synth Formulations Ltd 90.00

Arth-2 Minot Pharmaceuticals Pvt.Ltd 75.00

Arther Grace Drugs and Pharmaceuticals 75.00

Arther 150 D J Biotech Pvt.Ltd 70.00

 Artimal Indi Pharma Pvt.Ltd 80.00

Artimisa Rekvina Pharmaceuticals Pvt.Ltd 128.69

Beether Santo Formulations 95.00

Benther 150 Bennet Pharmaceuticals Ltd 84.00

Bester Stalwart Remedies Pvt.Ltd 64.00

Betmotil IPCA Laboratories Ltd 104.00

Chimel Ultra-Chiron Pharma Pvt.Ltd 75.00

Colither Coles Pharma 99.00

Colther Colours Life Sciences 25.00

Crush Yucca Pharmaceuticals 90.00

Dother MEDOZ PHARMACEUTICALS PVT.LTD 80.00

E keftal Health Care Formulations Pvt.Ltd 80.00

E mal Elcure Pharmaceuticals 115.50

E-ther Ester Formulations 97.00

Elther Elcure Pharmaceuticals 87.00

 Ethertek MediaTek Life Sciences Pvt.Ltd 99.00

Falcifast Pharma tech Healthcare 65.00

Falcimid Midas Biotech Pvt.Ltd 23.25

FRC-150 Micro Organics Pharmaceuticals Pvt.Ltd 75.00

Gnate Green ray pharmaceuticals Pvt.Ltd 72.00

Laristar Baltic Pharmaceuticals 45.00

Limarther Anca lima Life Science Ltd 89.00

MA-lock Chemo India 90.00

Malarther Akron Pharmaceuticals 75.00

Malasar Sarveas Pharmaceuticals 95.00

Maliago Secure Health Care INC. India 95.00

P cidal Globus Remedies Ltd 95.00

P ther Pharmakon Life Sciences 95.00

Palareether Ankom Laboratories 65.00

RT ther Humax Pharmaceuticals 81.12

Rapither Rapither 83.00

Reether150 Reco Drugs 20.00

Truther Tri Medic Pharma Pvt.Ltd 85.00

 COST VARIATION ANALYSIS OF VARIOUS
ANTIMALARIAL DRUGS:-
DRUGS DOSE NO. OF MAXIMUM PRICE MINIMUM PRICE COST RATIO %COST VARIATION
BRANDS (Rs.) (RS.)

ARTEMETHER 47 240.00 3.00 80.00 7900

Inj. 150mg/2ml-2ml
15 181.00 28.00 6.46 546.42
Inj. 75mg/1ml-1ml
60.00 28.00 2.14 114.28
Inj. 80mg/1ml 03
ARTESUNATE 19 1600.00 40.00 40 3900
Tab. 50mg x 10
Powd. 60mg x 1 31 219.00 120.00 1.825 82.5

Tab. 250mg x 10 02 1420.00 612.10 2.31 131.98

CHLOROQUINE Inj. 40mg/2ml 03 3.66 2.00 1.83 83.00

Inj. 40mg/5ml 10 17.84 3.45 5.17 417.10

Inj. 40mg/30ml 08 16.10 12.94 1.24 24.42

MEFLOQUINE (Tab. 250mg x 10) 13 1350.00 383.33 3.52 252.17

QUININE SULPHATE (Tab. 300mg x 10) 23 650.00 45.00 14.4 1344.4

(Tab. 600mg x 10) 12 111.25 94.00 1.18 18.35

ARTEMETHER + (Tab. 80/480mg x 10) 02 300.00 256.00 1.17 17.18

LUMEFANTRINE
 RESULT
The highest cost ratio and percentage cost variation was seen for Artemether
injection 150mg/2ml-2ml (cost ratio = 80 and % cost variation = 7900). The
lowest cost ratio was found for Artesunate Powd.60mg/1 injection (cost ratio =
1.825 and % cost variation = 82.5). Overall the tablets and injectables of
antimalarial showed considerable cost ratio and cost variation for e.g. Artesunate
50mg/10 tablets (40 and 3900) followed by Artemether 80mg-1ml injection
(2.14 and 114.28) respectively.
 DISCUSSION
• People living in developing countries pay heavy cost of
medicines. In India, more than 80% health financing is borne
by patients.

