Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 96728

AbstractMaterial and MethodsResultsDiscussionConclusionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : December | Volume : 3 | Issue : 6 | Page : 1871 - 1875

Price Variability Among The Oral Antibiotics Available In A South Indian Tertiary Care Hospital

PATEL D *, THIYAGU R **, MALLAYASAMY S *** PATEL H **** PANDEY S *****

*,**** Postgraduate Students ** - Senior Research Fellow ***- Senior Lecturer ***** Professor and Head Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, Karnataka, (India).

Correspondence Address :
R. Thiyagu
Senior Research Fellow,
Dept of Pharmacy Practice,
Manipal College of Pharmaceutical Sciences,
Manipal University,
Manipal, Karnataka,
India – 576104.
E-Mail : thiyagu.rajakannan@gmail.com (R.Thiyagu).
Phone : + 91- 820- 2922403

Abstract

Background: There exist a wide range of variation in the prices of drugs marketed in India and other countries of world. Very few studies have been conducted to reveal such price variations in the open market.
Objective: This Pharmacoeconomic study is designed to obtain the picture of price variability among the different oral antibiotic drugs available in the hospital pharmacy and their economic impact on patients.
Methods: Prices and the units of oral antibiotics sold included in the study were obtained from computer data base of hospital pharmacy department. The percentage price variation was calculated for all the brands of drugs. Brands were classified into costliest, cheapest and mid range based on the cost in comparison with all available brands for a drug. Impact of number of brands on percentage price variation was calculated. The cost incurred by the patient if costliest and the cheapest brands were prescribed for managing clinical condition was calculated.
Results: Percentage price variability of 30 brands was 0 - 25% and for 24 brands it was 25.1 - 50%. For 15 brands percentage price variability was more than 100%. It has been observed that costliest brands were preferentially prescribed over the cheaper alternatives. As the number of brands increased for any drug the percentage price variation (range) also increased.
Conclusion: It was observed that percentage price variation was higher among some drugs and this percentage price variation might result in bigger difference in cost of management of infections, if costlier brands were prescribed. Costlier brands were preferred more and there is a need to formulate policy at the Hospital level to address these issues.

Keywords

Antibiotics, Price variation, Hospital pharmacy, Pharmacoeconomics

Introduction
Rational use of medicines requires that patients receive medications appropriate to their clinical needs in doses that meet their requirements for an adequate period of time and at the lowest cost to them and their community (1). The irrational use leads to ineffective and unsafe drug treatment, worsening or prolonging of illness, and adverse drug reactions (2). Healthy competition in trade always provides a better option to the consumer but these does not hold right for the medicines as person who buys the medicines has very little choice in selection of the drugs (3). As per Central Drugs Standard Control Organization (CDSCO) of India, bioequivalence of a drug product is achieved if the rate and extent of absorption are not statistically different from those of reference product at certain significant levels when administered in the same molar dose. Many generic drugs are approved to be marketed based on the bio equivalence data. Generic drugs are widely believed to be bio-equivalent and provide same therapeutic effects as the innovator products (4). High cost of medicines has economic implications for the patients and also the patient compliance significantly depends on the cost of the medicines prescribed. In fact, several studies have indicated that therapeutic compliance is influenced by drug prices (3). Prices of prescription can affect users, suppliers and most importantly payers in health care systems. Price discrimination occurs in the pharmaceutical industry both in India and as well as in other countries.

According to industry, drug prices in India are the cheapest in the world yet the access to these medicines is increasingly getting restricted to those who can afford it. There exists a wide variation in the prices of drugs manufactured by different companies. In India very few patients are covered by health insurance and hence patients have to pay from their pocket (5). Jennifer et al. reported that there is potential savings from substituting generic drugs for brand-name drugs (6). But in many countries, there is a considerable variation in the price of generics also. Antibiotics are one of the commonly prescribed medicines in almost all the departments of any hospital. In the absence of comparative information on antibiotic prices it is difficult for physicians to prescribe the most economical treatment regimen. The current study was designed to assess the price variability pattern among the oral antibiotics and study their usage in relation to their cost.

Material and Methods

Prices of oral antibiotics included in the study were obtained from computer data base of hospital pharmacy department of the study site which is a tertiary care hospital. The selling cost of a particular drug manufactured by different companies in same strength available in hospital pharmacy department was compared. If only one brand was available for a drug without any competitor’s brand that particular drug was excluded. Parental antibiotics were not included in this study. The percentage variation in price was calculated using the following formula (3)

Percentage= Price of most expensive brand-price of least expensive brand
_________________________________________________________________x100


Price of least expensive brand



The difference between the prices of same drug of same strength e.g. amoxicillin 500 mg manufactured by the different Pharmaceutical companies available in hospital pharmacy was compared. The drugs were classified into five categories depending on the percentage (%) range 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.

