Variation in Prices of Cardiovascular Drugs in Public and Private Pharmacies in Nepal

Mishra, Shiva Raj; Kandel, Nirajan; Subedi, Narayan; Khanal, Vishnu

doi:10.1177/2333392814566508

Cited by 9 publications

(8 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Government of Nepal currently spends USD10.12 per capita in healthcare expenditure [24], thus, an increase of USD1.86 per capita would amount to a 18.4% increase in healthcare spending. It is also important to note that only 23% of the total healthcare expenditure is paid by the Government while 60% is out-of-pocket [24], with some out-of-pocket healthcare expenditure estimates for specific locales, medical conditions, and sub-populations being even higher (the remainder is paid via external development assistance sources) [25,26]. High out-ofpocket healthcare expenditures threaten people with low economic status due to impoverishment.…”

Section: Discussionmentioning

confidence: 99%

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Aryal¹,

Citrin

Halliday

et al. 2020

glob health res policy

View full text Add to dashboard Cite

Background: Low-and middle-income countries are facing an increasing burden of disability and death due to cardiovascular diseases. Policy makers and healthcare providers alike need resource estimation tools to improve healthcare delivery and to strengthen healthcare systems to address this burden. We estimated the direct medical costs of primary prevention, screening, and management for cardiovascular diseases in a primary healthcare center in Nepal based on the Global Hearts evidence based treatment protocols for risk-based management. Methods: We adapted the World Health Organization's non-communicable disease costing tool and built a model to predict the annual cost of primary CVD prevention, screening, and management at a primary healthcare center level. We used a one-year time horizon and estimated the cost from the Nepal government's perspective. We used Nepal health insurance board's price for medicines and laboratory tests, and used Nepal government's salary for human resource cost. With the model, we estimated annual incremental cost per case, cost for the entire population, and cost per capita. We also estimated the amount of medicines for one-year, annual number of laboratory tests, and the monthly incremental work load of physicians and nurses who deliver these services. Results: For a primary healthcare center with a catchment population of 10,000, the estimated cost to screen and treat 50% of eligible patients is USD21.53 per case and averages USD1.86 per capita across the catchment population. The cost of screening and risk profiling only was estimated to be USD2.49 per case. At same coverage level, we estimated that an average physician's workload will increase annually by 190 h and by 111 h for nurses, i.e., additional 28.5 workdays for physicians and 16.7 workdays for nurses. The total annual cost could amount up to USD18,621 for such a primary healthcare center. Conclusion: This is a novel study for a PHC-based, primary CVD risk-based management program in Nepal, which can provide insights for programmatic and policy planners at the Nepalese municipal, provincial and central levels in implementing the WHO Global Hearts Initiative. The costing model can serve as a tool for financial resource planning for primary prevention, screening, and management for cardiovascular diseases in other low-and middleincome country settings globally.

show abstract

Section: Discussionmentioning

confidence: 99%

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Aryal¹,

Citrin

Halliday

et al. 2020

glob health res policy

View full text Add to dashboard Cite

show abstract

“…15 Medication cost was estimated from the mean cost of generic formulations of the three most common antihypertensive medications used by trial participants in their recommended doses and multiplied by mean medication adherence. 16 For subsequent years, we assumed that FCHV training costs would decrease by 50% to account for lower requirement of FCHVs and shorter duration of refreshment trainings; FCHVs would visit all households to monitor the blood pressure of those not already diagnosed with hypertension and deliver lifestyle counselling three times a year in households where a new case is identified; all instruments would require annual replacement; and medication adherence is 50% in all years.…”

Section: Budget Impact Analysismentioning

confidence: 99%

Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN): a retrospective analysis

