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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 : Department of Pharmacognosy, Faculty of Pharmacy and Retrospective burden of Illness, Cost and budget Pharmaceutical Sciences, , Karachi- impact analysis 75270,

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

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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,

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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

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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

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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

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BIPY

COI

Fig 6: Cost of Illness Vs Budget Impact Per Year in Licorice Based Therapy

BIPOD

UC NO.

Fig 7: Budget Impact Per Onset Difference Between Triaminic DM and Licorice Based Therapies

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BIPYD BIPYD

UC NO.

Fig 8: Budget Impact Per Year Difference Between Triaminic DM and Licorice Based Therapies

Results and Discussion of Rs.1.51/- billion (US$ 14.52/- million). Mean COI per Burden of illness patient for therapies of Triaminic DM and Licorice were In City of Karachi, with its population of 20,819,302 people estimated at Rs.1,993.89/- (SEM ± 13.61) and Rs.1,453.02/- (approx. 20.82 million) [10], the prevalence of common cold (SEM ± 10.49) respectively among 178 union councils of City was found to be at 2,791,719 (approx. 2.79 million) people of Karachi. (Table-2), the mean burden of common cold was found to be at 170.50 DALY per 1000 population (@ US$1.77/- per Budget Impact Analysis DALY) for therapy with Triaminic DM (Figure-1) while BIPO and BIPY on annual household income of patient for 113.45 DALY per 1000 population (@ US$1.99/-per DALY) therapy with Triaminic DM was estimated at 2.01% and for therapy with Licorice (Figure-4), i.e. with a difference of 6.04% respectively (Figure-2 & 3). For therapy with Licorice, 57.07 DALY per 1000 population. it was estimated at 1.47% and 4.40% respectively (Figure-5 & 6). The BIPOD and BIPYD were calculated at 0.54% and Costs of Illness 1.64% respectively (Figure-7 & 8). During study, a direct The annual COI in Triaminic DM based allopathic therapy relationship of COI was identified with BIPO and BIPY. was estimated at Rs.5.57/- billion (US$ 53.56/- million @ Rs.104/- per US$) while for Licorice based therapy at Rs.4.06/- billion (US$ 39.04/- million), with clear difference

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Table 2: Cost, Burden of illness and Budget Impact Analysis of Licorice and Triaminic DM Based Therapies for Common Cold in 178 Union Councils of City of Karachi

