PHARMACOECONOMICS

Pharmaco economics focuses on the costs and benefits of drug therapy

and pharmaco economic evaluations provide a basis for resource
allocation and utilization. It is increasingly becoming important for
health policy.

Four techniques are used for economic evaluation, namely, cost-minimization

analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit
analysis.

EXAMPLES:

1. In acute musculoskeletal disorders (tendinitis, bursitis, painful

post operative conditions, rheumatoid arthritis), one among the
following drugs is used. The cost per unit of each drug is provided.

Drug name cost(Rs)/ Unit(mg) Dose(mg)/Frequency

Acetaminophen 0.50/ 500 500/ QID
Aspirin 0.25/ 350 350/TID
Ibuprofen 1.00/ 600 600/TID
Indomethacin 1.00/ 25 25/TID
Diclofenac 0.75/ 50 50/TID

Questions:

1.To which group does the above mentioned drugs belong?

2.Work out the cost for each drug.

3. Which drug causes the least gastrointestinal adverse effect as

anti-inflammatory agent?

1. The above mentioned drugs belongs to the group of NSAIDs

2. Acetaminophen (BTD)=rs.0.05/500mg 4=rs.2 /day
Aspirin (TDS)=rs.0.25x3=rs0.75/day
Indometharin (TDS)=rs.1x3=rs.3/day
Diclofenac(TDS)=rs.0.7x3=rs.2.25/day
3.Acetaminophen causes the least gastrointestinal effects as anti inflammatory
agent

2. Mr. X is suffering from uncomplicated chlamydial urethritis. The

cost of various regimen is given below

Schedule A: Cap Doxycycline 100mg bd 7 days

Tab Azithromycin 1gm single dose  3
Schedule B: days
Schedule C: Cap Amoxycillin 500 mg tds 7days

Price: Cap .Doxycycline

100mg - Rs 4.00
Tab. Azithromycin 500 - Rs
mg 17.50
Cap. Amoxycillin 500
mg - Rs 6.50
B
Questions:

A] To which group does the above mentioned drugs

belong?

B]Analyse the cost effectiveness

 C]If a Pregnant woman is suffering from
uncomplicated Chlamydial urethritis which therapy will
you select? Why?
A]Anti-microbial drugs

b) Cost of schedule
Schedule A : Cap .Doxycycline 100mg BD x 7days
Total capsules required =14 Cost per cap 100 mg = rs.4.00
Cost of the schedule A =4x14 =rs. 56

Schedule B :Tab .Azithromycin 1g ODx3days

Total Capsule required =3
Cost of the schedule B=17.50 x3 x2 =rs.105

Schedule C: Cap .Amoxycillin 500mg TDSx7days

Total capsules required =3x7=21
Cost of the schedule =6.50x21=rs.136.50

schedule A which is cost effective

c) Cap Amoxycillin 500mg TDS x7days in case of uncomplicated chalamydial

urethritis .Amidst the given anti-microbial agents only penicillin group of drugs
are safe for a pregnant female

3. A 60yr old diabetic male came to skin OPD with itchy patches
in abdomen. He was diagnosed as Tinea corporis & was started
on antifungal drugs.

SCHEDULE A: Tab .Griseofulvin 250mg BD for 4 weeks

SCHEDULE B: Tab .Fluconazole 150 mg OD once a week for 4

weeks

SCHEDULE C: Tab .Terbinafine 250mg OD for 4 weeks

Price : Tab .Griseofulvin 250mg – RS 2.60 / 250 mg tab

 Tab .Fluconazole 150 mg – RS 28.00 / 150 mg tab

Tab.Terbinafine250mg – RS. 20.00 / 250 mg tab

Questions :

A] To which group the above-mentioned drugs belong

B] Analyse the cost effectiveness

C]Among the above schedule drugs which is not effective against

T.Versicolor?

A] Anti-fungal drugs[Anti-microbial agents]

B]Schedule A : Tab .Griseofulvin 250mg -rs2.60 x 2x4x7=rs.145.6

Schedule B: Tab .Fluconazole 150 mg -rs.28 x1x4=rs.112

Schedule C: Tab .Terbinafine 250mg -rs.20x4x7 =rs.560

Schedule B is Economical

c)T.Griseofulvin 250mg BD x4 weeks is not effective against T.vesicolor

4. A 60 year old male a known case of cirrhotic liver with pedal

edema & ascites was planned to be treated with diuretics.

