Published: 2022-10-27

Rational use and cost variation analysis of antifungal drugs available in the Indian market: a pharmacoeconomic study

Pramod Kumar Manjhi, Chakrapani Kumar, Akhilesh Kumar Rana


Background: Fungal infections are the 4th most common skin disease affecting 984 million people. Fungal infections are mostly associated with the use of broad-spectrum antibiotics, corticosteroids, anticancer/immunosuppressant drugs, indwelling catheters and implants, and the emergence of AIDS. The aim of this study was to analyze the rational use, cost ratio, and percentage cost variations in different brands of the commonly prescribed antifungal drugs available in the Indian market.

Method: The maximum and minimum price of each brand of the drugs given in Indian rupees (INR) was noted by using ‘Drug Today’ (January to April 2021, volume II). The cost range, cost ratio, and the percentage cost variation for individual drug brands were calculated. The cost of tablets/capsule/injection was calculated and the cost ratio and percentage cost variation of various brands was compared.

Results: After calculation of cost ratio and percentage cost variation for each brand of antifungal agents, tab Itraconazole 100 mg had a maximum percentage cost variation of 733.33% and a cost ratio of 8.33 while tab Griseofulvin 250 mg had a minimum percentage cost variation of 16.98% and cost ratio of 1.16.

Conclusions: The present study shows there was a wide variation in the cost of the different brands of antifungal drugs manufactured by pharmaceutical companies which increases the economic burden. The clinicians prescribing these drugs should be aware of rational use and cost variation to reduce cost of drug therapy and improve patient compliance.



Rational use, Fungal infection, Antifungal drugs, Cost ratio, Percentage cost variation

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Conference of Experts on the Rational Use of Drugs (‎1985: Nairobi)‎. (‎1987)‎. The rational use of drugs: report of the Conference of Experts, Nairobi, 25-29 November 1985. World Health Organization. Available at:

Mehta S, Gogtay NJ. From the pen to the patient: Minimising medication errors. J Postgrad Med. 2005;51:3‑4.

World Health Organization. (‎2002)‎. Promoting rational use of medicines: core components. World Health Organization. Available at:

World Health Organisation. Rational use of Medicines; 2017. Available at: Accessed on May 25, 2021.

World Health Organization. (‎2012)‎. The pursuit of responsible use of medicines: sharing and learning from country experiences. World Health Organization. Available at:

James WD, Elston DM, Berger TG. Andrew’s diseases of the skin clinical dermatology. 12th ed. Philadelphia: Elsevier. 2016;285.

Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ et al. The global burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. J Investig Dermatol. 2013;134:1527-34.

Lakshmanan A, Ganeshkumar P, Raam Mohan S, Hemamalini M, Madhavan R. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian J Med Microbiol. 2015;33(5):134-6.

Al Balushi KA, Alzaabi MA, Alghafri F. Prescribing pattern of antifungal medications at a tertiary care hospital in Oman. J Clin Diagn Res. 2016;10(12):FC27-30.

Rezabek GH, Friedman AD. Superficial fungal infections of the skin diagnosis and current treatment recommendations. Drugs. 1992;43(5):674-82.

Murray PR, Rosenthal KS, Pfaller MA. Medical microbiology. 7th ed. Philadelphia: Elsevier. 2013;631.

Rang HP, Ritter JM, Flower RJ, Henderson G. Rang an Dale’s pharmacology. 8th ed. Elsevier. 2012;654.

Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008;51(4):2-15.

Kelly BP. Superficial fungal infections. Pediatr review/Am Acad Pediatr. 2012;33:4e22-37.

DAS S, Goyal R, Bhattacharya SN. Laboratory-based epidemiological study of superficial fungal infections. J Dermatol. 2007;34:248-53.

King DR, Kanavos P. Encouraging the use of generic medicines: Implications for transition economies. Croat Med J. 2002;43:462-9.

Kesselheim AS, Misono AS, Lee JL, Stedman MR, Brookhart MA, Choudhry NK et al. Clinical equivalence of generic and brand name drugs used in cardiovascular diseases. JAMA. 2008;300:2514-26.

Tilyard MW, Dovey SM, Rosentstreich D. General practitioners’ views on generic medication and substitution. N Z Med J. 1990;103:318-20.

Davit BM, Nwakanma PE, Buehler GJ, Conner DP, Haidar SH, Patel DT et al. Comparing generic and innovator drugs: A review of 12 years of bioequivalence Data from the United States Food and Drug Administration. Ann Pharmacother. 2009;43:1583-97.

Shrank WH, Cox ER, Fischer MA, Mehta J, Choudhry NK. Patients’ perceptions of generic medications. Health Aff (Millwood). 2009;28:546-56.

Hassali A, Stewart K. Quality use of generic medicines. Aust Prescr. 2004;27:80-1.

Drug Cost Control Order, 2013, Government of India. Available at: Accessed on 25 May, 2021.

Kotwani A. Will generic drug stores improve access to essential medicines for the poor in India? J Public Health Policy. 2010;31:178-84.