UC Triaminic DM Based Therapy Licorice Based Therapy S. Town Name UC Name / UC No. Prevalence Patient COI Patient COI BIPOD BIPYD DALY/1000 BIPO BIPY DALY/1000 BIPO BIPY No. Code (PKR) Code (PKR) 1 Ibraheem UC-01 16,584 C0001 1,973 197.52 1.99% 5.97% C0179 1,450 110.62 1.46% 4.39% 0.53% 1.58% 2 Bin Qasim Town UC-02 16,446 C0002 2,234 186.50 2.25% 6.76% C0180 1,495 77.79 1.51% 4.52% 0.75% 2.24% 3 Bin Qasim Town UC-03 16,614 C0003 1,922 190.23 1.94% 5.82% C0181 1,264 134.91 1.27% 3.82% 0.66% 1.99% 4 Bin Qasim Town Quaidabad UC-04 14,651 C0004 2,006 141.82 2.02% 6.07% C0182 1,571 104.90 1.58% 4.75% 0.44% 1.32% 5 Bin Qasim Town UC-05 15,552 C0005 1,783 173.72 1.80% 5.39% C0183 1,386 104.20 1.40% 4.19% 0.40% 1.20% 6 Bin Qasim Town Gulshan-E-Hadeed UC-06 15,134 C0006 2,182 164.51 2.20% 6.60% C0184 1,481 105.33 1.49% 4.48% 0.71% 2.12% 7 Bin Qasim Town Gaghar UC-07 16,353 C0007 1,599 184.30 1.61% 4.84% C0185 1,359 115.29 1.37% 4.11% 0.24% 0.73% 8 Town UC-01 15,815 C0008 1,917 172.38 1.93% 5.80% C0186 1,291 143.76 1.30% 3.91% 0.63% 1.89% 9 Darsano Chana UC-02 15,765 C0009 1,556 171.37 1.57% 4.71% C0187 1,414 107.20 1.43% 4.28% 0.14% 0.43% 10 Gadap Town Gadap UC-03 16,523 C0010 1,899 188.20 1.92% 5.75% C0188 1,617 101.95 1.63% 4.89% 0.28% 0.85% 11 Gadap Town UC-04 16,000 C0011 2,157 176.48 2.18% 6.53% C0189 1,421 125.12 1.43% 4.30% 0.74% 2.23% 12 Gadap Town UC-05 15,897 C0012 2,084 181.54 2.10% 6.31% C0190 1,251 72.65 1.26% 3.79% 0.84% 2.52% 13 Gadap Town UC-06 14,794 C0013 2,299 150.90 2.32% 6.96% C0191 1,070 113.17 1.08% 3.24% 1.24% 3.72% 14 Gadap Town UC-07 16,249 C0014 1,943 181.99 1.96% 5.88% C0192 1,250 166.88 1.26% 3.78% 0.70% 2.10% 15 Gadap Town Mangopir UC-08 16,473 C0015 1,892 187.13 1.91% 5.72% C0193 1,294 109.22 1.31% 3.92% 0.60% 1.81% 16 Model Colony UC-01 16,426 C0016 1,933 185.94 1.95% 5.85% C0194 1,497 162.78 1.51% 4.53% 0.44% 1.32% 17 Malir Town UC-02 14,852 C0017 2,055 152.08 2.07% 6.22% C0195 1,457 139.46 1.47% 4.41% 0.60% 1.81% 18 Malir Town UC-03 16,439 C0018 2,020 186.25 2.04% 6.11% C0196 1,648 163.07 1.66% 4.99% 0.38% 1.13% 19 Malir Town Khokarapar UC-04 15,737 C0019 2,155 170.75 2.17% 6.52% C0197 1,415 99.62 1.43% 4.28% 0.75% 2.24% 20 Malir Town Jafar-E-Tayyar UC-05 14,662 C0020 2,459 160.55 2.48% 7.44% C0198 