Cost variation analysis of commonly prescribed anti-diabetic drugs available in Indian market: a pharmaco-economic study

Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary lifestyle, the incidence of DM is increasing. The chronic nature of DM causes significant personal suffering and economic difficulty to families. The was aimed at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various pharmaceutical companies were obtained from current index of medical specialties (CIMS) website, Indian drug review (IDR) 2021 issue and National pharmaceutical pricing authority-pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, metformin 500 mg sustained release showed highest price variation (3668%). Minimum cost variation was found with glipizide 2.5 mg (65%). Amongst the fixed dose combinations, highest cost variation was seen with glimepiride 2 mg+metformin 1000 mg (2703%) while minimum cost variation was found with repaglinide 1 mg+voglibose 0.3 mg (29%).Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all.Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands   Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands   Background:  Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands        

An assessment of pattern of adverse drug reactions of cardiovascular drugs in a tertiary care institute

Background: Cardiovascular disease is very prevalent in India. So, use of cardiovascular drugs is also more. So, it is very important to keep watch on adverse drug reactions. Aim of this study was to assess the pattern of adverse drug reactions (ADRs) reported with cardiovascular drugs in a tertiary care institute.Methods: The study was carried out in medicine department of a tertiary care hospital over a period of one year. Each ADR was analysed for demographic data, causality, relationship between frequency of ADRs and the number of drugs used etc. In statistical analysis Microsoft excel 2013, SPSS software was used.Results: A total of 136 patients, 58 (43%) men and 78 (57%) women, using cardiovascular medications reported ADRs during the entire study period. Total 168 ADRs were reported out of which, Amlodipine (causing headache and edema feet) was the most common drug with 51 (30.3%) ADR’s followed by Enalapril, Aspirin and Isosorbide Dinitrate with 37 (22%), 24 (14.2%), 23 (13.6%) ADRs respectively. Most common ADR was headache (due to amlodipine and Isosorbide di nitrate) affecting 38 (22.62%) cases followed by dry cough 37 (22.02%) cases, edema feet 36 (21.43%), gastritis 24 (14.29%) and 10 (5.95%) of nausea.Conclusions: Monitoring ADRs in patients using cardiovascular drugs is a matter of importance since this class of medicines are mostly used as multidrug therapy and always prone for ADRs

A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy

Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication. Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis. Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity

Multiplicity of benign breast disease lesions and breast cancer risk in African American women

The risk of developing subsequent breast cancer is higher in women diagnosed with benign breast disease (BBD) but these studies were primarily performed in non-Hispanic white populations. Still, these estimates have been used to inform breast cancer risk models that are being used clinically across all racial and ethnic groups. Given the high breast cancer mortality rates among African American (AA) women, it is critical to study BBD in this population, to ensure the risk models that include this information perform adequately. This study utilized data from AA women who underwent benign breast biopsies at a hospital served by the University Pathology Group in Detroit, Michigan, from 1998 to 2010. Patients were followed for subsequent breast cancers through the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). BBD lesion scores were assigned to represent the severity or extent of benign breast lesions, with higher scores indicating a greater number of distinct lesion types. Of 3,461 eligible AA women with BBD in the cohort, 6.88% (n=238) subsequently developed breast cancer. Examined individually, six of the eleven lesions (apocrine metaplasia, ductal hyperplasia, lobular hyperplasia, intraductal papilloma, sclerosing adenosis, columnar alterations and radial scars) were significantly associated with increased risk of breast cancer after adjustment for age and year of biopsy and were further considered in multiple lesion models. For every different type of benign breast lesion, subsequent risk of breast cancer increased by 25% (RR=1.25, 95% CI: 1.10, 1.42) after adjustment for age at biopsy and proliferative versus non-proliferative disease. In summary, this study affirms the increased breast cancer risk in AA women with BBD, particularly in those with multiple lesions. These findings have implications for the management of breast cancer risk in millions of women affected by BBD, a high risk group that could benefit from personalized surveillance and risk reduction strategies

The Aspergillus fumigatus transcription factor RglT is important for gliotoxin biosynthesis and self-protection, and virulence

This is the final version (corrected proof). The final published version is available from Public Library of Science via the DOI in this recordData Availability: Short reads were submitted to the NCBI’s Sequence Read Archive under accession number SRP154617 (https://www.ncbi.nlm.nih.gov/sra/?term=SRP154617). The ChIPseq data are available from NCBI SRA (sequence read archive) database under accession number PRJNA574873 (https://www.ncbi.nlm.nih.gov/Traces/study/?acc=PRJNA574873&o=acc_s%3Aa).Aspergillus fumigatus is an opportunistic fungal pathogen that secretes an array of immune-modulatory molecules, including secondary metabolites (SMs), which contribute to enhancing fungal fitness and growth within the mammalian host. Gliotoxin (GT) is a SM that interferes with the function and recruitment of innate immune cells, which are essential for eliminating A. fumigatus during invasive infections. We identified a C6 Zn cluster-type transcription factor (TF), subsequently named RglT, important for A. fumigatus oxidative stress resistance, GT biosynthesis and self-protection. RglT regulates the expression of several gli genes of the GT biosynthetic gene cluster, including the oxidoreductase-encoding gene gliT, by directly binding to their respective promoter regions. Subsequently, RglT was shown to be important for virulence in a chemotherapeutic murine model of invasive pulmonary aspergillosis (IPA). Homologues of RglT and GliT are present in eurotiomycete and sordariomycete fungi, including the non-GT-producing fungus A. nidulans, where a conservation of function was described. Phylogenetically informed model testing led to an evolutionary scenario in which the GliT-based resistance mechanism is ancestral and RglT-mediated regulation of GliT occurred subsequently. In conclusion, this work describes the function of a previously uncharacterised TF in oxidative stress resistance, GT biosynthesis and self-protection in both GT-producing and non-producing Aspergillus species.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESPConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES)Wellcome TrustUniversity of MacauNational Science Foundation (NSF)Vanderbilt UniversityHoward Hughes Medical Institut