SCHEDULE A: Tab Frusemide 40 mg OD / morning for 5 days

SCHEDULE B: Tab Torsemide 20 mg OD / morning for 5 days

SCHEDULE C: Tab. Frusemide 20 mg +Tab Spironolactone

50mg BD for 5 days
 Price ; Tab .Frusemide 40 mg ; RS 2.00 / unit

Tab. Torsemide 20 mg ; RS 3.75 / unit

Tab. Frusemide 20 mg +Tab .Spironolactone 50mg; RS 4.00 / unit

Questions :

A] To which group does the above mentioned drugs belong

B] Analyse the cost effectiveness

A] Diuretic

B]Schedule A:Tab Frusemide = 2.00x5=rs.10

Schedule B: TabTorsemide =rs.3.75x5=rs.15.75

Schedule C:Tab Frusemide + Tab Spironolactone =rs.4x2x5=rs.40

Schedule A is Economical

5. An adolescent boy attending Medicine OPD with complaints of running nose

and sneezing for 3 days. He was diagnosed to have allergic rhinitis. Select an
appropriate regimen for management.

Regimen A – Tab. Astemizole 10 mg od x 5 days

Regimen B- Tab. Chlorpheniramine 25 mg od x 5 days

Regimen C- Tab. Cetrizine 10 mg od x 5 days

Cost of drugs:

Tab. Astemizole 10 mg Rs. 10.50/10 tab

Tab. Chlorpheniramine 25mg Rs. 4.50/10 tab

Tab. Cetrizine 10 mgRs.25.00/10 tab

Questions:
1.To which group does the above mentioned drugs belong?
2.Analyze the cost effectiveness?

A] Antihistaminics
B]
Regimen A
Tab . Astemizole
No. of tablets required =5
Cost per tablet rs. 10.50 /10 =rs.1.05
Total cost 1.05x5 =rs.5.25
Regimen B
Tab .Chlorpheniramine
No.of tablets required =5
Cost per tablet rs. 4.50/10 =rs.0.45
Total cost =0.45x5=rs.2.25
Regimen C
Tab.Cetrizine
No.of tablets required =5
Cost per tablet =rs.25/10=rs.2.5
Total cost =2.5x5 =12.5
Answer:
 Therefore Regimen B (Tab Chlorpheniramine ) is cost efficient .

6. Find out the cost effective treatment for a poor male patient aged
above 50 years suffering from amoebiasis.
Duration of treatment is 7 days.

Tab. Metronidazole 400 mg TDS Rs. 6.60 / 10 Tab

Tab. Tinidazole 300 mg BD Rs.20.00 /10 Tab

Tab. Secnidazole 500 mg Rs.31.90 / 4 Tab.

A] To which group the above mentioned drugs belong?

B] Analyze the cost effectiveness?

A]Anti-amoebic drug

B]

Tab.Metronidazole:

No. of tablets required =3x7=21

Cost per tablet =rs.0.66

Total cost =0.66x21 rs.13.86

Tab. Tinidazole:

No .of tablets required =2x7=14

Cost per tablet =rs.2

Total cost =2x14=28

Tab. Secnidazole:

No of tablets required =4

cost per 4 tablets = rs.31.9

Therefore , for 1 week rs.31.9 x7=rs.223.3

On comparing the cost & assuming 100% cure for each regimen the
patient is advised to take Tab .Metronidazole as it is more economical

7. Select a suitable drug for a low income patient, aged 48 years,

suffering from pain of left shoulder.

Duration of treatment is 1 week.

a)Tab. Diclofenac 50 mg TDS Rs.7.25 / 10 Tab

b)Tab. Piroxicam 20 mg BD Rs.26.98 / 10 Tab

c)Tab. Celecoxib 100 mg OD Rs.36.50 / 10 Tab

A] To which group does the above mentioned drugs belong?

B]Analyze the cost effectiveness

Answers

A]NSAIDS

B]
a) Diclofenac :

No of tablet required =3x7=21

Cost per tablet =7.25/10=0.725

Total cost =rs.15.22

b)Piroxicam:

No of tablets required =3x7=21

cost per tablet =26.98 /10=2.698

Total cost =2.698x4=rs.37.47

c)Celecoxib:

No of tablets =1x7=7

Cost per tablet =36.50/10 rs.3.65

Total cost =3.65x7=rs.25.55
On comparing the costs Tab Diclofenac is found to be economical.

