International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 08, April, 2013

Pages: 69-73

Date of Publication: 25-Apr-2013


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EVALUATION OF GENERIC AND BRANDED DRUG UTILIZATION PATTERN IN A TRIBAL DISTRICT TEACHING HOSPITAL OF SOUTH INDIA

Author: Mohammed Shakeel Mohammed Bashir, Kishor A Bansod, Ajay Khade

Category: Healthcare

Abstract:Background: Generic drugs are relatively cheap and equally effective as branded drugs. Government of Andhra Pradesh is promoting the use of generic drugs in all the districts and planning to open generic outlets in each district. We conducted the study to assess the status of use of generic drugs in a rural cum tribal district of Andhra Pradesh India. Materials and Methods: Case records of 200 patients analyzed retrospectively for use of generic and branded drugs. Equal cases were selected randomly from medicine, surgery, and gynecology and paediatrics departments. Result: A total of 952 drugs were used. 37.86% were prescribed by generic name. In general medicine, general surgery, obstetric and genecology and paediatrics 39.39%, 25.5%, 46.65% and 39.91% over all generic drugs and 52.70%, 28.86, 37.71% and 25.5% generic antimicrobials were used respectively. Ranitidine, Metoclopramide, Pheniramine, Frusemide, Dicyclomine, Nifidepine, Cefixime and Ceftriaxone were 100% prescribed by all the departments with brand names. All the departments prescribed Ampicillin as generic drug only. Conclusion: Quality controlled generic drugs are equally effective as branded drugs. We suggest that generic drugs are substitution for branded drugs which reduces over all treatment cost.

Keywords: Branded drugs, generic drugs, irrational medication

Full Text:

INTRODUCTION

In this century, increasing cost of drug therapy is a major problem for health care providers and patients in both developed and developing countries 1. Governments, insurance companies and health care providers are doing lot of efforts to control increased cost but health expenditures are not only increasing in developing countries but also in developed world every year. Apart from many reasons, ageing of the population, growing expectations regarding health by the society as well as the continuous improvement in health care facilities are the important reasons behind it in developed countries 2 while in developing nations there are different reasons.

Generic drugs are relatively cheap and equally effective as branded drugs. Because these drugs are launched after expiration of patent of the original innovative drug and companies producing such types of drugs after presenting data which indicates that their launched generic has 80%–125% bioavailability of the original drug. In most of the situations and for the many patients, variations in this range are probably having very less clinical consequences 3.

Thus generic pharmaceutical industry has the strong ability as a major force for shaping the economics of medication use. It is because generic drugs have huge potential to play an important role in containing costs of the drugs in disease management, although we cannot exactly and always easily measure the amount which we can save through the use of generic medications 4. Use of generic drugs has increased dramatically during last few decades and it is widely accepted practice in health care system 5. The economic impacts of generic drug use are much more on both the direction; in favor of consumers and against the RandD companies.

In India, pharmaceutical production is grossly diverse in nature. Lot of pharmaceuticals companies are manufacturing number of generic drugs 6. These drugs are cheap and easily available in India. Government of Andhra Pradesh is promoting use of generic drugs in all the districts and planning to open generic outlets in each district.

Prescription pattern can be evaluated retrospectively from clinical records of the institute or health care facility 7. Usually the main aim of such type of studies is to facilitate rational use of drugs in populations 8. It is one type of medical audit which review prescription status and, if needed prescription pattern can be modified for cost effective and rational use of medicine 9. Such type of studies also assesses the status of use of generic and branded drugs. In this background we planned the study to assess the actual status of use of generic drugs in this region so that suitable suggestion can be given.
MATERIALS AND METHODS

In this retrospective study case record of 200 patients belonging to general medicine, general surgery, obstetrics and gynecology and paediatrics department of Rajiv Gandhi Institute of Medical Science (RIMS) Adilabad were included. From each department case record of 50 hospitalized patients was randomly selected form medical record section of the institute. All the out patients record was excluded from the study. Case sheets were examined and findings related to use of generic and branded drugs recorded and analyzed using Microsoft Office Excel 2007.

Necessary permission was obtained from the institutional authorities for the study.

