Cost analysis of various branded versus generic chemotherapeutic agents used for the treatment of early breast cancer- a deep insight from India

ABSTRACT

Background

Breast cancer (BC) stands first with high incidence and mortality in India. Most of the oncologists are unaware of cost savings by utilising generic drugs.

Aim

To perform a cost minimization analysis of generic versus branded chemotherapeutic regimen for treatment of BC.

Methodology

CIMS (current index of medical stores) was referred for the cost of branded drugs and the generic cost was taken from Jan Aushadhi scheme. The percentage cost variation and potential cost-saving particular to BC regimens on substituting available generic drug was calculated using standard formula and costs were presented in Indian Rupees and US Dollars (as of 2019).

Results

Among the branded agents considered, a range of 25% to 606.11% cost variation was observed with cyclophosphamide and 5-Fluorouracil respectively. Gemcitabine proposed the highest cost variation (373.68%-990.78%) and cyclophosphamide (71.42%-114.28%) with the lowest variation when compared to generic drugs. The highest level of cost-saving (₹60,807.3 to ₹1,31,864.1) with TAC regimen and the lowest range (₹12,15.84 to ₹15,667.2) with AC regimen was observed among adjuvant therapy regimens.

Conclusion

Our evaluation inferred that substituting generic chemotherapeutic drugs can bring potential cost savings. Healthcare professionals and patients should aware and opt generic drugs to achieve goals of BC therapy.

KEYWORDS:

• Pharmacoeconomics
• breast cancer
• chemotherapy
• cost savings
• generic

Article Highlights

• BC ranked 1st in both incidence and mortality in India with 14% (162,468) of new cases including both genders of all ages and 12.19% (87,090) deaths.

• Drugs used in adjuvant systemic therapy are manufactured by various pharmaceutical companies, available as different branded drugs with variable high costs, which is not affordable by the patients. An alternative to branded drug, generic drugs are available in the Indian market, both the forms of drugs are having an identical (therapeutic) effect, but generic drugs are available as low cost and they can be used as a low-cost substitute.

• There are no studies that provide data on cost savings per dose, per cycle and overall cost savings in the total duration of therapy on choosing available generic chemotherapeutic drugs as adjuvant systemic therapy, specifically for BC.

• We conducted a cost minimization study to analyse the percentage of cost variation and to calculate cost savings by generic substitution in the total duration of therapy particular to chemotherapeutic regimens used for breast cancer.

• Among the branded agents considered, a range of 25% to 606.11% cost variation was observed which belongs to cyclophosphamide and 5-Fluorouracil respectively. Gemcitabine proposed the highest cost variation (373.68%-990.78%) and cyclophosphamide (71.42%-114.28%) with the lowest variation when compared to generic drugs. The highest level of cost-saving (₹60,807.3 to ₹1,31,864.1) with TAC regimen and the lowest range (₹12,15.84 to ₹15,667.2) with AC regimen was observed among adjuvant therapy regimens.

• This study aids healthcare professionals to understand cost-saving benefits that can be achieved by substituting generic chemotherapeutic drugs and in decision-making by considering the economic status of the patient in the treatment of breast cancer. In addition to educating patients and overcome the issues like high cost branded drugs associated noncompliance and misconceptions about generic drug available costs.

• We restricted our cost analysis to only breast cancer since it has a higher incidence and mortality rate than other cancer in India.

Author contribution statement

A Kashyap, M N Balaji and M Chhabra has done the literature review, Designed the study, collected the data and drafted the manuscript. M Rashid and P M Muragundi helped in reviewing, revising the manuscript and provided assistance in the analysis and interpretation of data. M Rashid involved in the preparation of data collection form. All authors approve this version ofthe manuscript and agree to be accountable for all the aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.