1,265 117.30 1.28% 3.83% 1.20% 3.61% 21 Malir Town UC-06 15,879 C0021 1,923 166.57 1.94% 5.82% C0199 1,508 115.92 1.52% 4.56% 0.42% 1.26% 22 Malir Town Ghazi Brohi Goth UC-07 15,474 C0022 2,131 171.92 2.15% 6.45% C0200 1,777 82.63 1.79% 5.38% 0.36% 1.07% 23 Gulberg Town Azizabad UC-01 15,330 C0023 1,976 162.04 1.99% 5.98% C0201 1,597 114.82 1.61% 4.83% 0.38% 1.15% 24 Gulberg Town Karimabad UC-02 15,636 C0024 1,648 168.56 1.66% 4.99% C0202 1,427 119.46 1.44% 4.32% 0.22% 0.67% 25 Gulberg Town UC-03 15,360 C0025 1,925 155.90 1.94% 5.82% C0203 1,461 135.63 1.47% 4.42% 0.47% 1.40% 26 Gulberg Town UC-04 15,604 C0026 1,798 167.90 1.81% 5.44% C0204 1,352 125.92 1.36% 4.09% 0.45% 1.35% 27 Gulberg Town Nasirabad UC-05 15,583 C0027 1,726 167.36 1.74% 5.22% C0205 1,265 118.59 1.28% 3.83% 0.46% 1.39% 28 Gulberg Town UC-06 16,052 C0028 1,975 185.08 1.99% 5.98% C0206 1,563 88.93 1.58% 4.73% 0.42% 1.25% 29 Gulberg Town UC-07 16,414 C0029 1,762 185.81 1.78% 5.33% C0207 1,460 123.93 1.47% 4.42% 0.30% 0.91% 30 Gulberg Town Shafeeque Mill Colony UC-08 15,797 C0030 1,959 172.03 1.98% 5.93% C0208 1,419 157.65 1.43% 4.29% 0.54% 1.63% 31 Town UC-01 15,093 C0031 1,889 150.48 1.91% 5.72% C0209 1,313 137.50 1.32% 3.97% 0.58% 1.74% 32 Firdos Colony UC-02 15,387 C0032 1,861 163.26 1.88% 5.63% C0210 1,487 88.48 1.50% 4.50% 0.38% 1.13% 33 Liaquatabad Town UC-03 16,158 C0033 1,984 180.00 2.00% 6.00% C0211 1,331 97.59 1.34% 4.03% 0.66% 1.98% 34 Liaquatabad Town UC-04 15,141 C0034 2,141 158.07 2.16% 6.48% C0212 1,390 85.70 1.40% 4.21% 0.76% 2.27% 35 Liaquatabad Town Qasiambad UC-05 16,399 C0035 2,024 185.47 2.04% 6.12% C0213 1,311 100.53 1.32% 3.97% 0.72% 2.16% 36 Liaquatabad Town UC-06 14,829 C0036 2,157 145.32 2.18% 6.53% C0214 1,574 113.74 1.59% 4.76% 0.59% 1.76% 37 Liaquatabad Town UC-07 14,791 C0037 1,909 157.08 1.93% 5.78% C0215 1,255 106.94 1.27% 3.80% 0.66% 1.98% 38 Liaquatabad Town Commercial Area UC-08 16,419 C0038 1,934 185.86 1.95% 5.85% C0216 1,444 116.25 1.46% 4.37% 0.49% 1.48% 39 Liaquatabad Town UC-09 16,366 C0039 1,687 192.30 1.70% 5.10% C0217 1,667 146.15 1.68% 5.04% 0.02% 0.06% 40 Liaquatabad Town No.01 UC-10 15,811 C0040 2,335 165.22 2.36% 7.07% C0218 1,210 122.06 1.22% 3.66% 1.13% 3.40% ~ 265 ~ Journal of Pharmacognosy and Phytochemistry

