Prescription analysis and cost of antidepressant drugs in major depressive disorder outpatients at the tertiary care hospital of Pakistan: a prospective approach

ABSTRACT

Objectives

To assess prescribing care indicators, utilization pattern, cost per prescription, cost ratios, and percent cost variation of antidepressants (ADs).

Method

A prospective cross-sectional study was carried out at the tertiary care hospital of Peshawar, Pakistan among major depressive disorder (MDD) outpatients from July 2019 to February 2020. The ideal standards for World Health Organization (WHO) prescribing care indicators were used. The ePharma Guide was used to calculate the cost in Pakistani rupees (Rs) and United States dollar (USD) 2021 (exchange rate: 1 USD = 154.43 Rs).

Results

A total of 296 MDD patients received 846 drugs (average 2.86; range:1–8), of which 366 were ADs (average number ADs/prescription; 1.23). About 23% (n = 68) of patients received more than one AD. Only 21 (5.7%) generic ADs were prescribed, and 346 (94.5%) ADs were prescribed from the hospital formulary list. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (67.5%). The average cost of ADs per prescription per month was 700.95 Rs (4.54 USD). Escitalopram (5.69 Rs; 0.04 USD) showed highest cost ratio and maximum percentage cost variation (468.97%).

Conclusion

This study observed low generic prescribing, a higher prescribing trend of SSRI, wide differences in cost ratio and percentage cost variation among ADs.

KEYWORDS:

• Antidepressants
• drugs
• generic drugs
• cost
• hospital
• Pakistan

Acknowledgments

We would like to acknowledge and extend our gratitude to Quaid-i-Azam University, Islamabad, Pakistan, and Lady Reading Hospital (LRH), Peshawar, Pakistan.

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 in this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The study concept and design: S Kamran and K Shah. Writing of the manuscript: S Kamran and Z Khan. Data analysis: M Saqlain, M Khan, and Z Ali. Obtaining data: S Kamran, Z Nazar, and H Rashid. Interpretation of results: S Kamran, Z Khan, and K Shah. Critical revisions of the manuscript: Z Nazar, K Shah, Y Karatas, and N Rahman. All authors approved the final version of the manuscript to be published.

Supplementary material

Supplemental data for this article can be accessed here

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.