Analysis of number of prescriptions of oral antibiotics filled in the pharmacy with their cost was studied to find out most prescribed brands. These brands were further classified into the costliest, the cheapest and the mid range comparing with the price of all the brands of that particular drug.

Drugs were classified into three different groups based on number of available brands viz., Group I with less than 3 brands and Group II with 3-5 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.

Hypothetical clinical situation of infections, where in antibiotic therapies to be used were considered and the cost to a patient was calculated. Five drugs viz., cefuroxime axetil, levofloxacin, cefdinir, ofloxacin and cefpodoxime were selected since they had more than 100% price variation. The cost to be incurred by a patient was calculated for costliest and cheapest brand.

Results

The prices of 34 oral antibiotic drugs available in the hospital pharmacy of a tertiary care hospital were compared and analyzed for the variation. A total of 117 brands of these 34 drugs were available and prescribed by clinicians. The number of brands available in various categories based on the percentage price variation is presented in (Table/Fig 1). Thirty brands were available in the category of 0-25% price variation which was the largest group compared to other categories of price variation. Extreme percentage price variation between brands of same drugs was found in case of levofloxacin 500mg (1837.77%) and cefixime 200 mg (0.67%).

Drugs were categorized as three groups’ viz., 1) Costliest brands were preferred. 2) Cheapest brands were preferred and 3) Mid range priced brands were preferred (Table/Fig 2). Out of total drugs studied, it was found that costliest brands were preferably prescribed over cheaper brands (44.12%).

When the number of brands available for drugs were studied it was found that as the number of brands increases the range of prices also increases but the mean price variation remained same (Table/Fig 3).

When the cost of managing illness with certain antibiotic regimen was studied for their common indication, a big difference was found when costlier and cheaper brands were used. In case of levofloxacin which is used for managing complicated urinary tract infection in a one week regimen the cost of therapy was $ 0.648 with cheaper brand whereas it will cost $ 13.27 if the costliest brand was prescribed. This shows more than 20 fold difference in the cost of therapy (Table/Fig 4).

Discussion

Indian market is predominantly a branded generic market i.e. more than one company selling a particular drug under different brand names apart from the innovator company. So, the number of pharmaceutical products available in the market also is very high in the range of 60,000-70,000 products (2). This situation has led to greater price variation among drugs marketed. Antibiotics class of drugs is very commonly prescribed for prophylaxis and also for the treatment of infectious disease. The prices of the oral antibiotics prescribed and available in hospital pharmacy were compared. More than 50% price variation was noted in 35% of the brands. Only 30 brands were in the group of 0-25% price variation. Remaining 53 brands had price variation above 25% and in some cases more than 100% price variation which is not an acceptable situation to patients. The average price variation for this study was 93%. In a study conducted by P.R.Shankar et al. in Nepal, they found out that mean percentage price variation for antibiotics was around 38.1% (3). Our study showed more price variation than that study. The reason for such high price variation might be that India is altogether a different country in terms of its size, strong manufacturing industry and the sheer number of players. Even though large number of pharmaceutical companies help in bringing down the cost of medicines due to competition, there is a tendency among pharmaceutical companies to promote the idea that the brands priced higher are better than their cheaper counter parts which is not true. In this market situation patient might be prescribed with costly brands adding to his/her burden which could be avoided if there is strong mechanism to control price variation among brands.

In a study conducted by Rataboli P.V et al where a database of drugs marketed in India was used to find the percentage price variation from average of marketed antibiotics, 3 drugs fell in 0 - 25% and 25.1 - 50% variation group, 5 drugs fell each in 50.1 - 75% and 75.1 - 100% while 11 drugs were having more than 100% price variability (7). In comparison with the open market situation reported by that study, this study reported a much less price variation pattern. This might be attributed to the systems of Pharmacy and Therapeutic committee which has some control over selection of drugs. Pharmacy and Therapeutic committee in this hospital performs cost comparison of brands before adding it into the hospital formulary and this helps to control price variation to an extent. Thorough cost evaluation by the Pharmacy and Therapeutic committee before including in the hospital formulary will be an ideal situation and this might help patients especially from poor economic background (8).

