Journal of Clinical and Diagnostic Research. 2023 Aug, Vol-17(8): FC06-FC09 6 6 DOI: 10.7860/JCDR/2023/65520.18297 Original Article Pharmacology Section Variation in Cost Among Anticancer Drugs Available in India: A Cross-sectional Study INTRODUCTION Cancer is an abnormal growth of cells, also known as malignancy. Over 100 types of cancers affect humans, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. Symptoms vary depending on the type of cancer. The treatment of cancer includes chemotherapy, radiation, and/or surgery [1]. Signs and symptoms may include a lump, prolonged cough, abnormal bleeding, weight loss, and a change in bowel habits [2]. Tobacco use is responsible for about 25% of cancer deaths [3]. Another 10% are attributed to obesity, poor diet, lack of physical activity, or excessive alcohol consumption [3-5]. Cancer is often treated with a combination of radiation therapy, surgery, chemotherapy, and targeted therapy [3,6]. As of 2019, approximately 18 million new cases occur annually worldwide [7]. In 2020, it was projected that there would be 1,392,179 cancer patients in India [8]. The most common types of cancer in males are lung cancer, prostate cancer, colorectal cancer, and stomach cancer. In females, the most common types are breast cancer, colorectal cancer, lung cancer, and cervical cancer [9]. Generally, anticancer drugs are more expensive than any other category of drugs and significantly contribute to the growing drug expenditure for patients [10]. In developed countries, where a medical insurance system is in place, affordability of anticancer drugs may not be a concern. However, in developing countries like India, where medical insurance is still emerging, affordability becomes a major issue [11]. Due to the lack of comparative information on anticancer drug prices, it is challenging for clinicians to prescribe more affordable medicines. Very few studies on cost variation analysis of different anticancer drugs have been published. Adwal SK and Baghel R reported a wide variation in the prices of most anticancer drugs available in India, such as the alkylating agent carboplatin 150 mg injection (1100%) and the lowest variation with the antimetabolite anticancer agent cytarabine 500 mg injection (6.56%) [12]. Siddiqui M and Rajkumar SV reported difficulties in determining the true generic price and found that generic cancer drugs are costly in developed countries [13]. Prices of anticancer drugs are subject to regular changes, so this study focuses on the cost variation in the year 2020-2021 compared to past literature. It aims to help physicians and policymakers become aware of the cost variations among drugs and make informed decisions regarding pricing. Therefore, this study was designed to analyse the percentage variation in cost among different brands of anticancer drugs available in the Indian market. MATERIALS AND METHODS A cross-sectional study was conducted in the Department of Pharmacology at Symbiosis Medical College, Symbiosis International University, Pune, Maharashtra, India. The study duration was six months, from March 2021 to August 2021. The study received approval from the Institutional Ethics Committee (IEC) with approval RAMANAND JANARDHANRAO PATIL 1 , PRASAN RAMCHANDRA BHANDARI 2 , SANJAY DASHRATH GAIWALE 3 , VIVEK JAWAHAR DUGAD 4 , SANTOSH BABURAO JAGTAP 5 Keywords: Cancer, Ceiling price, Cost analysis, Cost variation, Pharmacoeconomic ABSTRACT Introduction: Cancer is an abnormal growth of cells, and it encompasses over 100 types of cancers that affect humans. Cancer management often involves a combination of radiation therapy, surgery, chemotherapy, and targeted therapy. Anticancer drugs, in general, tend to be more expensive compared to other categories of drugs, significantly contributing to the overall drug expenditure incurred by patients. Aim: To analyse the percentage variation in cost among different brands of anticancer drugs available in the Indian market. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Symbiosis Medical College, Symbiosis International University, in Pune, Maharashtra, India. The study duration was six months, from March 2021 to August 2021. Data on the prices of anticancer drugs were collected and analysed using the October 2020 to January 2021 edition of the Current Index of Medical Specialities (CIMS). A total of 29 anticancer drugs with different strengths were considered. The cost of a particular anticancer drug with the same dose and dosage form produced by different companies was compared. Drugs were selected based on their strength and dosage forms. The cost of one tablet, capsule, or injection was calculated in Indian Rupees (INR). The cost of a single unit was compared, and the difference between the maximum and minimum costs was calculated. Subsequently, cost ratios and the percentage of cost variation were determined. The study findings were recorded in both Microsoft Word 2016 and Excel 2016, and they were expressed as absolute numbers and percentages. Results: Bortezomib 3.5 mg was the costliest among anticancer drug which was priced at INR 18,988.00, while the cheapest was methotrexate 2.5 mg tablet, priced at INR 1.886. Among the anticancer drugs, pacilitaxel 260 mg injection had the highest cost ratio of 1 29.3055, whereas cisplatin 10 mg injection had the lowest cost ratio 1. Regarding cost variation, pacilitaxel 260 mg injection showed the highest percentage of cost variation at 2830.5555%, while cisplatin 10 mg injection showed the lowest at 0%. Conclusion: This study revealed a significant variation in prices, cost ratios, and cost variation among different anticancer drugs, providing insights into the price discrepancies observed in the market. The findings can help physicians and policymakers become aware of the cost variations among these drugs and make informed decisions regarding pricing.