Cost variation analysis of oral anti-diabetic agents available in drug store of the tertiary care hospital and in Indian market

Background: Diabetes, a chronic disorder and requires life-long treatment. Cost of drug treatment is a major hurdle related to medication compliance in Type 2 Diabetes Mellitus. The objective of the study was to find out the cost of antidiabetic drugs available in the drug store of a tertiary care hospital and compare it with the different brands of the same drugs available in Indian market. To evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost.Methods: Cost of single compound and combination compound oral antidiabetic drugs available in drug store and those same drugs in Indian market manufactured by different companies, in the same strength, number and dosage form. The percentage price variation between minimum and maximum cost of drugs were calculated. The percentage difference in cost of antidiabetic drugs available in drug store and in the Indian market was calculated.Results: The percentage price variation of oral antidiabetic drugs available in drug store was found to be as follows. In sulfonylureas, it was highest in Glimepiride (2mg) 1962, 96%, among biguindes, Metformin (500mg) 3012.5%, among alpha glucosidase inhibitors Voglibose (0.2mg) 387.17%. Voglibose (0.3mg) 361.30%. Among combination therapy Voglibose (0.3mg) + Metformin (500mg) 2809% showed maximum price variation.Conclusions: The average percentage price variation of different brands of the same drug is very wide and hence the physician must keep this in mind while prescribing since the drug treatment of type II diabetes mellitus is usually lifelong. Hence, manufacturing companies should aim to decrease the price variation while maintaining the therapeutic efficacy. Drug store of tertiary care hospital should try to provide the oral antidiabetic drug with least cost and sell the generic drugs

Knowledge, attitude and practice towards adverse drug reactions reporting in post graduate students of a tertiary care hospital

Background: Adverse Drug Reactions (ADRs) are a major cause of morbidity and mortality. Under reporting of ADRs by health care professionals is a very common problem worldwide. So, the present study was planned to assess the knowledge, attitude and practices of postgraduate (PG) students towards ADR reporting and suggest possible ways for improvement.Methods: It was a cross sectional questionnaire-based study conducted among 44 PG students using a questionnaire with questions on knowledge (21), attitude (13) and practices (15) of ADR reporting. The questionnaire was analyzed question wise and the percentage was calculated using Microsoft Excel spreadsheet in Microsoft Office 2010 software.Results: Most of them were aware of the term pharmacovigilance (PV) (95.45%). 54.55% agreed to be trained on how to report an ADR. 88.63% knew about the existence of pharmacovigilance committee in the institute.93% of participants knew that Central Drug Standard Control Organization (CDSCO) is responsible for monitoring of ADRs. 56.82% were aware about VIGIBASE an online software to report ADR. 81.82% of participants had agreed to witness ADRs in patients but only 38.64% reported them. The main reason behind it was non – availability of ADR forms. 42.55% opine that mobile based app would be the most preferred method to send ADR information to an ADR reporting center.Conclusions: There exists a huge gap between ADR experienced and ADR reported by PG students. Participants agreed upon necessity of reporting ADR and periodic briefing about PV

Antimicrobial utilization pattern in indoor patients of obstetrics and gynecology ward of a tertiary care hospital

Background: Rational prescribing of antimicrobials is fundamentally necessary to reduce incidence of antimicrobial resistance. To evaluate the rationality of antimicrobial prescribing practices in patients admitted to obstetrics and gynecology ward of a tertiary care hospital using ICMR guidelines and to check how many drugs were prescribed from NLEMI.          Methods: It was a prospective observational study. Study included newly admitted patients in obstetrics and gynecology ward receiving antimicrobial therapy. Drugs prescribed to the patients during their hospital stay were noted from case sheets in case record form. WHO core and economic indicators were used to analyze prescribing patterns. Medguideindia.com was referred for prices of drugs. Results: Average number of drugs prescribed for a patient admitted in the obstetrics and gynecology ward were 3.22 and 4.31 respectively. Percentage of drugs prescribed by their generic name were 37.11% and 39.42% in obstetrics and gynecology ward respectively. 26.85% and 34.14% of patients received drugs through parenteral route in obstetrics and gynecology wards respectively. All antimicrobials were prescribed from NLEMI. Conclusions: WHO recommends prescribing all drugs by their generic names. Average duration of antimicrobial treatment was higher than recommended average duration suggested by ICMR. ICMR recommends use of 2nd generation cephalosporins but in the present study 3rd generation cephalosporins were used. For rational use of antimicrobials and to reduce their cost it is recommended to prescribe antimicrobials by their generic names and reduce treatment duration by referring to ICMR Guidelines and NLEMI

