Publication:

Cost variation analysis of disease modifying anti rheumatic drugs in Indian market

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease with systemic complications, necessitating treatment to manage inflammation and prevent joint damage. In India, significant cost discrepancies exist among branded formulations of generic drugs, posing a financial burden on patients and impacting treatment adherence. This study focuses on cost differences of disease modifying anti rheumatic drugs (DMARDs) among Indian brands and advocating strict adherence to drug price control order (DPCO) rules and suggests scheduling non-scheduled drugs under DPCO.

Methods This observational study analysed the cost of 6 oral DMARDs across 16 tablet formulations using data from National Pharmaceutical Pricing Authority (NPPA) and DPCO ceiling prices 2024. Number of brands per formulation, cost ratios, percentage variations, and DPCO price violations was analysed. Statistical analysis was performed using Microsoft Excel Office 2021, and Zotero was utilized for managing references.

Results This study highlights significant price variations among DMARDs in the Indian market, with methotrexate 2.5mg exhibiting the highest cost ratio (1:3.63) and percentage cost variation (263.6%). Azathioprine 50mg has the most brands available (23), while sulfasalazine 500mg, sulfasalazine 1000mg, and tofacitinib 11mg are among the formulations with the fewest brands (3 each). Notably, sulfasalazine 500mg and hydroxychloroquine 200mg showed the most frequent instances of pricing violations above DPCO recommendations.

Conclusions Strict regulation for price control and monitoring should be implemented since the DPCO has not yet achieved its goal of enforcing price ceilings, and non-scheduled drugs should be included under DPCO regulations effectively to enhance adherence to RA therapy.