DRUG UTILIZATION PATTERN AND PHARMACOECONOMIC ANALYSIS OF ANTIHYPERTENSIVE DRUGS PRESCRIBED IN SECONDARY CARE HOSPITAL IN GUJARAT, INDIA
Objective: Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not
detected early and treated appropriately. A large number of antihypertensive drugs alone or in various combinations are available, and physicians
need to choose most appropriate drug for a particular patient. Pharmacoeconomic and drug utilization studies at regular intervals help physicians to
prescribed rational drugs with high efficacy along with minimal cost.
Methods: The prospective observational study was conducted at Seth H. J. Mahagujarat Hospital from July to December 2013. 250 hypertensive
patients, attending medicine outpatient department were included for drug utilization study and 100 hypertensive patients, attending in patients
department were included for pharmacoeconomics analysis during the study period.
Result: The most frequently prescribed antihypertensive drug as monotherapy, as combination therapy and in fixed dose combinations was calcium
channel blocker (Amlodipine). Generic drugs showed same efficacy as brand drug, but both drugs were significantly differed in the prize. Among 100
inpatients admitted for the hypertensive condition in general ward total of direct medical cost was 65.19% and total of indirect medical cost was
34.81%. Î²-blocker and diuretics were the most effective therapy which is followed by the clonidine, envas (Enalapril), and then, amlodipine.
Conclusion: We concluded from this study that use of Î²-blockers and diuretics were most cost-effective for the hypertensive patients in this study.
Keywords: Antihypertensive drugs, Drug utilization study, Pharmacoeconomics analysis.
1. Saseen JJ. Essential hypertension. In: Kode-kimble MA, editors.
Applied Therapeutics: The Clinical Use of Drugs. 9th ed. USA:
Lippincott Williams and Wilkins; 2009. p. 314.
2. Available from: http://www.who.int/gho/ncd/risk_factors/blood_
pressure_prevalence_text/en. [Last downloaded on 2016 Apr 16].
3. Causes of Death. Geneva: World Health Organization; 2008. Available
4. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H,
et al. A comparative risk assessment of burden of disease and injury
attributable to 67 risk factors and risk factor clusters in 21 regions,
1990-2010: A systematic analysis for the Global Burden of Disease
Study 2010. Lancet 2012;380(9859):2224-60.
5. World Health Organization. Impact of Out-of-pocket Payments for
Treatment of Non-Communicable Diseases in developing Countries:
A Review of Literature WHO Discussion Paper 02/2011. Geneva:
World Health Organization; 2011.
6. World Health Organization and World Economic Forum. From Burden
Table 3: Combination drug therapy in hypertensive patients
First line of drug Second drug
Number of patients Combination drugs Antihypertensive
class of drug
Number of patients
Ca++channel blocker (s) Atenolol 47 Î²â€‘blockers+Ca+channel
Revolol 2 Telmisartan 4
Enalapril 4 Enalapril 5
Telmisartan 2 Clonidine 5
Clonidine 2 Furosemide 7
Diuretic Amlodipine 3 Ca+2 channel
Atenolol 1 Telmisartan 1
Telmisartan 7 Revolol+enalapril Furosemide 1
Î²â€‘blocker (s) Losartan 2
Telmisartan 4 Amlodipine+furosemide Clonidine 1
Enalapril 1 Total triple therapy 29
Table 4: Analysis of cost minimization
Brand name Cost/tablet (Rs.) Cost/30 tablet (Rs.) Suggested
Cost/tablet (Rs.) Cost/30 tablet (Rs.) Benefit of
Amtas (Intas) 3.18 97.2 UDP (Unison) 0.6 18 77.5
Amlodac (Zydus) 3.24 95.5 79.2
Cupine at 2.89 86.7 UDP at (Unison) 0.927 27.83 58.86
Table 5: Costâ€‘effectiveness ratio of different antihypertensive drugs
S.No Class of antihypertensive drug Average of total cost for treatment (Rupees) (C) QALYs Cost effectiveness=C/QALYs
1 Envas (enalapril) 3478 0.6749 5153.38
2 Amlodac (amlodipine) 3551 0.6496 5467.36
3 Cupineâ€‘AT (amlodipine+atenolol) 3728 0.6071 6140
4 Arkamin (clonidine) 3263 0.6492 5025.30
5 Betaloc (atenolol) 3630 0.7410 4894.57
6 Amifrue (furosemide) 3560 0.7499 4746
7 Losartan 3925 0.606 5902
QALYs: Quality adjusted life year
Solanki and Patel
Asian J Pharm Clin Res, Vol 10, Issue 3, 2017, 120-124
to Best Buysâ€: Reducing the Economic Impact of Non-Communicable
Diseases in Low-and Middle-Income Countries. Geneva: World Health
Organization and World Economic Forum; 2011. Available from: http://
7. World Economic Forum and the Harvard School of Public Health. The
Global Economic Burden of Non-communicable Diseases. Geneva:
World Economic Forum and the Harvard School of Public Health; 2011.