Pharmacoeconomic assessment and comparing efficacy between cetirizine, levocetirizine, loratadine and fexofenadine in allergic rhinitis patients

Background: A successful treatment of allergic rhinitis is considered not only as relief from sneezing, itching, rhinorrhoea, congestion but also as the functional impact on the patient’s daily life. The cost of treating allergic rhinitis and indirect costs related to loss of workplace productivity are substantial.Methods: The present study was single centered, open label, randomized, four Arm, parallel-group, comparative clinical study between orally administered Cetirizine, Levocetirizine, Loratadine and Fexofenatidine in patients with allergic rhinitis conducted at MIMER Medical college and Dr. Bhausaheb Sardesai hospital in rural Maval Taluka in Pune district of Maharashtra State.Results: Total Nasal Symptom Score differs significantly for all the treatment groups. Subsequent pairwise contrasts using a Bonferroni adjustment reveals maximum reduction of symptoms in Levocetirizine group. Cost effectiveness ratio was effective for Levocetirizine followed by Cetirizine, Loratadine, and Fexofenadine.Conclusions: From the analysis of results, the study shows that both Levocetirizine and Cetirizine control the symptoms of allergic rhinitis better as compared to Loratadine and Fexofenadine but Levocetirizine was a better choice in comparison to others due to its cost effectiveness

Assessment of cost effectiveness of antihistaminics in allergic rhinitis patients in rural region by Nasal cytology: a simple and inexpensive tool

Background: This study was to assess the usefulness of nasal smear as a quick, easy and inexpensive diagnostic method for allergic rhinitis and for assessment of the cost effectiveness of antihistaminics.Methods: This study was conducted in rural setting of tertiary care hospital. Nasal smears were taken from 52 patients with a clinical history of nasal allergy having nasal congestion score of at least 3 or more. Nasal smears were stained with Hematoxilin-Eosin and examined by pathologists.Results: A total of 52 patients 13 in each groups of the age group 18 to 65 years (Mean age, 33.73±10.23 years); 48.08% are Female and 51.92% are Male were randomized and received either Cetirizine, Levocetirizine, Loratadine, or Fexofenadine over a period of one week. The association of eosinophil before and after the treatment was obtained using logistic regression analysis for each treatment separately. Eosinophil is marginally associated with Cetirizine before and after treatment.Conclusions: Evaluation of eosinophils in nasal smear is an insensitive but cheaper test for the diagnosis of allergic rhinitis and use as a simple tool for comparison of cost effectiveness among commonly used oral antihistaminics. pharmacoeconomic analysis of present comparative clinical study shows that cetirizine is a better choice in comparison with levocetrizine, loratidine and fexofenadine due to its cost effectiveness

Visual analogue scale: a simple tool in rural region for physician’s global evaluation and patient’s self-evaluation in allergic rhinitis

Background: The study was done with the objective to study whether the physician’s global evaluation of the consultation corelates with patient’s self-evaluation to patient outcome concerning symptom relief of nasal congestion by using visual analogue scale.Methods: A total of 52 patients completed a visual analogue score questionnaire presented at the consultation. 52 patients were reached in a seven days follow-up after the consultation. Patient’s outcome measures conducted at MIMER Medical College and Dr. Bhausaheb Sardesai Hospital in rural Maval Taluka in Pune district of Maharashtra state.Results: Physician’s self-evaluation of the consultation was much more strongly associated with outcome than the patient’s evaluation.Conclusions: The difference between the physician’s and patient’s evaluation of the consultation to predict patient outcomes indicates that the physician’s self-evaluation of the consultation is of importance

