Journal of Pharmacognosy and Phytochemistry 2017; 6(1): 258-270 E-ISSN: 2278-4136 P-ISSN: 2349-8234 JPP 2017; 6(1): 258-270 Pharmacoeconomic evaluations and comparison of Received: 05-11-2016 Accepted: 06-12-2016 licorice (Glycyrrhiza glabra L.) with triaminic DM Syed Muzzammil Ahmad based therapies for common cold in the city of Karachi: Department of Pharmacognosy, Faculty of Pharmacy and Retrospective burden of Illness, Cost and budget Pharmaceutical Sciences, University of Karachi, Karachi- impact analysis 75270, Pakistan Iqbal Azhar Professor of Pharmacognosy and Syed Muzzammil Ahmad, Iqbal Azhar, Nadia Ahmad and Syeda Dean, Faculty of Pharmacy and Darakhshan Masroor Pharmaceutical Sciences, University of Karachi, Karachi- 75270, Pakistan Abstract Objective: To compare two therapeutic entity from societal perspective, i.e. ‘Licorice’ with ‘Triaminic Nadia Ahmad DM’ in monetary savings and reduction of burden of cold with minimum impact on household budget of Department of Pharmaceutics, patient in population of all 178 union councils of City of Karachi, Pakistan. Faculty of Pharmacy and Methods: Stratified random sampling was used, selecting total of 356 patients. Taking frequency of Pharmaceutical Sciences, common cold at 3 colds annually with discount rate at 3% for calculating burden of illness in terms of University of Karachi, Karachi- disability adjusted life years. The budget impact analysis was carried out calculating budget impact per 75270, Pakistan onset and budget impact per year values. Syeda Darakhshan Masroor Results: Annually, the Licorice was found responsible for 57.07 less DALY per 1000 population with a Department of Pharmacognosy, saving of Rs.1.51/- billion (US$ 14.52/- million) than with Triaminic DM. Faculty of Pharmacy and Conclusions: Licorice provide more utility with less impact on budget of a patient in comparison with Pharmaceutical Sciences, treatment of symptoms of common cold with Triaminic DM. University of Karachi, Karachi- 75270, Pakistan Keywords: Licorice, Triaminic DM, burden of illness, disability-adjusted-life-years, budget impact 1. Introduction Although there are advances in treatment methodologies yet common cold proves to be a societal burden that impacted budget of masses. Almost 25% of common cold is still without any proven pathogen [1]. Historically, several herbal and allopathic medicines are in use for treatment of symptoms of common cold [2]. Herbal medicine Licorice and allopathic medicine Triaminic DM (Dextromethorphan: 10mg/5ml, Pseudoephedrine (HCl):30mg/5ml) a product by Novartis Pharma (Pakistan) Ltd. are utilized by patients across the globe under different [3-5] brand names . For allopathic medicines, although several pharmacoeconomics studies have been conducted globally, yet there is a lack of such studies on herbal medicines [6] especially no research in the selected region, i.e. City of Karachi, Pakistan. Few similar studies were conducted in the past for determining pharmacoeconomics benefits. From societal perspective, costs related to DALYs were previously calculated in Kenya for vaccination (with Rotarix) against rotavirus diseases and found to be cost-effective with a ratio of US$142 per DALY [7]. Regarding budget impact analysis, in France, generalized probiotic was estimated to save 2.4 million common respiratory tract infection days (CRTI-days), 291,000 antibiotic courses and 581,000 sick leave days, based on York Health Economics Consortium (YHEC) data. Applying the Cochrane data (previously known as the Cochrane Collaboration), reductions were 6.6 million CRTI days, 473,000 antibiotic courses and 1.5 million sick days. From the national health services (NHS) perspective, probiotics’ economic impact was about €14.6 million saved according to YHEC and €37.7 million according to Cochrane. While higher savings were observed in children, active smokers and people with [8] more frequent human contacts . In Pakistan, due to the changes in consumer price index, the dynamics of the inflation rate in Correspondence the country averaged 7.86% from the year 1957 until 2016 [9]. The rise in price of acquired Syed Muzzammil Ahmad resources has made the necessity of national savings on top priority than ever before. Department of Pharmacognosy, Faculty of Pharmacy and Similarly, to estimate cost per DALY and budget impact of use of Licorice, present study was Pharmaceutical Sciences, devoted for its comparison with Triaminic DM. University of Karachi, Karachi- 75270, Pakistan ~ 258 ~ Journal of Pharmacognosy and Phytochemistry Methods 178 union councils which were divided for age wise sample The herb 'Licorice' (i.e. utilizing oral infusion of roots of collection in accordance with proportions of each of the 16 ‘Glycyrrhiza glabra L.’; 1 cup; 3.5gm, thrice daily) was different age groups (i.e. Table-1 from 0-75+ years with engaged as sample while the allopathic medicine 'Triaminic- difference of 5 years in between) as defined by Pakistan DM' (Dextromethorphan: 10mg/5ml, Pseudoephedrine Bureau of Statistics [10]. Following formula was used for age (HCl):30mg/5ml; 10ml thrice daily) was selected as control in group based sample size: the study. Taking average annual house hold income per person (AAHIPP) at Rs.99,150/- [10], the 356 patients (sample size of 178 patients each for Triaminic DM and Licorice based therapy) were selected as stratified random samples from population of 20,819,302 (approx. 