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I Psychiotric Association of Nepal Vol.l, No;7, 2077 Cost comparison of a commonly prescribed Antidepres,sant (Escitalopram) . Kunwar A R* ,,;.,,xr:i :.I, ,. l Adibes;s: Associate Professor, Kathmandu'Medical College,Sinamnngal, Kathmandu E m ail* C ot e sp o n din g auth o t : anmkunw ar@ y aho o. c o m Abstract s. The treatment cost of antidepressant can prices of an antidepressant drug. in vary widely. The objective of ttris study is to find out the variation pharmaceutical companiei(:"'il-ibl" Method: We compared the price of an antidepressant escitalopram produced by various was taken as it is widely Escitalopram monl!1. six over therapy Jrn ury 2010) and compared the cost of antideprcssant companies making pharmaceutical ", by different names trade multiple under prescribed antidepressant in Nepal and it is sold I \ I l} t) it ideal for this study. : than 50 o/o more in Results: The cost of most expensive product over 6 monihs in comparison to cheapest product was more 20mg - Rs' l0mg and 20mg categories. ilopraur-t0mg-Rs. 1263.6 and 20mg-Rs. 2527.zvs Feliz S lOmg - Rs. 1953 and than expensive more .2) Rs. I 861 (Szetalo I Omg 47% and 17O6) (Nexito Rs. lOmg 35oZ products were 3780. Tvro other Rs lz63-q(Elopram l0mg product the cheapest - marketed Conclusion: This study concluded that there is wide price difference in the gost of an antidepressant escitalopram antidepressants, which by different pharmaceutical companies. Clinicians shoutd be aware of the cost difference between can lead to significant savings to patients and society as a whole. Key rvords: Cost comparison, Antidepressmg Escitalop'ram t:: INTRODUCTION that are often marketing a single compound (such Antidepressants are one ofthe most comnmbrprescfted drugs t. The indication for antidepressant includes major escitalopram). Even though the chemical composition, strength and quality of products are similar, there is wide variation in the cost ofthese drugs. To see what is the cost variation ofa given antidepressant we took one ofthe most commonly prescribed antidepressant escitalopram in Nepal depreisive disorder, generalized amiet5r disorder, obsessive corypulsive disorder, and intractable pain and so on. Antidepressants are often prescnlbed for a long period. Usual course is anywhere berween 6 to 12 mmths and some patients may take these drugs foryears- Due to this, overall cost ofan antidepressant cost catrbe hugeEscitalopram is a selective serotonin rerptake inhibitor (SSRI) approved for the treament of aduls with major depressive disorder, generalized anxiety disordcr, and 2 social anxiety disorder . Escitalopram is marketed since h *. '*, (clinical experience) that is marketed by multiple pharmaceutical companies. In ourknowledge this is a fust such study that has looked into costing ofan antidepressant in Nepal. Our aim is to find the cost variation" of an antidepressant in Nepalese pharmaceutical market. METHOD 2002 and is an active part of &e older drug citalopram r- Vvarious which has been in marketed since 1989 randomized control trials comparing escitalogam against other antidepressants for patients with major depressive disorder have shown probable better efltcacy and acceptability especially for acute response tal- Over this last couple of years escitalopram is increasingly being We took one of the most commonly prescribed antidepressant that is marketed by multiple phannaceutical companies. We only compared only one antidepressant so that we can keep all other factors constant such as physician preference, indication, side effects, chemical composition and strength (hence their influence in prescribing an antidepressant was nullified). We obtained the cost of all available brands of escitalopram from apharmacy. We also obtained the price directly from thepackaging of aproduct and also compared theprice from t'wo differentpharmacies to see ifthere was aprice difference betweenpharmacies. We also calculated what would be the cost for a typical treatment of anti depressant assuming all prescriptions of depression were prescribed for 6 months' We used the following formula to find the total cost of depression over course of treatment (6 monts). prescribed by physicians in Nepal, which has lsd 1e vat'ieus pharmaceutical companies marketing this drug under different brand name. As this drug is often taken for a long period, the financial burden maybe significant to a patient and society in general. The cost may also be a factor whetherpatient continues to take this drug so it is important for prescribers to be aware of the cost of the drugs they prescribe. Given all other