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        

Comparisons of Flutter Analyses for an Experimental Fan

Two propulsion aeroelasticity codes were used to model the aeroelastic characteristics of an experimental forward-swept fan that encountered flutter during wind tunnel testing. Both of these three-dimensional codes model the unsteady flowfield due to blade vibrations using the Navier-Stokes equations. In the first approach, the unsteady flow equations are solved using an implicit time-marching approach. In the second approach, the unsteady flow equations are converted to a harmonic balance form and solved using a pseudo-time marching method. This paper describes the flutter calculations and compares the results to experimental measurements

Flutter analysis of supersonic axial flow cascades using a high resolution Euler solver. Part 1: Formulation and validation

This report presents, in two parts, a dynamic aeroelastic stability (flutter) analysis of a cascade of blades in supersonic axial flow. Each blade of the cascade is modeled as a typical section having pitching and plunging degrees of freedom. Aerodynamic forces are obtained from a time accurate, unsteady, two-dimensional cascade solver based on the Euler equations. The solver uses a time marching flux-difference splitting (FDS) scheme. Flutter stability is analyzed in the frequency domain. The unsteady force coefficients required in the analysis are obtained by harmonically oscillating (HO) the blades for a given flow condition, oscillation frequency, and interblade phase angle. The calculated time history of the forces is then Fourier decomposed to give the required unsteady force coefficients. An influence coefficient (IC) method and a pulse response (PR) method are also implemented to reduce the computational time for the calculation of the unsteady force coefficients for any phase angle and oscillation frequency. Part 1, this report, presents these analysis methods and their validation by comparison with results obtained from linear theory for a selected flat plate cascade geometry. A typical calculation for a rotor airfoil is also included to show the applicability of the present solver for airfoil configurations. The predicted unsteady aerodynamic forces for a selected flat plate cascade geometry and flow conditions correlated well with those obtained from linear theory for different interblade phase angles and oscillation frequencies. All the three methods of predicting unsteady force coefficients, namely, HO, IC, and PR, showed good correlations with each other. It was established that only a single calculation with four blade passages is required to calculate the aerodynamic forces for any phase angle for a cascade consisting of any number of blades, for any value of the oscillation frequency. Flutter results, including mistuning effects, for a cascade of stator airfoils are presented in Part 2 of the report

A Review of Recent Aeroelastic Analysis Methods for Propulsion at NASA Lewis Research Center

This report reviews aeroelastic analyses for propulsion components (propfans, compressors and turbines) being developed and used at NASA LeRC. These aeroelastic analyses include both structural and aerodynamic models. The structural models include a typical section, a beam (with and without disk flexibility), and a finite-element blade model (with plate bending elements). The aerodynamic models are based on the solution of equations ranging from the two-dimensional linear potential equation to the three-dimensional Euler equations for multibladed configurations. Typical calculated results are presented for each aeroelastic model. Suggestions for further research are made. Many of the currently available aeroelastic models and analysis methods are being incorporated in a unified computer program, APPLE (Aeroelasticity Program for Propulsion at LEwis)

A theoretical and experimental analysis of macrodecoration of defects in monocrystalline silicon

Microdefect distribution in a monocrystalline silicon wafer is identified by saturating the wafer with copper at a high temperature followed by copper precipitate growth through rapid cooling followed by surface polishing and subsequent microdefect-decorating etching. The decorated microdefect field consists of etch pits that are formed by the difference in the etching rates of the precipitate influenced region around microdefects, and the etching rate of the surrounding defect-free silicon. Interplay between liquid-phase mass-transport effects and surface kinetics plays a key role in the microdefect decoration. It is shown that the macrodecoration of microdefects is typically realized in the absence of significant effects of the liquid-phase diffusion. The developed phenomenological model leads to classification of etchants as either polishing or potentially decorating and to identification of conditions necessary for an efficient microdefect decoration. The competing effects of kinetics toward microdefect decoration and liquid-phase transport toward surface polishing are quantified by theoretically derived solutions for the decorating efficiency and the polishing efficiency. Autoerosion of the microdefects by mildly polishing etchants is also quantified. Analytical expressions for the microdefect-decorating and microdefect-polishing conditions are presented. Finally, decorating and polishing etchants are experimentally identified from a group of etchants and the proposed theory is verified by experimental data.peer-reviewe

Steps in the Negative-Differential-Conductivity Regime of a Superconductor

Current-voltage characteristics were measured in the mixed state of Y1Ba2Cu3O(7-delta) superconducting films in the regime where flux flow becomes unstable and the differential conductivity dj/dE becomes negative. Under conditions where its negative slope is steep, the j(E) curve develops a pronounced staircase like pattern. We attribute the steps in j(E) to the formation of a dynamical phase consisting of the succesive nucleation of quantized distortions in the local vortex velocity and flux distribution within the moving flux matter.Comment: 5 pages, 3 figure