• The situation becomes more complex due to the presence of

number of brands with variety of names and prices.

• The price variation assumes significance when the cost ratio

exceeds 2 and percentage cost variation exceeds 100. By this
fact the above analysis showed that there is not much
significant price variation among oral antimalarial drugs.
 DISCUSSION
• The minimum variation shown by oral antimalarial was found
to be for fixed dose combination of Artemether and
Lumefantrine (cost ratio <2 [1.17] and % price variation <100
[17.18]) while other oral drugs all showed cost ratio more than
2 and % cost variation more than 100.

• But there was significant price variation among injectable

antimalarial for example there is significant cost ratio and cost
variation of Artemether injection 150mg/2ml (cost ratio = 80
and % cost variation = 7900).
 CONCLUSION
Ceiling cost of drugs are fixed by national pharmaceutical pricing
authority (NPPA) government of India in accordance with DPCO
2013. Despite this there exists a wide variation of drug costs
within one drug with the availability of various brands. Also, the
national pharmaceutical pricing authority (NPPA) should act
strictly to ensure that the prices of antimalarial drugs and their
combinations are brought under control so that all patients
irrespective of the economical class should be able to afford these
medicines and get treated completely.
 REFERENCE

1.Drug Cost Control Order, 2013, Government of India.

2. CIMS Oct, 2018-Jan. 2019.

3. Drugsupdate.com
http://www.drugsupdate.com/

4. Medi India
https://www.medindia.net/

5. Drug Today
 CHAPTER 4
COST VARIATION ANALYSIS
OF ANTIFUNGAL DRUGS
 INTRODUCTION
• The incidence of fungal infections is on continuous rise because of
immunosuppression due to cancer chemotherapy, organ transplant, AIDS,
corticosteroid overuse and indiscriminate use of broad-spectrum
antibiotics.
• Indian pharmaceutical industry is one of the largest pharmaceutical
markets in the world. It has a large number of branded formulations as well
as generic brands of the same drug.
• Rational use of medicines not only involves prescribing a medication that
is appropriate to the clinical need, at the proper dose, for the proper
duration but also at an affordable cost since compliance of the patient may
significantly depend on the cost of the prescribed medicines
 AIM AND OBJECTIVE
 To evaluate the cost of different brands of anti-
fungal drugs available in India, and to analyze the
variations in cost of same dosage of different
brands of the same active drug.
 METHODS
Cost range, cost ratio and percent cost variation were calculated per ten
dosages for oral formulations and per unit dosage for injectable formulations.
The cost range was expressed as minimum cost per ten dosages to maximum
cost per ten dosages and these were obtained from (CIMS) Oct, 2018-Jan.
2019 and from Drug Today January to March 2019, Vol (1). . The cost
ratio was calculated as quotient of maximum cost over minimum cost. Cost
ratio gives an idea about how many times is the costlier brand expensive than
the cheapest brand of the same drug. Percentage cost variation per ten
dosages for oral formulations and per unit dosage for injectable formulations
was calculated as follows:
Cost variation (%)

[(Maximum cost − Minimum cost)/ Minimum cost] ×100

Cost ratio = Price of the costliest brand /Price of the least costly brand.
Example:-

DRUG BRANDS MANUFACTURER PRICE

CASPOFUNGIN Cancidas MSD 14685.00

(Inj. 70mg)
Canducid Zyphars 8477.13

Capsodru Drukst Biotech 10500.00

Casfung Glenmark 10695.50

Caspercid Aventis Pasteur 13088.88

Caspocare BPRL 9900.00

Caspogin Cipla 12087.50

Casponova Innova 9000.00

Casporan sun 10480.00

Kabifungin Fresenius kabi 10581.90

Savacap Sava Medica 7980.00

 Cost Variation Analysis of Antifungal Drugs Available in India
DRUGS DOSE NO. OF BRANDS MAXIMUM PRICE MINIMUM PRICE (Rs.) COST RATIO %COST VARIATION
(Rs.)