8. World Health Organization. Introduction to drug utilization research.
WHO International Working Group for Drug Statistics Methodology,
WHO Collaborating Centre for Drug Statistics Methodology, and
WHO Collaborating Centre for Drug Utilization Research and
Clinical Pharmacological Services. Oslo, Norway: World Health
9. Figueiras A, Caamano F, Otero JG. Methodology of drug utilization
studies in primary health care. Gac Sanit 2000;14:7-19.
10. Chobanian AV, Bakris GL, Black HR. National heart, lung, and blood
institute Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure; National High Blood Pressure
Education Program Coordinating Committee. The Seventh Report of
the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure: The JNC 7 Report. JAMA
11. Ganguli A, Hong SH. Profiles of Initial Drug Therapies Among
Newly Diagnosed Hypertensive Patients with No Compelling
Indications. Poster (PCV53) Presented At: International Society for
Pharmacoeconomics and Outcomes Research 12th Annual International
Meeting, May; 2007.
12. After the diagnosis: Adherence and persistence with hypertension
therapy. Am J Manag Care 2005;11 13 Suppl: S395-9.
13. Lichtenberg FR. Are the benefits of newer drugs worth their
cost? Evidence from the 1996 MEPS. Health Aff (Millwood)
14. Available from: http://www.interlinkconsultancy.com/pdfs/
[Last downloaded on 2016 Apr 22].
15. Acharya KG, Shah KN, Solanki ND, Rana DA. Evaluation of
antidiabetic prescriptions, cost and adherence to treatment guidelines:
A prospective, cross-sectional study at a tertiary care teaching hospital.
J Basic Clin Pharm 2013;4(4):82-7.
16. Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP. Incidence and
precursors of hypertension in young adults: The Framingham Offspring
Study. Prev Med 1987;16(2):235-51.
17. Gupta R, Guptha S, Gupta VP, Prakash H. Prevalence and determinants
of hypertension in the urban population of Jaipur in western India.
J Hypertens 1995;13(10):1193-200.
18. Malhotra P, Kumari S, Kumar R, Jain S, Sharma BK. Prevalence and
determinants of hypertension in an un-industrialised rural population of
North India. J Hum Hypertens 1999;13(7):467-72.
19. Deepa R, Shanthirani CS, Pradeepa R, Mohan V. Is the â€˜rule of halvesâ€™ in
hypertension still valid?--Evidence from the Chennai Urban Population
Study. J Assoc Physicians India 2003;51:153-7.
20. Anand MP. Prevalence of hypertension amongst Mumbai executives.
J Assoc Physicians India 2000;48(12):1200-1.
21. Dopa M. Pattern of drug use in hypertension in a tertiary hospital:
A cross sectional study in the in-patient wards. Indian J Pharmacol
22. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L,
Hansson L, et al. 1999 World Health Organization-International Society
of Hypertension Guidelines for the management of hypertension.
Guidelines sub-committee of the World Health Organization. Clin Exp
23. Busari OA, Olanrewaju TO, Desalu OO, Opadijo OG, Jimoh AK,
Agboola SM, et al. Impact of patientsâ€™ knowledge, attitude and
practices on hypertension on compliance with antihypertensive drugs
in a resource-poor setting. TAF Prev Med Bull 2010;9(2):87-92.
24. Al-Tuwijri AA, Al-Rukban MO. Hypertension control and comorbidities
in primary health care centers in Riyadh. Ann Saudi Med
25. Tamuno I, Fadare J. Drug treatment for hypertension in a tertiary health
care facility in Northern Nigerian. Int J Pharm 2011;2(2):104-9.
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