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ABSTRACT
Background
With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs.
Methods
Data on listed prices of selected cardiovascular drugs – essential (NLEM) and non-essential (NNLEM) – were sourced from multiple drug information compendia. Price of medications was calculated in cost-per-defined-daily-dose (DDD)-units and NLEM vs. NNLEM drugs were compared. Regression analysis was used to explore the determinants of percentage cost variation (PCV) of drugs.
Results
The median-cost/DDD of essential medicines was lower as compared to non-essential ones for all therapeutic drug classes, with greatest difference observed for antianginals and least for heart failure medicines. There were substantial cost variations with values in excess of 1000% for six medicines, all being essential. The regression analysis failed to demonstrate a significant effect of essentiality on PCV (β = 0.19, P = 0.314).
Conclusions
Our analyses demonstrate considerable cost variations for some essential cardiovascular medicines. Given the need for prolonged and often, lifelong-treatment, there is significant potential for cost savings based on chosen brand, highlighting the need for patient as well as prescriber education.
Article highlights
In order to improve the affordability of medicines, governments across the globe have instituted various forms of pharmaceutical price controls.
In India, the prevailing drug price control order sets ceiling prices for all essential medicines.
In this study, we evaluated the cost variations among drugs indicated for various cardiovascular conditions and performed cost-analysis comparing essential and non-essential drugs.
The median cost/DDD of essential medicines tended to be lower as compared to non-essential ones. However, considerable cost variations were found for some essential cardiovascular medicines.
Based on the need for prolonged treatment with these medicines, there is a significant potential for reducing out-of-pocket healthcare expenditure, highlighting the need for patient as well as prescriber education.
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.
Author contributions
The study was conceived and designed by A.K. Kakkar and S. Khanijo. S. Khanijo, G. Bhusal, G. Vishwas, G. Arora took part in data acquisition and verification.A.K. Kakkar and S. Khanijo participated in analysis and interpretation of data.A.K. Kakkar, S. Khanijo, R. Kumar, and A. Patil contributed to drafting the article, critical review, and revisions.