8. A 35 year old female was diagnosed to have peptic ulcer and was
suggested the following treatment options. Find out the cost effective
treatment.
Regimen 1:
Cap .Amoxycillin 1000mg BD
Tab .Clarithromycin 500 mg BD } 2 weeks
Tab .Lansoprazole 30 mg BD

Regimen 2:
Tab .Clarithromycin 500mg BD
Tab .Tinidazole 500mg BD } 2 weeks
Cap .Omeprazole 20mg BD

PRICE LIST:
Cap .Amoxycillin 500mg Rs.5.32/ capsule
Tab .Clarithromycin 500mg Rs.64/tablet
Tab .Lansoprazole 30mg Rs.4.25/capsule
Tab .Tinidazole 500mg Rs.2.95/tablet
Cap .Omeprazole 20mg Rs.3.30/capsule
A] To which group the above mentioned drugs belong?
B]Analyze the cost effectiveness?
A]Anti-H.pylori drugs
B]

Regimen 1 :

 Cap. Amoxicillin

500 mg tablet = Rs.5.32

 Cap. Amoxicillin 1000 mg = 5.32 x 2 = 10.64

 No. of capsules required = 2 x 14 = 28
Cost per 1000mg tablet = Rs. 10.64
Total cost = 10.64 x 28
= Rs. 297.92
 Tab. Clarithromycin
500 mg tablet = Rs.64
No. of tablets required = 2 x 14 = 28
Total cost = 64 x 28 = Rs. 1792

 Tab. Lansoprazole
30mg tablet = 4.25
Total no. of tablet = 2 x 14 = 28
Total cost = 4.25 x 28 = Rs. 119

Regimen 2
Tab Clarithromycin Rs.64 x 2 = Rs.128 = 128 x 4 = Rs. 1792
Tab Tinidazole Rs.2.95 x 2 x 7 = 5.9 x 14 = Rs.82.60
Cap Omeprazole = Rs.3.30 x 2 x 7 x 2 = Rs. 92.4

Total cost of Regimen 1 = Rs. 297.92 + 1792 + 119 = Rs. 2208.92

Total cost of Regimen 2 = Rs. 1792 + 82.60 + 92.40 = Rs. 1967.00

 Regimen 2 is cost effective.

9. Two combination drug regimens are available for severe
hypertension. Find out the cost benefit regimen.

Regimen 1:

Tab Amlodipine 5 mg BD

Tab Lisinopril 5mg BD

Regimen 2:

Tab Losartan 25mg BD

Tab Atenolol 50 mg BD

PRICE LIST:

Tab Amlodipine 5mg Rs.1.58/capsule

Tab Lisinopril 2.5mg Rs. 2.25/tablet

Tab Losartan 25 mg Rs.7/tablet

Tab Atenolol100mg Rs.4/tablet

1.To which group does the above mentioned drugs belong?

2.Analyze the cost effectiveness

1.Anti-hypertensive drugs

2.

Regimen 1

Tab Amlodipine =rs.1.58x2=rs.3.16

Tab Lisinopril =rs.2.25x2 =rs.4.5x2=rs.9.00

Cost of regimen -12.16

Regimen 2

Tab Losatan rs.7x2=rs.14

Tab .Atenolol rs.2x2=rs.4

Total cost of regimen 1 = Rs.12.16/day

Total cost of regimen 2 = Rs.18/day

Regimen 1 is cost effective.

10 .Treatment schedules available for uncomplicated chloroquine-

resistant P.falciparum infection.

Schedule 1:

Tab .Quinine sulphate 650 mg TDS ×7 days

Tab .Doxycycline 100mg BD ×7 days

Schedule 2:

Tab Quinine sulphate 650 mg TDS×7 days

Cap Clindamycin 600mg BD ×7 days

PRICE LIST:

Tab Quinine sulphate 650mg Rs.305.00/10 tablets

Cap Doxycycline 100mg Rs.40.00/10 capsules

Cap Clindamycin 600 Rs.120/capsule

1.To which group does the above mentioned drugs belong?

2.Analyze the cost effectiveness

1.Anti-malarial drugs

2.

Schedule 1:

Tab Quinine sulphate =rs. 30.50 /tab x21 = rs.640.50

Tab Doxycycline rs.4 /tab =4x2 =8x7 =rs.56

Total cost of schedule rs.696.50

Schedule 2:

Tab Quinine sulphate =rs.30.50x3=rs.91.50

Tab Clindamycin rs.120x2 =240x7=rs.1680

Total cost =rs.2320.50

Thus cost effective Regimen is Regimen 1.

11. A 25 year old male patient with signs and symptoms of upper
respiratory infection was suggested the following regimens. Find out
the cost benefit treatment schedule.

Schedule 1:

Cap Amoxycillin 500mg TDS ×7 Days

Schedule 2:

Tab .Cephadroxil 500mg Bd * 7 days

Schedule 3:

Tab .Azithromycin 500 mg od*3 days

PRICE LIST

Cap Amoxycillin 500mg Rs.70/10 Capsules

Tab Cephadroxil 500mg Rs.40/10 tablets

Tab Azithromycin 500 mg Rs. 60/3 tablets

A]To which group does the above mentioned drugs belong?

