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DOI: 10.1055/s-0044-1779721
Pharmacoeconomic Analysis of Treating Lung Cancer with Different Regimens Using the Cheapest and Costliest Brand and the Generic Jan Aushadhi Drugs Marketed in India
Abstract
Background/Purpose of the Study The costs of chemotherapy drugs which are vital in the treatment of lung cancer can be exorbitant. The current study was undertaken to ascertain cost minimization analysis by comparing costliest and cheapest branded with Jan Aushadhi (JA) drugs marketed in India.
Methods The cost of costliest, cheapest branded, and JA drugs were collected from the designated reference sites. The cost difference, cost ratio, and percentage of cost variation were calculated as per cost minimization study guidelines.
Results The results of the analysis suggest that the JA drugs were much cheaper than the branded drugs and when used in regimens resulted in substantial cost savings. The biggest financial advantage was seen in the commonly used cisplatin–pemetrexed regimen where cost saving of Rs. 268,002 was observed for the whole treatment of six cycles. Using JA drugs also reduced the cost for the targeted therapy with gefitinib and erlotinib.
Conclusion The cost minimization study, which is the first in this field of lung cancer, clearly indicates the usefulness of JA drugs in reducing financial costs for the patient.
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Keywords
lung cancer - anticancer drugs - pharmacoeconomics - Jan Aushadhi - cost difference - cost ratio - percentage of cost variationIntroduction
Chemotherapy is important in lung cancer treatment, and depending on the stage, it is used either as the only modality or before or after surgery or radiation.[1] However, chemotherapy costs patient substantially and liquidates their lifelong earnings/savings. In hospital pharmacy, cost minimization analysis (CMA) is important aspect and attempts at understanding the financial impact of drug costs on the patient considering different marketed brands. The Government of India has initiated Jan Aushadhi (JA) outlets across the country where generic drugs are available at reduced price and has been immensely useful for the poor.[2] The current study compared the CMA taking into account the most expensive and least expensive branded anticancer drugs with the JA drugs. By assessing the economics of chemotherapy drugs, the study aims to provide insights into optimizing health care budgets and promoting the adoption of economically viable treatment options.
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Materials and Methods
Inclusion and Exclusion Criteria
The inclusion criteria considered were to include only those drugs and regimens used in the curative or palliative lung cancer treatment, in accordance to National Comprehensive Cancer Network guidelines. The exclusion criteria included all other drugs and regimen used for treating other cancers.
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Study Method
This CMA was performed in accordance to the tenets of pharmacy and health economics research guidelines from October to December 2021. The study evaluated the cost disparities between the costliest and cheapest drugs under the premise that all other costs associated with the delivery of treatment remained constant. Costs of the branded anticancer drugs available in India were obtained from the Current Index of Medical Specialties and the Monthly Index of Medical Specialties, India. JA drug costs were ascertained from the booklet available and from the Pharmaceuticals and Medical Devices Bureau of India. Cost difference, cost ratio, and percentage of cost variation were calculated per tablet/capsule/injection as described earlier.[3]
Anticancer drugs have to be strictly administered considering the body surface area (BSA) of the patient. Bearing this in mind, for this study, the dose and the financial cost for treating lung cancer were estimated adopting the recent National Institute of Nutrition, Hyderabad, India details on average height and weight for Indian men and women. The values of 55 kg and 5.3 feet (162 cm) tall for Indian woman and 65 kg and 5.8 feet (177 cm) tall for Indian man were considered.[4] BSA was calculated and observed to be 1.58 for women and 1.78 for men. For carboplatin, which needs to be provided based on the patient's glomerular filtration rate (GFR) and creatinine clearance, the value of 0.7 for creatinine was considered.[5] The cost for both males and females was calculated for the various regimens for one cycle as well as for six cycles and represented in tables. The primary outcome of the study was to evaluate the cost disparities between the costliest and cheapest chemotherapy drugs used in the treatment of lung cancer.