It was noted that mean percentage price variation did not change much as the number of brands increased per drug. But the range and standard deviation clearly appeared to increase as the number of brands per formulation increased. In this situation it is not prudent to use just mean percentage price variation as it may make the interpretation difficult. These findings calls for restriction of number of brands in hospital and inclusion of fewer brands in the hospital formulary and physicians should also restrict themselves by prescribing limited (2-3) brands per drug. Active involvement of Pharmacy and Therapeutic committee and hospital administrators will help in controlling the number of brands in the hospital formulary consequently reducing the percentage variation of price in management of diseases.

In this study it has been noted that costliest brands of drugs were mostly prescribed than their cheaper counterparts even though there is no evidence that costly brands are better in terms of bioavailability or efficacy. This tendency of prescribing costliest brand particularly in antibiotic class which are already expensive may contribute to poor compliance which in turn might result in increased drug resistance. Employing the use of cheaper options in disease management makes the treatment to be more affordable and successful. In a study reported by Das.S.C et al out of 7 drugs studied costliest bands were sold more than cheapest brands in case of 5 drugs and this shows the tendency to prescribe costliest brands among the prescribers (9). There is clearly a need to inform clinicians on the cheaper choices to bring some change in prescribing practice. Promotional strategies of pharmaceutical companies have to be studied further to understand this issue.
When the cost of management of clinical conditions with antibiotics was studied it was noted that there was a minimum of two fold to twenty fold difference in cost of therapy between costliest and cheapest brands. In case of Cefuroxime one week course for bronchitis cost $ 5.93 with the cheapest brand whereas the same therapy will cost $ 21.05 if the costliest brand is used. India being a developing country with a Per capita income of $770.69 (10) such high cost for one week of therapy might put patients at financial trouble. In India mostly patients are paying out of their pockets for their medical bills and are not covered by insurance schemes unlike developed countries. In this situation it is prudent to revisit the costing mechanisms and the huge difference between pricing of brands have to be regulated by concerned agencies. Further studies exploring the reasons for such a price variation and ways to counter this trend will go long way in rationalizing the cost of managing infections with antibiotics.

Conclusion

The average percentage price variation of different brands of the same drug manufactured in India and available in hospital is very wide. As the number of brands for a drug increases percentage price variation also shows concurrent increase. Costliest brands were preferred over cheaper brands and this shows the need for educating physician and further study of this issue. At the hospital level authorities and concerned committees have to frame policies on these aspects. There is a need for concerted action from regulatory authorities, doctors, pharmacists and general public at large to address this issue of antibiotic price variation.

References

1.
Salman MT, Akram MF, Rahman S, Khan FA, Haseen MA, Khan SW. Drug prescribing pattern in surgical wards of a teaching hospital in north India. Indian Journal for the Practising Doctor. 2008;5:5-6.
2.
Thomas M. Rational drug use and essential drug concept. In: G. Parthasarthi, Karen Nyfort-Hasen, eds. A textbook of clinical pharmacy practice. Ed 1, Orient Longman, 2004;72-73.
3.
Shankar PR, Subish P, Mishra P, Lalit M. Ambiguous pricing of Nepalese medicines. Journal of institute of medicine. 2006;28:35-38.
4.
Guidelines for Bioavailability and Bioequivalence studies, Central drug standard control organization. http://www.cdsco.nic.in/html/BE%20Guidelines%20Draft%20Ver10%20March%2016,%2005.pdf . Accessed May 20, 2009.
5.
Essential drugs and medicines: Drug finance, World health organization. http://www.whoindia.org/EN/Section2/Section5/Section160_959.htm. Accessed on March 22, 2009.
6.
S. Haas, K. A. Phillips, E. P. Gerstenberger, A. C. Seger. Potential Savings from Substituting Generic Drugs for Brand-Name Drugs: Medical Expenditure Panel Survey, 1997-2000. Ann Intern Med. 2005;142:891-897.
7.
Rataboli PV, Dang A. Antimicrobial price variation: Conundrum of medical profession. J Postgrad Med. 2007;53:72-74.
8.
Olav M. Bakke. How many drugs do we need? World health forum. 1986;7:252-255.
9.
S.C.Das, M.Mandal, S.C.Mandal. A critical study on availability and price variation between different brands: Impact on access to medicines. Indian J. pharm.Sci. 2007;69:160-163.
10.
India's per capita income doubles to Rs 38,084. http://www.rediff.com/money/2009/feb/09indias-per-capita-income-doubles-to-rs-38084.html Accessed May 24, 2009.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com