Seismically induced landslide hazard and exposure modelling in Southern California based on the 1994 Northridge, California earthquake event

Quantitative modelling of landslide hazard, as opposed to landslide susceptibility, as a function of the earthquake trigger is vital in understanding and assessing future potential exposure to landsliding. Logistic regression analysis is a method commonly used to assess susceptibility to landsliding; however, estimating probability of landslide hazard as a result of an earthquake trigger is rarely undertaken. This paper utilises a very detailed landslide inventory map and a comprehensive dataset on peak ground acceleration for the 1994 Mw6.7 Northridge earthquake event to fit a landslide hazard logistic regression model. The model demonstrates a high success rate for estimating probability of landslides as a result of earthquake shaking. Seven earthquake magnitude scenarios were simulated using the Open Source Seismic Hazard Analysis (OpenSHA) application to simulate peak ground acceleration, a covariate of landsliding, for each event. The exposure of assets such as population, housing and roads to high levels of shaking and high probabilities of landsliding was estimated for each scenario. There has been urban development in the Northridge region since 1994, leading to an increase in prospective exposure of assets to the earthquake and landslide hazards in the event of a potential future earthquake. As the earthquake scenario magnitude increases, the impact from earthquake shaking initially increases then quickly levels out, but potential losses from landslides increase at a rapid rate. The modelling approach, as well as the specific model, developed in this paper can be used to estimate landslide probabilities as a result of an earthquake event for any scenario where the peak ground acceleration variable is available

Nail lacquer films’ surface energies and in vitro water-resistance and adhesion do not predict their in vivo residence

The in vivo residence of nail lacquers (which are ideal topical drug carriers for the treatment of nail diseases) determines their frequency of application, and is thereby expected to influence patient adherence and success of treatment. Thus in vitro measurements to indicate lacquers’ in vivo residence are routinely conducted during formulation development. However the literature on in vitro-in vivo correlations is severely limited. Thus, the aim of the work discussed in this paper was to investigate correlations between in vivo residence and in vitro film resistance to water, in vitro film adhesion and surface energy of lacquer films. In vivo measurements were conducted on fingernails in six volunteers. Seven commercially available nail lacquers were tested in commonly-used measurements. Correlations between in vivo residence and in vitro water resistance and adhesion were found to be extremely poor. The surface energies of the lacquer films (which were between 33 and 39 mJ/m2) were also not predictive of in vivo residence. High density polyethylene (HDPE) sheet – whose surface energy was determined to be similar to that of the human nailplate – was found to be a suitable model for the nailplate (when investigating surface energy) and was used in a number of experiments

Standardized Treatment of Active Tuberculosis in Patients with Previous Treatment and/or with Mono-resistance to Isoniazid: A Systematic Review and Meta-analysis

Performing a systematic review of studies evaluating retreatment of tuberculosis or treatment of isoniazid mono-resistant infection, Dick Menzies and colleagues find a paucity of evidence to support the WHO-recommended regimen

Assessing Tuberculosis Case Fatality Ratio: A Meta-Analysis

Background: Recently, the tuberculosis (TB) Task Force Impact Measurement acknowledged the need to review the assumptions underlying the TB mortality estimates published annually by the World Health Organization (WHO). TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment. Methods: We searched for eligible studies in the PubMed and Embase databases through March 4(th) 2011 and by reference listing of relevant review articles. Main analyses included the estimation of the pooled percentages of: a) TB patients dying due to TB after having initiated TB treatment and b) TB patients dying during TB treatment. Pooled percentages were estimated using random effects regression models on the combined patient population from all studies. Main Results: We identified 69 relevant studies of which 22 provided data on mortality due to TB and 59 provided data on mortality during TB treatment. Among HIV infected persons the pooled percentage of TB patients dying due to TB was 9.2% (95% Confidence Interval (CI): 3.7%-14.7%) and among HIV uninfected persons 3.0% (95% CI: 21.2%-7.4%) based on the results of eight and three studies respectively providing data for this analyses. The pooled percentage of TB patients dying during TB treatment was 18.8% (95% CI: 14.8%-22.8%) among HIV infected patients and 3.5% (95% CI: 2.0%-4.92%) among HIV uninfected patients based on the results of 27 and 19 studies respectively. Conclusion: The results of the literature review are useful in generating prior distributions of CFR in countries with vital registration systems and have contributed towards revised estimates of TB mortality This literature review did not provide us with all data needed for a valid estimation of TB CFR in TB patients initiating TB treatmen