20.82 million) from Table 1: Percentage Wise Division of Sample Size of 178 Patients among Age Groups in Common Cold Age Group Age Group Wise Actual Sample Size (No. of Patients)/equal S. No. Percentage of Total Population (In Years) proportions in population from patients to be picked 1 0 to 4 yrs 14.80% 26 2 5 to 9 yrs 15.65% 28 3 10 to 14 yrs 12.95% 23 4 15 to 19 yrs 10.37% 18 5 20 to 24 yrs 8.97% 16 6 25 to 29 yrs 7.37% 13 7 30 to 34 yrs 6.22% 11 8 35 to 39 yrs 4.77% 9 9 40 to 44 yrs 4.45% 8 10 45 to 49 yrs 3.53% 6 11 50 to 54 yrs 3.21% 6 12 55 to 59 yrs 2.15% 4 13 60 to 64 yrs 2.04% 4 14 65 to 69 yrs 1.20% 2 15 70 to 74 yrs 1.09% 2 16 75 yrs & over 1.21% 2 Layered style interviews, questionnaires and opinion surveys [11-13] were used to get maximum input in the study and were comprised of blend of open and closed ended questions. Interviews were however, rarely used in situations whenever Where, respondents were not able to respond to the questionnaires N = number of deaths due to miscellaneous reasons while questionnaires and r = discount rate (constant rate of 0.03 in clinical opinion surveys were available to the respondents both in the calculations) form of paper based or as online survey with Limesurvey™ e = natural logarithm (constant value of approx. 2.71828) and surveymonkey.com. These were the only mode of data LDT = standard life expectancy at age of death in years capturing which were more convenient, relatively cheap and P = prevalence of common cold [15] more respondent friendly than interviews as respondents were DW= disability weight i.e. 0.007 for common cold able to complete and submit on their own feasibility and LDB = duration of the case until remission or death (years) convenience. Data gathered were managed via software, i.e. with Microsoft Excel 2016 while statistically analyzed along The DALY per 1000 people was calculated by following with graph generation with the help of IBM® SPSS version formula: 23. Disability Adjusted Life Years (DALY) While, US$ per DALY was calculated by: Each for Triaminic DM and Licorice based therapy for common cold, disability adjusted life years (DALYs) were calculated for both allopathic and herbal therapy combining years of life lost due to premature death (YLL) and years of life lost due to disability (YLD) considering discount rate of 3% (0.03) using following formula [14]: Budget impact per onset (BIPO) BIPOs both for allopathic and herbal therapies of common cold were calculated with following formula: where, For allopathic therapy with Triaminic DM: For herbal therapy with Licorice: therefore, ~ 259 ~ Journal of Pharmacognosy and Phytochemistry Budget impacts per year (BIPYs) were calculated with following formula: For allopathic therapy with Triaminic DM: Where, BIPOT = budget impact per onset for Triaminic DM BIPOL = budget impact per onset for Licorice COIT = cost of illness with Triaminic DM For herbal therapy with Licorice: COIL = cost of illness with Licorice Budget impact per onset difference (BIPOD) For budget impact per onset difference, again the allopathic Budget impact per year difference (BIPYD) therapy was given benefit of doubt and therefore, budget Like budget impact per onset difference, budget impact per impact per onset in Licorice therapy (BIPOL) was subtracted year in Licorice therapy (BIPYL) was subtracted from budget from budget impact per onset in Triaminic DM therapy impact per year in Triaminic DM therapy (BIPYT) to calculate (BIPOT). Budget impacts per onset difference (BIPOD) budget impact per year difference (BIPYD), i.e. with between BIPO of allopathic and herbal therapies of common following formula: cold (i.e. BIPOT and BIPOL) were calculated with following formula: OR OR Where, BIPYT = budget impact per year for Triaminic DM therapy BIPYL = budget impact per year for Licorice therapy f = approx. yearly frequency of common cold Budget impact per year (BIPY) DALY COI Fig 1: Cost of Illness Vs Disability Adjusted Life Years in Triaminic DM Based Therapy ~ 260 ~ Journal of Pharmacognosy and Phytochemistry BIPO COI Fig 2: Cost of Illness Vs Budget Impact Per Onset in Triaminic DM Based Therapy BIPY COI Fig 3: Cost of Illness Vs Budget Impact Per Year in Triaminic DM Based Therapy ~ 261 ~ Journal of Pharmacognosy and Phytochemistry DALY COI Fig 4: Cost of Illness Vs Disability Adjusted Life Years in Licorice Based Therapy BIPO COI Fig 5: Cost of Illness Vs Budget Impact Per Onset in Licorice Based Therapy ~ 262 ~ Journal of Pharmacognosy and Phytochemistry BIPY COI Fig 6: Cost of Illness Vs Budget Impact Per Year in Licorice Based Therapy BIPOD UC NO.