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Results
The cost of the individual JA, costly, and cheap branded anticancer drugs marketed in India is presented in [Table 1]. The highest cost saving was observed by replacing branded with JA drug for the commonly used cisplatin–pemetrexed regimen, where saving of Rs. 268,002 was observed ([Tables 2] and [3]). The cost savings for other regimens are presented in [Tables 2] and [3] for males and females, respectively. The CMA conducted for a 1-year course of the targeted therapy drugs gefitinib and erlotinib showed that JA drug resulted in substantial cost savings when compared with its branded counterparts ([Table 4]).
Abbreviation: JA, Jan Aushadhi.
Abbreviations: AUC, area under the curve; D, day; JA, Jan Aushadhi; PCV, percentage of cost variation.
Abbreviations: AUC, area under the curve; D, day; JA, Jan Aushadhi; PCV, percentage of cost variation.
Abbreviations: JA, Jan Aushadhi; PCV, percentage of cost variation.
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Discussion
The cost of chemotherapy varies according to the type and stage of lung cancer, and the anticancer drug and the regimen being planned, and imposes severe financial burden on the patients.[6] The results indicate that the costs for drugs with the same strength vary and that generic JA medications are cheaper than the branded drugs ([Table 1]).[7] In clinics, pemetrexed, which is usually used with cisplatin or carboplatin, is a first-line, maintenance, and second- or third-line treatment for non–small cell lung cancer (NSCLC),[8] and substitution with a JA drug results in a significant cost reduction for both male and female patients ([Tables 2] and [3]). A substantial saving was also observed in the CMA for cisplatin–etoposide, gemcitabine–cisplatin, and other regimens when JA drugs were used ([Tables 2] and [3]).
In recent years, inhibiting Epidermal Growth Factor Receptor (EGFR), which is overexpressed in 10 to 15% of NSCLC patients, is observed to be effective, and the drugs erlotinib, gefitinib, afatinib, and osimertinib are reported to be effective.[9] [10] Erlotinib and gefitinib work by blocking the EGFR tyrosine kinase domain through competitive linking at the adenosine triphosphate-binding site.[10] The use of JA drugs resulted in significant cost savings for patients. Lung cancer chemotherapy poses a significant financial challenge, particularly in resource-constrained nations such as India. The overall cost encompasses expenses related to drugs, medical equipment, and hospital stays, placing a substantial burden on patients. For individuals grappling with lung cancer, out-of-pocket expenditures manifest at every stage, spanning initial visits to local health facilities to ultimate diagnosis and treatment at tertiary health care centers. The financial strain is evident in expenses incurred for preliminary investigations, diagnostic tests, and the unavoidable costs associated with travel and accommodation during referrals to higher tier health care facilities. To alleviate the financial strain, the widespread establishment of JA stores, particularly in rural areas, holds promise for assisting economically disadvantaged populations. The same could facilitate the realization of reduced drug prices, aligning with the aspiration for more affordable health care. Instituting social safety nets for marginalized communities stands to enhance accessibility to essential and quality pharmaceuticals. Essential improvements in pharmaceutical policies at both national and state levels are imperative to amplify cost-effectiveness, thereby widening public access to chemotherapy medications.
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Conclusion
The observations of the study indicate that the prices of treating lung cancer were decreased, when JA anticancer drugs were used. The findings of the study will be of tremendous value to the patient population, the health care fraternity, and the society at large.
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Conflict of Interest
None declared.
Ethics
No patient-specific data or information were required for the study focus on the pharmacoeconomics of drug pricing. Cost of data on medications is available in public domain, and the study did not require approval from an Institutional Review Board.
Ethics Committee Approval
Not required.
