Shewade D G, Dkhar S A, Reddy P M, Ramaswamy S
Department of Pharmacology, JIPMER, Pondicherry 605 006.
J Assoc Physicians India. 2000 Mar;48(3):307-10.
To analyse cost and adverse reactions of psychotropic drugs for their cost-effective use.
Four hundred and sixty nine psychotropic formulations from CIMS, June 1998 were evaluated for (a) extent of variation in retail price for same strength and dosage form, (b) role of number of companies manufacturing the same formulation and (c) companies pricing their product at price less than average of maximum and minimum price in relation to number of products marketed by them. The side effects of antipsychotic and antidepressant drugs were graded for their severity and cumulative side effects score. Side effect index and cost index were calculated on relative basis and their product was used as cost benefit index.
Fifty per cent of psychotropic drugs had less than 100% price variation with highest of 2049% for risperidone 4 mg tablets. A direct relationship existed between the drug cost and price variation wherever the variation crossed 200%. Similar trend was noticed between the minimum price variations and the number of companies marketing the product. There was no appreciable relationship between number of products marketed and pricing by the manufacturer. Cumulative side effect score was lowest (10) for trifluoperazine and pimozide and highest (15) for risperidone amongst antipsychotic drugs, whereas amongst antidepressants fluoxetine had lowest (1.75) and amitryptyline had highest (28.5) cumulative side effect score.
One has to be more careful while selecting a brand of a drug when price variation is more (200-2049%). Trifluoperazine (1.0) and fluoxetine (1.7) were found to be most economical with better cost benefit index compared to thioridazine (494.2) and clomipramine (113.0) in their respective groups. Thus our analysis provides basic information regarding cost effective therapy with psychotropic drugs.
分析精神药物的成本及不良反应，以实现其成本效益最大化。
对1998年6月CIMS中的469种精神药物制剂进行评估，内容包括：（a）相同规格和剂型的零售价格变化幅度；（b）生产相同制剂的公司数量所起的作用；（c）产品定价低于最高和最低价格平均值的公司与其所销售产品数量的关系。对抗精神病药物和抗抑郁药物的副作用按严重程度分级，并计算累积副作用评分。在相对基础上计算副作用指数和成本指数，并将二者的乘积用作成本效益指数。
50%的精神药物价格变化幅度小于100%，其中利培酮4毫克片剂的价格变化幅度最高，达2049%。当价格变化幅度超过200%时，药物成本与价格变化之间存在直接关系。在最低价格变化与销售该产品的公司数量之间也发现了类似趋势。所销售产品数量与制造商定价之间没有明显关系。在抗精神病药物中，三氟拉嗪和匹莫齐特的累积副作用评分最低（10分），利培酮最高（15分）；而在抗抑郁药物中，氟西汀的累积副作用评分最低（1.75分），阿米替林最高（28.5分）。
当价格变化幅度较大（200%-2049%）时，选择药物品牌时必须更加谨慎。与各自组中的硫利达嗪（494.2）和氯米帕明（113.0）相比，三氟拉嗪（1.0）和氟西汀（1.7）被发现最具经济性，成本效益指数更佳。因此，我们的分析提供了有关精神药物成本效益治疗的基本信息。
