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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 89-93

Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital


1 Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Mangalore, Karnataka, India
2 Department of General Medicine, KS Hegde Medical Academy and Hospital, Mangalore, Karnataka, India

Date of Web Publication19-Jan-2018

Correspondence Address:
Dr. Javedh Shareef
Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Deralakatte, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_21_17

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  Abstract 


Aims: Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital.
Settings and Design: Hospital pharmacy department.
Subjects and Methods: Price, strength and brands of parenteral antibiotics included in the study were obtained from a computer database of hospital pharmacy department. The difference between the maximum and minimum prices of various brands manufactured by different companies with the same drug was analysed, and percentage variation and the cost ratio in the prices was estimated.
Statistical Analysis Used: Descriptive statistics such as frequency and percentage.
Results: Overall, prices of 15 single drug antibiotics available in 24 strengths marketed in 68 brands and 7 fixed-dose combinations available in 15 strength marketed in 49 brands were analysed. The maximum price variation and highest cost ratio between brands of single drug parenteral antibiotics were found to be more in amoxicillin 250 mg (270.43%) with cost ratio (1:3.7) and minimum in ceftazidime 2000 mg (5.26%) with cost ratio (1:1.05). In the case of fixed-dose combinations of parenteral antibiotics, the highest cost ratio (1:4.20) and percentage price variation (320.84) was found to be with cefoperazone 500 mg + sulbactam 500 mg combination, and the lowest cost ratio (1:1.11) and the percentage price variation (11.44) were found to be amoxicillin 600 mg + clavulanate 600 mg combination. The percentage price variability of 12 brands was 0%–25%, and for 26 brands, it was 50%–75%. For 13 brands, percentage price variability was >100%.
Conclusions: Pharmacoeconomics aspects should be taken into consideration by healthcare practitioners while prescribing antibiotics to the patients for infectious disease management which will facilitate compliance, minimise antibiotic resistance and treatment failure.

Keywords: Hospital pharmacy, parenteral antibiotics, pharmacoeconomics, price variation


How to cite this article:
Shareef J, Mateti UV, James JB, Rao D, Stanly SM, Samaga L. Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital. J Patient Saf Infect Control 2017;5:89-93

How to cite this URL:
Shareef J, Mateti UV, James JB, Rao D, Stanly SM, Samaga L. Analysis of price variation among parenteral antibiotics available in a tertiary care teaching hospital. J Patient Saf Infect Control [serial online] 2017 [cited 2018 Sep 20];5:89-93. Available from: http://www.jpsiconline.com/text.asp?2017/5/2/89/223692




  Introduction Top


The rapid rise in the cost of drugs all over the world is a serious issue for people belonging to lower economic status which significantly affects the drug compliance.[1] Medicines are manufactured by various pharmaceutical companies, and most of them are sold under different brand names. Competition among the pharmaceutical companies leads to marked variation in the price of some drugs and they promote their branded drugs vigorously. In general, healthy competition in trade always provides a better quality and cost benefits to the consumers. However, these do not apply for patients as they are unaware of the availability of generic drugs and have little choice in the selection of the drugs. Most of the doctors prescribe branded drugs that are costly in place of generic drugs which increase the financial burden on patients.[2],[3] Various studies have shown that therapeutic failure and adherence are influenced by the drug prices.[4],[5],[6] There exist urgent needs to reduce price variation among diverse formulations of drugs available in Indian market, as well as in other countries. Drug pricing control order (DPCO) plays a major role in reducing the price of drugs manufactured by different pharmaceutical companies in India. The Government of India controls and fixes the prices of certain drugs by bringing these drugs under DPCO and makes it affordable.[7]

India faces the challenge of treating a range of infectious diseases from a milder illness capable of being perceived easily in a simple way to a serious illness such as tuberculosis, malaria, respiratory infection, dengue fever with the potential to cause morbidity and mortality. Availability of life-saving antimicrobials is of paramount importance in all countries afflicted by such virulent diseases. Antibiotics are among the classes of agents most commonly prescribed in almost all the departments of any hospital.[8] There are various antibiotics available which include penicillin, cephalosporin, fluoroquinolones, aminoglycoside, tetracycline primarily indicated for the prophylaxis, and treatment of bacterial infections caused by both Gram-positive as well as Gram-negative organisms.[9] Indian markets are flooded with a huge number of antibiotics, and the same drugs are marketed under different brands with a marked variation in their prices of the same formulation. In developed countries, where a system of medical insurance is in effect, it may not be a concern, but in developing countries like India, where the medical insurance is only in an emerging stage, affordability to antibiotics becomes a major concern.[10] Moreover, in the absence of comparative information on antibiotic prices puts the prescribing physicians in a difficult state to select the best drug at the same time most economical treatment regimen.