quality of a drug is same; it will probably make sense to prescribe the most cost effective drug for the aforementioned reasons. In Nepali drug market there are multiple drug companies Kunwar: Cost comparison of a as commonly prescribed Antidepressant (Escitalofam) , J Psychiatric Assoeiation of Nepal Vol.7, No.l,207l Cost ofantidepressant per day X 180 days (6 months) = cost ofone course ofanti depressant implication forpatients and socigty. Depression is.one of the most common disorder and canies significant disabitrity to people who suffer from it. The proper treatrnent is vital for the recovery. In developed countries, in any given time Table l: Cost figures of the Escitalopram drug about25o/o of the population are receiving medication depressrorrr!]r. various trade names along with 6 months cost comparison berween different brands of Escitalopram name Elopram (Magnus) 5me society is becoming more aware and number ofproviders (psychiatrist and otherphysician) are increasiug, the more ?Omo 4.47 lOms -------l 7.02 14.04 and more people in Nepal will also be receiving If we assume that there are 10,000 individuals who are receiving escitalopram for various 5.56 9.48 18.96 causes, the cost ofprescribing cheaper brand will lead to over all saving between Rs. 44,20,000 to 68,94,000 for 10.34 20.68 'antidepressants. _ Nexito (Sun) for rn Nepai rnere rs no ciear data as how manypeople are receiving antidepressant. As r,rnder Szetalo (Pyramol) 5.63 lOmg and at least double that amount for20 mg. is just for one antidepressant. Ifwe assume similar differences exist between most of the drugs This above cost prescribed in Nepal, overall cost to our medical system could be enonnous. It might be coincidental but notahle that the cheapest product is marketed by Nepali pharmaceutical company, whereas all the otherexpensive brands are imported from India. Elopram (Magnus) 8M.6 (Sun) 1263.6 2527.2 1000.81 1706.4 3412.8 (Pyramol) 1013.4 1861.2 F (Torrent) 1069.2 1953 Difference 2&.6 689.4 CONCLUSION There is wide difference in the cost of an antidepressant, 3722.4 escitalopram marketed by different pharmaceutical companies. Prescribers must be aware of this price 3906 difference as choosing the most cost effective brand could save millions to consumers and society in general. In our 1378.8 clinical practice we have often seen patients who have uost difference 26,46,000 69,94,000 stopped taking medication due to expense of medication. In this situation prescribing cheaper alternative could 1,37,99,000 increase the compliance to treatment and may improve the outcome forpatient too. lation are Above results indicate that there is wide variation in cost of escitalopram marketed by different pharmaceutical companies. In 5mg strength the most expensive product Feliz S from Torrent) was more than 50% expensive than the cheapest product (Elopram from Magnus), and was 35Yo cheaper tlian the next cheapest product (Nexito from Sun). Similarly differencein cost was also observed in l0 REFERENCES l. Comparing Selective Serotonin Reuptake Inhibitors (SSRIs) to Tricyclic Antidepressants [InternetJ c2009 [Updated 200 9 Dec 7 : Cited 20 I I Feb 28]. Available from htp ://www. emedexpert. comy'compare,/ssris-vs-tca. shtul# I mg and 20 mg category. 2. Escitalopram [Internet] c 201I [Updated 201I Feb 28: Cited 201I Feb 281. Available at http://en.wikipedia.orgl When comparing cost over the course of antidepressant, wiWEscitalopram there was also significant cost difference between products. The cost of most expensive product over 6 months in 3. Tomer G. Prevailing against cost-leader competitors comparison to cheapestproduct was more than 50 % more in I Omg and 20mg categories. Elopram I 0rng - Rs. 1263.6 and 20mg *Rs.2527.2 vs Feliz S lOmg - Rs. 1953 and 20mg-Rs. 3780. Two otherproducts were 35oZ (Nexito lOmg - Rs. I 706) and 47%o (Szetalo I Omg - Rs. I 861.2) more expensive than the cheapestproduct (Elopram lOmg - Rs. 1263.6). in the pliarmaceutical industry. Journal of Generic Medicines 2008;l(10): 174l-1343. Available from http:// www. generics. co. iVdocs/P r ev ailngo/o2Ua gainst%2 Ocost- w/ 4. Cipriani A, Santilli C, Furukawa TA, Signoretti A, Nakagawa A, McGuire H, Churchill R, Barbui C. Escitalopram versus other antidepressive agents for DISCUSSION depression. Cochrane Database 2009, Issue Above finding clearly indicates that there is a significant cost difference between same product marketed by different phamraceutical companies. This has a significant 1465 I 858.CD006532.pub2 ACKNOWLEDGEMENT Kunwar: Cost comparison of a commonly prescribed futidepresmnt (Escitalopnm) 2 of Systematic Reviews 2. Art. No.: CD006532. DOI: 10.1002/