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References
- 1 Noronha V, Pinninti R, Patil VM, Joshi A, Prabhash K. Lung cancer in the Indian subcontinent. South Asian J Cancer 2016; 5 (03) 95-103
- 2 Kolasani BP, Malathi DC, Ponnaluri RR. Variation of cost among anti-cancer drugs available in Indian market. J Clin Diagn Res 2016; 10 (11) FC17-FC20
- 3 Kashyap A, Balaji MN, Chhabra M, Rashid M, Muragundi PM. Cost analysis of various branded versus generic chemotherapeutic agents used for the treatment of early breast cancer- a deep insight from India. Expert Rev Pharmacoecon Outcomes Res 2020; 20 (04) 355-361
- 4 National Institute of Nutrition. India n.d. Accessed September 30, 2022, at: https://www.nin.res.in/RDA_short_Report_2020.html
- 5 Chandran S, Rao S, Prasad KR. et al. Alterations in hematological, liver and renal parameter levels in people afflicted with lung cancer. Int J Medical Laboratory Research. 2019; 4 (01) 30-34
- 6 Singh N, Agrawal S, Jiwnani S, Khosla D, Malik PS, Mohan A. et al. Editorial: Lung Cancer Worldwide. Lung Cancer in India. J Thorac Oncol 2021; 16 (08) 1250-1266
- 7 George T, Baliga MS. Generic anticancer drugs of the Jan Aushadhi scheme in India and their branded counterparts: the first cost comparison study. Cureus 2021; 13 (11) e19231
- 8 Scagliotti GV, Parikh P, von Pawel J. et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008; 26 (21) 3543-3551
- 9 Lynch TJ, Bell DW, Sordella R. et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004; 350 (21) 2129-2139
- 10 Johnson M, Garassino MC, Mok T, Mitsudomi T. Treatment strategies and outcomes for patients with EGFR-mutant non-small cell lung cancer resistant to EGFR tyrosine kinase inhibitors: focus on novel therapies. Lung Cancer 2022; 170: 41-51
Address for correspondence
Publikationsverlauf
Artikel online veröffentlicht:
21. März 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Noronha V, Pinninti R, Patil VM, Joshi A, Prabhash K. Lung cancer in the Indian subcontinent. South Asian J Cancer 2016; 5 (03) 95-103
- 2 Kolasani BP, Malathi DC, Ponnaluri RR. Variation of cost among anti-cancer drugs available in Indian market. J Clin Diagn Res 2016; 10 (11) FC17-FC20
- 3 Kashyap A, Balaji MN, Chhabra M, Rashid M, Muragundi PM. Cost analysis of various branded versus generic chemotherapeutic agents used for the treatment of early breast cancer- a deep insight from India. Expert Rev Pharmacoecon Outcomes Res 2020; 20 (04) 355-361
- 4 National Institute of Nutrition. India n.d. Accessed September 30, 2022, at: https://www.nin.res.in/RDA_short_Report_2020.html
- 5 Chandran S, Rao S, Prasad KR. et al. Alterations in hematological, liver and renal parameter levels in people afflicted with lung cancer. Int J Medical Laboratory Research. 2019; 4 (01) 30-34
- 6 Singh N, Agrawal S, Jiwnani S, Khosla D, Malik PS, Mohan A. et al. Editorial: Lung Cancer Worldwide. Lung Cancer in India. J Thorac Oncol 2021; 16 (08) 1250-1266
- 7 George T, Baliga MS. Generic anticancer drugs of the Jan Aushadhi scheme in India and their branded counterparts: the first cost comparison study. Cureus 2021; 13 (11) e19231
- 8 Scagliotti GV, Parikh P, von Pawel J. et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008; 26 (21) 3543-3551
- 9 Lynch TJ, Bell DW, Sordella R. et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004; 350 (21) 2129-2139
- 10 Johnson M, Garassino MC, Mok T, Mitsudomi T. Treatment strategies and outcomes for patients with EGFR-mutant non-small cell lung cancer resistant to EGFR tyrosine kinase inhibitors: focus on novel therapies. Lung Cancer 2022; 170: 41-51