In this context, this price variation of parenteral antibiotics has to be monitored. Furthermore, to the best of our knowledge, no study has been carried out which compares the cost of parental antibiotics of different brands. Hence, the current study was designed to analyse the price variability pattern among the parenteral antibiotics by calculating the percentage variation of cost.


  Subjects and Methods Top


The prices of the parenteral antibiotics included in the study were obtained from the hospital pharmacy department of the study site which is a tertiary care teaching hospital. The selling price of a particular drug manufactured by different companies in the same strength available in a hospital pharmacy department was compared. The drug formulation being manufactured by only one company without any competitor's brand was not included in the study. Oral antibiotics were not a part of this study. The percentage variation in price was computed using the following formula.



The difference between the prices of the same drug of the same strength manufactured by the different pharmaceutical companies available in the hospital pharmacy department was compared. The drugs were divided into five categories depending on the percentage (%) of price variation. Five categories were as follows: 0%–25%, 25.1%–50%, 50.1%–75%, 75.1%–100% and more than 100% price variation.

At the same time, drugs were classified into three different groups based on number of available brands as Group-I with <2 brands and Group–II with 2–5 brands and Group–III with more than 5 brands and the correlation between the number of brands of a particular drug and percentage price variability was calculated.

The cost ratio and ratio of cost of costliest to the cheapest brand of the same generic drug was estimated. This gives an estimate, how many times the costliest brand costs more than the cheapest one in each generic group.


  Results Top


Prices of 22 parenteral antibiotics (15 single and 7 combination preparations) available in 117 different brands in the hospital pharmacy of a tertiary care hospital were compared and analysed for the price variation. Twelve parenteral antibiotics were excluded from the study as they were available as one brand without any competitor's brand.

In the case of single drug therapy, 68 brands were available for 15 parenteral antibiotics drug therapy and are prescribed by clinicians. Twenty-six brands were offered in the category of 50%–75% price variation which was the highest group compared to the other categories of price variation. Among the single drug parenteral antibiotics, extreme percentage price variation and highest cost ratio between brands of same drugs was found in the case of amoxicillin 250 mg (270.43%) with cost ratio (1:3.7) and minimum in the case of ceftazidime 2000 mg (5.26%) with cost ratio (1:1.05). [Table 1] shows the number of brands available in various categories based on the percentage price variation and cost ratio for the single drug therapy [Figure 1].
Figure 1: Represents the number of brands with percentage price variation of single drug parenteral antibiotics

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Table 1: Price variation and cost ratio among single drug therapy of parenteral antibiotics

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In the case of fixed-dose combinations of parenteral antibiotics, cefoperazone 500 mg + sulbactam 500 mg combination showed the highest cost ratio (1:4.20) and percentage price variation (320.84) and the lowest cost ratio (1:1.11) and percentage price variation (11.44) was found to be for amoxicillin 300 mg + clavulanate 600 mg combination. [Table 2] shows the number of brands available in various categories based on the percentage price variation and cost ratio for the fixed-dose combinations of parenteral antibiotics.
Table 2: Price variation and cost ration among combination drug therapy of antibiotics

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  Discussion Top


It is evident from this study that there is a wide discrepancy in the price of parenteral antibiotics in the Indian market. Moreover, more than one company sells a drug under different brand names which might lead to the situation of greater price variation among drugs marketed. The studies done earlier on oral hypoglycaemic agents, antihypertensive's, antiretrovirals and peptic ulcer drugs showed the wide price variation among different brands containing the same ingredients.[11],[12],[13] Although a lot is known about the efficacy, safety and suitability of drugs, the cost factor is often neglected and ignored.