Voriconazole 200 15 6823.30 1812.55 3.76 276.44

Voriconazole* 200 17 17709.00 4400.00 4.02 302.47

Ketoconazole 200 34 347.00 18.00 13.72 1827.7

Caspofungin* 50 13 14115.00 6250.00 2.25 125.84

70
11 14685.00 7980.00 1.84 84.02

Terbinafine 250 74 3570.00 97.85 36.48 3548.44

500
10 260.00 135.00 1.92 92.59

Itraconazole. Tab 100 16 440.00 72.00 6.11 511.1

200
10 500.00 100.00 05 400.00

Itraconazole. Cap 100 42 676.25 88.50 7.64 664.12

200 27 675.00 36.00 18.75 1775.00

Fluconazole 50 10 320.6 33.7 9.51 851.33

150
200 144 5100.00 23.2 219.82 21882.75
400
10 440 125.00 3.52 252.00

06 550.00 220.00 2.5 150.00

Griseofulvin 125 06 24.70 6.58 3.75 275.37

250 15 37.70 12.72 2.96 196.38

375 04 48.10 18.51 2.59 159.85

500 05 155.00 33.93 4.56 356.82

Amphotericin 50 23 7609.52 263.50 28.87 2787.86

B
Liposomal*
 RESULTS
The costs of a total of 8 antifungal drugs available in 20 different
formulations were analyzed and a substantial variation in cost was
observed. Of 20 drug formulations studied, percentage cost variation of
18 drug formulations was more than 100% out of which 5 had this
variation more than 1000%. Cost ratio was also observed to be very high
and 18 drug formulations had this ratio more than 2. Fluconazole 150
mg had maximum percentage cost variation of 21882.75% and cost ratio
of 219.82 with the highest number of 144 companies manufacturing it,
while Caspofungin 70 mg had minimum percentage cost variation of
84.02% and cost ratio of 1.84.
 DISCUSSION
 The study revealed that various antifungal formulations of different
brands available in India have huge cost variation.

 One of the major causes of the high cost of medicines is prescription by

brand names. For some medicines, the difference in cost between the
branded and generic product varies from less than two-fold to more than
100-fold.

 Competition usually bring about a decline in costs of the products and is

expected to decrease the cost variation however, on the contrary in the
present study it was observed that more is the no of mfg companies a
particular formulations wider is cost variation and vice versa
 DISCUSSION
 Generic drugs are substantially lower in cost than the branded drugs
and healthcare cost can be reduced to some extent if physicians
prescribe drugs in generics.

 The government of India has recently started generic drug stores all
over the country where medicines are available at cheaper rates. The
quality of generic medicines available in these stores at cheaper rates
should be tested and compared with popular brands to build
confidence among prescribers, pharmacists, and consumers for
promoting the use of generic drugs.
 CONCLUSION
There is a wide variation in the cost of various brands of antifungal

drugs available in India. For rational drug use, cost is an equally

important factor which commonly gets ignored while prescribing.

Therefore, such studies comparing the cost of different brands of a class

of drugs can aid in the prescription of drugs affordable to the common

man. Generic drug prescribing can decrease the expenditure of patient on

the drug and compliance can be improved. Adequate information should

be provided to the physicians regarding cost, bioequivalence and quality

of drugs.
 CONCLUSION
 Results of this study indicate that there is an urgent need of
controlling cost variation among different brands of available
antifungal drugs. Drug costs are controlled according to Drug Price
Control Order 2013 (DPCO). Ceiling cost of drugs are fixed by
National Pharmaceutical Pricing Authority (NPPA) Government of
India in accordance with DPCO 2013.
 Therefore, there is a need for coordinated action from regulatory
authorities, pharmaceutical companies, physicians, pharmacists
and the general public at large to address the problem of huge
variation in the cost of the drugs.
 REFERENCES

1. Drug Today January to March 2019.

2. CIMS India – mims.com
3. www.practo.com
4. www.1mg.com
5. www.medplus.com
THANK YOU…