Krishnan

Finkelstein

Kallestrup

et al. 2019

The Lancet Global Health

View full text Add to dashboard Cite

Background The greatest risk factor for cardiovascular disease is hypertension, which can be alleviated via diet, exercise, and adherence to medication. Yet, blood pressure control in Nepal is inadequate, which is partly hindered by a lack of evidence-based, low-cost, scalable, and cost-effective cardiovascular disease prevention programmes. The the community-based management of hypertension in Nepal (COBIN) study was a 12-month community-based hypertension management programme of blood pressure monitoring and lifestyle counselling intervention undertaken by female community health volunteers (FCHVs) in Nepal, against usual care, which showed success in reducing blood pressure. Here we aimed to retrospectively quantify the budget impact and cost-effectiveness of the scale-up of the programme. MethodsIn this retrospective analysis, we collected participant-level data from the COBIN study; programme delivery cost data from programme administrators from the COBIN study group; and popualtion and other data from WHO, the World Bank, and the Nepalese Government. We estimated costs per participant and total costs of a national scaleup of the COBIN programme focusing on two scenarios: scenario A, delivery of the intervention to only people aged 25-65 years with hypertension; and scenario B, delivery of the intervention to all adults aged 25-65 years regardless of hypertension status. Effectiveness was based on in-trial blood pressure reductions converted to cardiovascular disease disability-adjusted life-years (DALYs) averted. The primary cost-effectiveness measure was incremental cost per averted cardiovascular disease DALY (calculated using the incremental cost-effectiveness ratio [ICER]) from a health system perspective, including programme delivery and incremental medication costs. We did univariate sensitivity analyses of scenario B to assess the effect of uncertainty in key parameter values in our calculations.Findings From a health system perspective, the first-year budget impact was US$7·1 million in scenario A and $10·8 million in scenario B. With each subsequent year, the costs decreased by approximately 50%. In the base-case cost-effectiveness analysis, from the health system perspective, scenario A resulted in an ICER of $582 per DALY averted and scenario B resulted in an ICER of $411 per DALY averted. The ICER was most sensitive to uncertainty in the number of total avertable cardiovascular disease DALYs in the eligible population.Interpretation The programme is projected to be highly cost-effective in both scenarios compared with the WHO thresholds for cost-effectiveness for Nepal. For policy makers intending to meet the UN Sustainable Development Goal of reducing premature mortality from non-communicible diseases, this intervention should be considered.

show abstract

“…This price control regulation is effective in controlling the prices of the limited number of pharmaceutical products available in the Nepalese market [18], but the inclusion of a limited number of pharmaceutical products in the price control list may allow pharmaceutical industries to sell other products at a higher cost. Previous studies from Nepal have reported substantial price variation of medication used for the management and treatment of NCDs [18][19][20]. However, these studies did not include anticancer medicines.…”

Section: Introductionmentioning

confidence: 99%

Price variation among different brands of anticancer medicines available in hospital pharmacies of Nepal

Shrestha

Poudel

et al. 2020

J of Pharm Policy and Pract

View full text Add to dashboard Cite

Objective: To assess the variation in price among different brands of anticancer medicines available in hospital pharmacies at Nepalese cancer hospitals. Methods: The price of different brands of the same anticancer medicines available in the hospital pharmacies of two cancer hospitals was assessed. Prices of different dosage forms such as a single tablet, capsule and vial were calculated. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical industries was determined, and the percentage variation in price was calculated. The prices of medicines (brands) were also compared with the price determined by the government where available. Results: Price variation was assessed for 31 anticancer medicines belonging to six broad categories. Prices were found to vary maximally among the following medicines, each belonging to separate categories: among alkylating agents, the price of temozolomide 100 mg capsule varied 308%; among antimetabolite agents, the price of pemetrexed 500 mg injection varied 134%; among hormonal drugs, the price of letrozole 2.5 mg tablet varied 200%; among antibody class, the price of trastuzumab 440 mg injection varied 73%; among natural products, the price of irinotecan 100 mg injection varied 590%; and among miscellaneous agents, the price of bortezomib 2 mg injection varied 241%. There was a significant difference in the mean MRP of the alkylating agents with the antimetabolites (p-value 0.006) and the monoclonal antibody (p-value <.001). Antimetabolites, natural products, hormonal therapy all had significant mean differences in their MRPs with the monoclonal antibodies. (p-value <.001) and the monoclonal antibodies had a significant mean difference in the MRP with the miscellaneous agents. (p-value <.001).

show abstract

Variation in Prices of Cardiovascular Drugs in Public and Private Pharmacies in Nepal

Cited by 9 publications

References 9 publications

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN): a retrospective analysis

Price variation among different brands of anticancer medicines available in hospital pharmacies of Nepal

Contact Info

Product

Resources

About