Aeromechanics Analysis of a Distortion-Tolerant Fan with Boundary Layer Ingestion

A propulsion system with Boundary Layer Ingestion (BLI) has the potential to significantly reduce aircraft engine fuel burn. But a critical challenge is to design a fan that can operate continuously with a persistent BLI distortion without aeromechanical failure -- flutter or high cycle fatigue due to forced response. High-fidelity computational aeromechanics analysis can be very valuable to support the design of a fan that has satisfactory aeromechanic characteristics and good aerodynamic performance and operability. Detailed aeromechanics analyses together with careful monitoring of the test article is necessary to avoid unexpected problems or failures during testing. In the present work, an aeromechanics analysis based on a three-dimensional, time-accurate, Reynolds-averaged Navier-Stokes computational fluid dynamics code is used to study the performance and aeromechanical characteristics of the fan in both circumferentially-uniform and circumferentially-varying distorted flows. Pre-test aeromechanics analyses are used to prepare for the wind tunnel test and comparisons are made with measured blade vibration data after the test. The analysis shows that the fan has low levels of aerodynamic damping at various operating conditions examined. In the test, the fan remained free of flutter except at one near-stall operating condition. Analysis could not be performed at this low mass flow rate operating condition since it fell beyond the limit of numerical stability of the analysis code. The measured resonant forced response at a specific low-response crossing indicated that the analysis under-predicted this response and work is in progress to understand possible sources of differences and to analyze other larger resonant responses. Follow-on work is also planned with a coupled inlet-fan aeromechanics analysis that will more accurately represent the interactions between the fan and BLI distortion

Orbiter LH2 Feedline Flowliner Cracking Problem

In May of 2002, three cracks were found in the downstream flowliner at the gimbal joint in the LH2 feedline at the interface with the Low Pressure Fuel Turbopump (LPFP) of Space Shuttle Main Engine (SSME) #1 of Orbiter OV-104. Subsequent inspections of the feedline flowliners in the other orbiters revealed the existence of 8 additional cracks. No cracks were found in the LO2 feedline flowliners. A solution to the cracking problem was developed and implemented on all orbiters. The solution included weld repair of all detectable cracks and the polishing of all slot edges to remove manufacturing discrepancies that could initiate new cracks. Using the results of a fracture mechanics analysis with a scatter factor of 4 on the predicted fatigue life, the orbiters were cleared for return to flight with a one-flight rationale requiring inspections after each flight. OV-104 flew mission STS-112 and OV-105 flew mission STS-113. The post-flight inspections did not find any cracks in the repaired flowliners. At the request of the Orbiter Program, the NESC conducted an assessment of the Orbiter LH2 Feedline Flowliner cracking problem with a team of subject matter experts from throughout NASA

Extent of Thoracic Aortic Atheroma Burden and Long-Term Mortality After Cardiothoracic Surgery A Computed Tomography Study

ObjectivesWe hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery.BackgroundIn patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown.MethodsWe reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up.ResultsA total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03).ConclusionsExtent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs

Sociobiological Control of Plasmid copy number

Background:&#xd;&#xa;All known mechanisms and genes responsible for the regulation of plasmid replication lie with the plasmid rather than the chromosome. It is possible therefore that there can be copy-up mutants. Copy-up mutants will have within host selective advantage. This would eventually result into instability of bacteria-plasmid association. In spite of this possibility low copy number plasmids appear to exist stably in host populations. We examined this paradox using a computer simulation model.&#xd;&#xa;&#xd;&#xa;Model:&#xd;&#xa;Our multilevel selection model assumes a wild type with tightly regulated replication to ensure low copy number. A mutant with slightly relaxed replication regulation can act as a &#x201c;cheater&#x201d; or &#x201c;selfish&#x201d; plasmid and can enjoy a greater within-host-fitness. However the host of a cheater plasmid has to pay a greater cost. As a result, in host level competition, host cell with low copy number plasmid has a greater fitness. Furthermore, another mutant that has lost the genes required for conjugation was introduced in the model. The non-conjugal mutant was assumed to undergo conjugal transfer in the presence of another conjugal plasmid in the host cell.&#xd;&#xa;&#xd;&#xa;Results:&#xd;&#xa;The simulatons showed that if the cost of carrying a plasmid was low, the copy-up mutant could drive the wild type to extinction or very low frequencies. Consequently, another mutant with a higher copy number could invade the first invader. This process could result into an increasing copy number. However above a certain copy number within-host selection was overcompensated by host level selection leading to a rock-paper-scissor (RPS) like situation. The RPS situation allowed the coexistence of high and low copy number plasmids. The non-conjugal &#x201c;hypercheaters&#x201d; could further arrest the copy numbers to a substantially lower level.&#xd;&#xa;&#xd;&#xa;Conclusions:&#xd;&#xa;These sociobiological interactions might explain the stability of copy numbers better than molecular mechanisms of replication regulation alone