RESULT

A total of 952 drugs were used by all the departments for the management of 200 different types of hospitalized patients. Out of 952 drugs 37.86% were prescribed by generic names while rest of the drugs by brand names. Maximum number of generic drugs were prescribed by obstetric and genecology (46.65%). Paediatrics and general medicine department used almost equal number of generic drugs; 39.91% and 39.39% respectively. General surgery department prescribed mainly branded drugs (74.50%) table-1.    

Branded drugs were used most commonly in antimicrobial category in which all the departments used more than 50% branded antimicrobials except general medicine department in which they used 47.3% branded antimicrobials. Paediatric department used 74.5% branded drugs in antimicrobial category and general surgery department used 71.14% branded antimicrobials while obstetrics and gynecology department used 62.29% branded drugs (Table-2). 

Ranitidine, Metoclopramide, Pheniramine, Frusemide, Dicyclomine, Nifidepine, Cefixime and Ceftriaxone were 100% prescribed by all the departments with brand names only. Ampicillin was the only drug which was prescribed by all the departments as generic drug only.

DISCUSSION

Uses of generic drugs become common in United States in the decade of 1970s. But in those days many of those generic drugs caused bioavailability problems 10. So it is well debated since many years that whether the generic drugs are equal to branded drugs or whether these drugs are of good quality and have fully investigated. There are also some questions that the bioequivalence studies can give the sufficient guarantee of efficacy and safety of generic drugs 11.

Generic drugs which are launched only after bioequivalence studies should be sufficient guarantee for clinicians to routinely substitute generic drugs for branded drugs. But narrow therapeutic drugs should be substituted cautiously since the safety and efficacy issue exist with these drugs. FDA firmly believes that generic drug should always be prescribed with the full expectation that the recipient will receive the same clinical benefit as can be with innovator drug 17.

In our study we observed use of almost 38% generic drugs by the four major departments of the institute. It is much higher in comparison to the observations of Irshaid et al 12 who observed use of 15% generic drugs in Saudi Arabia. But Guyon AB et al 13 in Bangladesh at primary health care centre level observed much higher number (78%) of use of generic drugs and Massele AY et al 14 in Dar es Salaam, Tanzania also found prescription of very high number of generic drugs in all health care facilities which were almost 80% of all prescriptions. In India, Ravi Shankar P et al 15 in South region found 67.4% of the drugs were prescribed by brand name which is higher in comparison to our findings. But generic drug utilization pattern was much less (7.4%) in Pune region of India as observed by Anuja et al 16. Bapna et al 17 also observed use of less number of generic drugs in comparison to branded drugs at primary health care level in southern India.

Above observations indicates that there is no uniform report regarding use of generic drugs as different patterns of generic drug utilizations are observed in different countries and even the different regions of India. There might be many reasons for such type of pattern. It may be health insurance related matter like in western world where insurance providers insist for generic substitution leading to high number of generic drug utilization. In some countries clinicians prescribe less generic drugs due to their belief of under quality of generic drugs. In some region pharmaceutical inducements to clinicians promote more utilization of branded drugs. Some governments promote generic drugs vigorously. Thus there are lots of factors which affect prescription pattern of generic drugs.

Use of Ampicillin only in generic form in our study indicates that generic drugs are qualitatively equal to branded drugs since it is most common antimicrobial agent which is used in most of the government institutions due to its cheap cost for the management of various conditions. As far as use of mostly branded cephalosporin in our region is concerned, it increases treatment cost which will not be helpful for the region since the district is tribal in nature with majority of population living in rural cum tribal areas 18

CONCLUSION

Quality controlled generic drugs are equal in term of safety and efficacy. We suggest that generic drugs can be used since these drugs are cost effective which will have greater positive socioeconomic impact in this tribal region. Costly 3rd generation cephalosporins can be switched over with cheap generics or alternative antimicrobials to reduce health care costs.

ACKNOWLEDGMENT

We are thankful to Mr. M. Salimuddin record section incharge (Junior Assistant), RIMS Adilabad for his invaluable help during data collection. Authors also acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

Table- 1: Use of Generic and Branded Drugs

References:

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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