41 Liaquatabad Town UC-11 15,874 C0041 1,899 173.66 1.92% 5.75% C0219 1,739 108.58 1.75% 5.26% 0.16% 0.48% 42 Kalyana UC-01 15,406 C0042 1,820 163.61 1.84% 5.51% C0220 1,478 122.79 1.49% 4.47% 0.34% 1.03% 43 New Karachi Town Sir Syed UC-02 15,122 C0043 1,717 170.73 1.73% 5.20% C0221 1,635 98.60 1.65% 4.95% 0.08% 0.25% 44 New Karachi Town UC-03 16,352 C0044 1,882 184.29 1.90% 5.69% C0222 1,407 115.28 1.42% 4.26% 0.48% 1.44% 45 New Karachi Town Godhra UC-04 15,905 C0045 1,936 174.32 1.95% 5.86% C0223 1,263 123.58 1.27% 3.82% 0.68% 2.04% 46 New Karachi Town UC-05 15,169 C0046 1,922 158.67 1.94% 5.82% C0224 1,635 112.40 1.65% 4.95% 0.29% 0.87% 47 New Karachi Town Hakeem Ahsan UC-06 15,685 C0047 2,049 169.55 2.07% 6.20% C0225 1,628 77.80 1.64% 4.93% 0.42% 1.27% 48 New Karachi Town Madina Colony UC-07 15,119 C0048 2,143 151.04 2.16% 6.48% C0226 1,497 118.23 1.51% 4.53% 0.65% 1.95% 49 New Karachi Town Faisal UC-08 15,913 C0049 2,103 174.57 2.12% 6.36% C0227 1,568 160.08 1.58% 4.74% 0.54% 1.62% 50 New Karachi Town Khameeso Goth UC-09 15,853 C0050 1,945 173.27 1.96% 5.89% C0228 1,560 137.13 1.57% 4.72% 0.39% 1.16% 51 New Karachi Town Mustufa Colony UC-10 15,433 C0051 2,350 171.00 2.37% 7.11% C0229 1,569 109.57 1.58% 4.75% 0.79% 2.36% 52 New Karachi Town Khawaja Ajmeer Nagri UC-11 16,414 C0052 2,053 185.81 2.07% 6.21% C0230 1,407 131.64 1.42% 4.26% 0.65% 1.95% 53 New Karachi Town Gulshan-e-Saeed UC-12 16,659 C0053 1,736 207.24 1.75% 5.25% C0231 1,538 151.43 1.55% 4.65% 0.20% 0.60% Shah Nawaz Bhutto Colony UC- 54 New Karachi Town 15,349 C0054 2,169 162.39 2.19% 6.56% C0232 1,257 101.61 1.27% 3.80% 0.92% 2.76% 13 55 UC-01 15,160 C0055 2,040 158.42 2.06% 6.17% C0233 1,545 79.29 1.56% 4.67% 0.50% 1.50% Town North Nazimabad 56 Pahar Ganj UC-02 15,867 C0056 2,049 166.29 2.07% 6.20% C0234 1,597 137.41 1.61% 4.83% 0.46% 1.37% Town North Nazimabad 57 Khando Goth UC-03 15,056 C0057 2,187 149.81 2.21% 6.62% C0235 1,539 123.76 1.55% 4.66% 0.65% 1.96% Town North Nazimabad 58 Haidery UC-04 16,335 C0058 1,924 183.93 1.94% 5.82% C0236 1,223 130.35 1.23% 3.70% 0.71% 2.12% Town North Nazimabad 59 Sakhi Hasan UC-05 14,743 C0059 1,897 156.13 1.91% 5.74% C0237 1,547 131.07 1.56% 4.68% 0.35% 1.06% Town North Nazimabad 60 Farooq-e-Azam UC-06 15,812 C0060 1,846 186.74 1.86% 5.59% C0238 1,402 100.56 1.41% 4.24% 0.45% 1.34% Town North Nazimabad 61 UC-07 15,028 C0061 1,938 142.77 1.95% 5.86% C0239 1,717 84.46 1.73% 5.20% 0.22% 0.67% Town North Nazimabad 62 Shadman Town UC-08 15,503 C0062 2,251 165.73 2.27% 6.81% C0240 1,408 110.54 1.42% 4.26% 0.85% 2.55% Town North Nazimabad 63 Buffer Zone UC-09 16,015 C0063 1,994 176.81 2.01% 6.03% C0241 1,262 139.97 1.27% 3.82% 0.74% 2.21% Town North Nazimabad 64 Buffer zone-1 UC-10 16,491 C0064 1,882 195.25 1.90% 5.69% C0242 1,563 125.00 1.58% 4.73% 0.32% 0.97% Town 65 Town UC-01 16,745 C0065 2,214 193.24 2.23% 6.70% C0243 1,434 104.82 1.45% 4.34% 0.79% 2.36% 66 Darya Abad UC-02 15,006 C0066 1,797 155.31 1.81% 5.44% C0244 1,536 84.18 1.55% 4.65% 0.26% 0.79% 67 Lyari Town UC-03 16,230 C0067 1,771 189.08 1.79% 5.36% C0245 1,242 83.26 1.25% 3.76% 0.53% 1.60% 68 Lyari Town Khada Memon Society UC-04 16,313 C0068 1,943 183.52 1.96% 5.88% C0246 1,208 99.51 1.22% 3.66% 0.74% 2.22% 69 Lyari Town Baghdadi UC-05 15,124 C0069 1,997 157.74 2.01% 6.04% C0247 1,412 105.11 1.42% 4.27% 0.59% 1.77% 70 Lyari Town Shah Baig Line UC-06 15,736 C0070 2,137 177.82 2.16% 6.47% C0248 1,490 113.93 1.50% 4.51% 0.65% 1.96% 71 Lyari Town Behar Colony UC-07 15,828 C0071 2,065 172.68 2.08% 6.25% C0249 1,525 86.42 1.54% 4.61% 0.54% 1.63% 72 Lyari Town Ragiwara UC-08 15,452 C0072 1,819 164.56 1.83% 5.50% C0250 1,584 109.86 1.60% 4.79% 0.24% 0.71% 73 Lyari Town Singo Line UC-09 15,191 C0073 1,786 159.05 1.80% 5.40% C0251 1,699 125.93 1.71% 5.14% 0.09% 0.26% 74 Lyari Town UC-10 15,142 C0074 1,812 158.08 1.83% 5.48% C0252 1,405 131.74 1.42% 4.25% 0.41% 1.23% 75 Lyari Town UC-11 15,131 C0075 2,151 157.82 2.17% 6.51% C0253 1,659 98.65 1.67% 5.02% 0.50% 1.49% ~ 266 ~ Journal of Pharmacognosy and Phytochemistry