Cost variation analysis of antipsychotic drugs available in Indian market: an economic perspective

Background: Pricing of drugs plays a very important role in a developing country like India especially in the management of chronic conditions. There exists a huge price variation among the different brands of the same drug. Hence this study was planned to find out variation in prices of antipsychotic drugs marketed in India. The objective was to compare the percentage price variation and cost ratio of various formulations of oral and parenteral antipsychotic drugs available in the Indian market.Methods: Cost of oral and parenteral antipsychotic drugs available in the Indian market manufactured by different companies, in the same strength, number and dosage form was obtained from http://www.medguideindia.com. The percentage price variation and cost ratio of each formulation was calculated.Results: Among the typical group of antipsychotic drugs, Tab Haloperidol 0.25mg shows maximum price variation of 650% and a cost ratio of 7.5 followed by Tab Trifluoperazine 1mg having a price variation of 555.5% and a cost ratio of 6.55. Among the atypical group of drugs, tab Risperidone 3mg shows a price variation of 2282.35% with a cost ratio of 23.82 followed by Tab Risperidone 4mg with a price variation of 1976.92 % and a cost ratio of 20.76.Conclusions: There is a wide variation between the minimum and maximum cost among the different brands of the same drug in the same formulations. Combined efforts are needed from the regulatory authorities, pharmaceutical companies, physicians and pharmacist towards controlling the prices and attaining maximum economic benefits for the patient

A study of potential drug-drug interactions among critically ill patients at a tertiary care hospital

Background: Drug interaction is said to occur when presence of one drug affects the activity of another drug when both are administered together. This action can be synergistic or antagonistic. The objective was to study the prevalence of potential drug-drug interactions (pDDI), their severity, clinical significance, and their association with patient characteristics in intensive care unit (ICU) at a tertiary care hospital.Methods: A prospective, observational study was conducted in ICU patients for a period of 3 months to assess the pDDI using Medscape drug checker software and Lexi-Comp, inc. version: 2.7.5. drug interact android mobile application.Results: A total of 183 subjects were included in the study with a prevalence of 76.50% pDDI occurring in patients, majority of which were suffering from cardiovascular conditions (26.23%). In those with hospital stay more than five days, 92% had pDDI. There were 229 potentially interacting drug pairs with corticosteroids, aspirin, beta blockers, and diuretics being commonly involved in pDDI. A total of 2336 interactions were observed with an occurrence rate of 12.76 DDI per patient. Severity was moderate in 64%, interaction mechanism was pharmacodynamic in 72.49% and risk rating category was C in 77.1% of the study population.Conclusions: The present study showed high concomitant administration of potentially interacting drugs. The prevalence confirmed the association of age and polypharmacy. Vigilant prescribing approach is needed to prevent hazardous outcomes of pDDI

Assessment of cost effectiveness of antihistaminics in allergic rhinitis patients in rural region by Nasal cytology: a simple and inexpensive tool

Background: This study was to assess the usefulness of nasal smear as a quick, easy and inexpensive diagnostic method for allergic rhinitis and for assessment of the cost effectiveness of antihistaminics.Methods: This study was conducted in rural setting of tertiary care hospital. Nasal smears were taken from 52 patients with a clinical history of nasal allergy having nasal congestion score of at least 3 or more. Nasal smears were stained with Hematoxilin-Eosin and examined by pathologists.Results: A total of 52 patients 13 in each groups of the age group 18 to 65 years (Mean age, 33.73±10.23 years); 48.08% are Female and 51.92% are Male were randomized and received either Cetirizine, Levocetirizine, Loratadine, or Fexofenadine over a period of one week. The association of eosinophil before and after the treatment was obtained using logistic regression analysis for each treatment separately. Eosinophil is marginally associated with Cetirizine before and after treatment.Conclusions: Evaluation of eosinophils in nasal smear is an insensitive but cheaper test for the diagnosis of allergic rhinitis and use as a simple tool for comparison of cost effectiveness among commonly used oral antihistaminics. pharmacoeconomic analysis of present comparative clinical study shows that cetirizine is a better choice in comparison with levocetrizine, loratidine and fexofenadine due to its cost effectiveness