B]Analyze the cost effectiveness

A] Anti microbial agents-Antibiotics

B]

Schedule 1
 Capsule Amoxycillin

No.of tablets required 3x7=21

Cost per tablet =rs.7

Total cost =21x7=rs.147

Schedule 2

Tab Cephadroxil

No of tablets required=2x7=14

Cost per tablet =rs.4

Total cost =4x14=rs.56

Schedule 3

Tab Azithromycin

No of tablets required =3

Cost per tablet =20

Total cost for tablets =rs.60

Schedule 2 is more economical .

12. Treatment options available for Urinary Tract Infection are as

follows. Choose the one which is cost effective.
Treatment 1:

Tab .Cotrimoxazole BD × days (Sulfamethoxazole 800

mg+Trimethoprim 160 mg)

Treatment 2:

Tab .Ciprofloxacin 500 mg BD ×7 days

Treatment 3:

Cap Amoxycillin + Tab clavulanate ×7days bd

PRICE LIST:

Tab Cotrimoxazole Rs.2.75/tablet

Tab Ciprofloxacin 500 mg Rs.80/10 tablets

Cap Amoxycillin + Tab clavulanate 150/6tablets

Treatment 1:

Tab Cotrimoxazole

Cost per tablet per day =rs.2.75x2=rs.5.5

Total cost rs.5.5x7=rs.38.5

Treatment 2
Tab Ciprofloxacin

Cost per tablet per day =rs.8x2=rs.16

Total cost rs.16x7=rs.112

Treatment 3

Cap Amoxycillin + Tab Clavulanate

Cost per tablet per day =rs.150/6x2=rs.50

Total cost rs.50x7=rs.350

Thus the cost effective drug is Tab Cortrimoxazole.

13. A patient with gonorrhoea is to be treated with any one of the

following regimens. Work out the cost benefit.

A. Cap. Amoxycillin 3g & Tab Probenecid 1g single dose

B. Tab. Ciprofloxacin 500mg single dose

Price list:

1).Cap.Amoxycillin 500mg Rs.70/10 Capsules

2).Tab.Probenecid 1g Rs. 50/10 Tablets

3) Tab.Ciprofloxacin 500mg Rs.150/ 10 tablets

A]To which group does the above mentioned drugs belong?

B] Analyze the cost effectiveness

A] Anti-microbials

B]

Regimen A

Total no.ofAmoycillin capsule required =6

Cost of 6 capsules =6x7=rs.42

Tablet Probenecid cost=rs.5

Total cost of Regimen =rs.42+5=rs.47

Regimen B

Cost of one Ciprofloxacin tablet =rs.15

Answer :

Thus ,Assuring the equal efficacy for both the

regimen ,Regimen B is more economical than Regimen A .

14. The following regimens are available to manage a case of AIDS

patient . Work out the cost benefit ratio for 1 day.

Regimen A:

Cap. Zidovudine 300mg bd

Tab .Lamivudine 150mg bd

Tab .Efavirenz 600mg od

Regimen B:

Cap. Zidovudine 300mg bd

Tab .Lamivudine 150mg bd

Tab .Lopinavir 400mg bd

Cost :

1.Cap .Zidovudine 300mg Rs. 180/10 tablets

2.Tab.Lamivudine150mgRs. 140/10tablets

3.Tab. Efavirenz 600mg Rs.700/10 tablets

4. Tab.Lopinavir 200mg Rs.400/10tablets

A]To which group does the above mentioned drugs belong?

B] Analyze the cost effectiveness

A] ART DRUGS

B]

Regimen A

1)Cap. Zidovudine

Total Capsules required per day =2

Cost of capsules required per day =2x18=rs.36

2)Tab.Lamivudine

Total tablets required per day =2

Cost of capsules required per day =14 x2 =rs.28

3)Tab.Efavirenz

Total tablets required per day =1

Cost of tablet per day =rs.70

Total cost of Regimen A =36+28+70=rs.134

Regimen B

1)Capsule Zidovudine

Total capsules required per day =2

Cost of capsules required per day = 2x18=rs.36

2)Tab.Lamivudine

Total tablets required per day =2

Cost of tablets required per day =2x14 =rs.28

3)Tab.Lopinavir

Total tablets required per day =4

Cost of tablets required per day=40x4=rs.160

Total cost of Regimen B =36+28+140=rs.224

Answer:

Regimen A is cheaper compared to Regimen B.