Antibiotics are the class of agents which are very commonly prescribed for the treatment and prophylaxis of various infectious diseases. The complete resolution of the disease depends a lot on the patient compliance. Higher medication costs are often being considered as an important factor for medication non-adherence, dropouts/lost follow-ups and drug resistance. Hence, the practitioner must be sensitised about the cost of therapy to make sure adequate patient compliance.[14]

In the present study, the prices of parenteral antibiotics available as a single drug and combination drug therapy available in the hospital pharmacy were collected and analysed for price variation and cost ratio. More than 50% variations were noted in 70% of the brands available as both single- and fixed-dose combinations. Of the total 68 brands available for single-drug antibiotics, only 12 brands belonged to the group <25% variations, whereas the majority (56 brands) had price variation of more than 25% and in some cases, more than 100% price variations were noted which were largely unaffordable to the most of the patients. In the case of fixed-dose combinations, only 14 brands (28.57%) fell into the category of less than 50%, whereas most (71%) of the brands had a price variation of more than 50%.

In a study conducted by Shankar et al.[15] in Nepal, the mean percentage price variation for antibiotics was considered to be 38.1%, and the study carried out by Patel et al.[16] in India showed a price variation for oral antibiotics was around 93%. Our study showed a price variation which was found to be 81.86%. The reason for such high price variation might be that India is a big country in terms of its population and geographically with strong manufacturing industry and the sheer number of players. Even though a large number of manufacturing companies help in bringing down the cost of medicines due to competition, there is a tendency among pharmaceutical companies of promoting an idea that the brands priced higher are better than their cheaper counterparts which are not true. Hence, a robust mechanism to control price variation among brands could be put in practice in bringing down and regulating the cost of branded drugs.

In a study conducted by Rataboli and Dang [17] were a database of drugs marketed in India was used to find the percentage price variation from the average of marketed antibiotics. Three drugs fell in 0%–25% and 25.1%–50% range group. Five drugs fell each in 50.1–75 and 75.1%–100% while 11 drugs were having more than 100% price variations. In comparison with this study, our study reported a high price variation pattern. This might be attributed to the systems of pharmacy and therapeutic committee which has control over the selection of drugs as most of the hospitals analyse cost comparison of brands before entry into the hospital formulary. This might serve to control price variation to some extent.

Hence, it becomes the need of the hour that urgent measures must be taken by the government to bring about the uniformity in the price by implementing a provision of drug manual of comparative prices to the prescribers which will lead to cost-effective therapy to the patients.

Further studies are needed to be carried out investigating the reasons for the increased price variation among the branded drugs to figure out an effective way to overcome this trend which will go a long way in rationalising the pharmacoeconomics aspects of antibiotics in the infectious disease management.


  Conclusion Top


The study highlights that the price variation of different brands of the same drug available in the hospital formulary is very wide. Pharmacoeconomics aspects should be taken into consideration by health care practitioners while prescribing antibiotics to the patients for infectious disease management. This in turn will serve to minimise antibiotic resistance, non- adherence and treatment failure. Thorough cost evaluation of drugs with different brands available in the market at the hospital level authorities and concerned committees before including in the hospital formulary will be an ideal situation and might be very useful to patients with poor of low socioeconomic background.

Acknowledgement

We would like to express our gratitude to the Head and staffs of the pharmacy department in Justice K S Hegde Charitable Hospital, Deralakatte, Mangalore, for their support and cooperation in carrying out the study. We are also very thankful to the Principal, NGSM Institute of Pharmaceutical sciences for providing necessary support and encouragement to the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
Chawan VS, Badwane SV, Gawand KV, Chhaya MU. Analysis of price variation amongst different formulations of anxiolytic drugs available in Indian market. Int J Res Med sci 2016;4:2398-401.  Back to cited text no. 2
    
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Karve AV, Paul KB. Economic analysis of oral cephalosporins in the Indian market. Int J Res Med Sci 2016;4:4143-9.  Back to cited text no. 8
    
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Brunton LB, Lazo JS, Parker KL, editors. Penicillins, cephalosporins and other beta lactam antibiotics. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 12th ed., Ch. 53. New York: McGraw-Hill; 2011. p. 741-8.  Back to cited text no. 9
    
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Shukla AK, Sharma P. Cost variation analysis of antidyslipidemic drugs. Int J Basic Clin Pharmacol 2016;5:1850-5.  Back to cited text no. 14
    
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Patel D, Thiyagu R, Surulivelrajan M, Patel H, Pandey S. Price variability among the oral antibiotics available in a South Indian tertiary care hospital. J Clin Diagn Res 2009;3:1871-5.  Back to cited text no. 16
    
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    Figures

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    Tables

  [Table 1], [Table 2]



 

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