76 Town Old Haji Camp UC-01 15,802 C0076 2,169 179.35 2.19% 6.56% C0254 1,522 114.88 1.54% 4.61% 0.65% 1.96% 77 Garden UC-02 16,040 C0077 1,889 170.02 1.91% 5.72% C0255 1,626 118.38 1.64% 4.92% 0.27% 0.80% 78 Saddar Town UC-03 15,202 C0078 1,802 172.54 1.82% 5.45% C0256 1,315 106.26 1.33% 3.98% 0.49% 1.47% 79 Saddar Town City Railway Station UC-04 14,798 C0079 2,220 150.94 2.24% 6.72% C0257 1,468 100.63 1.48% 4.44% 0.76% 2.28% 80 Saddar Town UC-05 16,223 C0080 1,941 181.37 1.96% 5.87% C0258 1,292 128.65 1.30% 3.91% 0.65% 1.96% 81 Saddar Town UC-06 15,319 C0081 1,754 161.77 1.77% 5.31% C0259 1,428 121.33 1.44% 4.32% 0.33% 0.99% 82 Saddar Town / UC-07 14,818 C0082 2,123 151.44 2.14% 6.42% C0260 1,621 94.69 1.63% 4.90% 0.51% 1.52% 83 Saddar Town Saddar UC-08 16,674 C0083 2,151 183.75 2.17% 6.51% C0261 1,627 143.73 1.64% 4.92% 0.53% 1.59% 84 Saddar Town Civil Line UC-09 14,826 C0084 1,934 151.52 1.95% 5.85% C0262 1,397 101.11 1.41% 4.23% 0.54% 1.62% 85 Saddar Town Clifton UC-10 14,926 C0085 2,299 153.59 2.32% 6.96% C0263 1,353 83.29 1.36% 4.09% 0.95% 2.86% 86 Saddar Town UC-11 15,768 C0086 1,758 171.40 1.77% 5.32% C0264 1,291 114.32 1.30% 3.91% 0.47% 1.41% 87 Town UC-01 15,094 C0087 2,205 157.13 2.22% 6.67% C0265 1,747 104.75 1.76% 5.29% 0.46% 1.39% 88 Sultanabad UC-02 14,854 C0088 2,313 152.10 2.33% 7.00% C0266 1,472 126.85 1.48% 4.45% 0.85% 2.54% 89 Keamari Town Kemari UC-03 15,949 C0089 1,657 189.95 1.67% 5.01% C0267 1,296 95.06 1.31% 3.92% 0.36% 1.09% 90 Keamari Town Baba Bhit UC-04 15,178 C0090 1,718 165.44 1.73% 5.20% C0268 1,353 119.15 1.36% 4.09% 0.37% 1.10% 91 Keamari Town UC-05 15,962 C0091 1,867 182.92 1.88% 5.65% C0269 1,407 80.61 1.42% 4.26% 0.46% 1.39% 92 Keamari Town UC-06 15,345 C0092 2,273 162.35 2.29% 6.88% C0270 1,463 94.68 1.48% 4.43% 0.82% 2.45% 93 Keamari Town Shershah UC-07 15,764 C0093 1,941 171.35 1.96% 5.87% C0271 1,265 107.20 1.28% 3.83% 0.68% 2.05% 94 Keamari Town Gabo Pat UC-08 15,650 C0094 2,031 168.86 2.05% 6.15% C0272 1,736 91.55 1.75% 5.25% 0.30% 0.89% 95 Gulshan-E-Ghazi UC-01 14,738 C0095 1,842 155.93 1.86% 5.57% C0273 1,545 106.11 1.56% 4.67% 0.30% 0.90% 96 Baldia Town Itahad Town UC-02 14,673 C0096 2,380 142.18 2.40% 7.20% C0274 1,508 99.04 1.52% 4.56% 0.88% 2.64% 97 Baldia Town Islam Nagar UC-03 15,678 C0097 1,801 169.48 1.82% 5.45% C0275 1,552 113.04 1.57% 4.70% 0.25% 0.75% 98 Baldia Town Nai Abbadi UC-04 16,135 C0098 1,568 187.00 1.58% 4.74% C0276 1,474 149.57 1.49% 4.46% 0.09% 0.28% 99 Baldia Town Saeedabad UC-05 16,047 C0099 2,239 177.48 2.26% 6.77% C0277 1,452 103.66 1.46% 4.39% 0.79% 2.38% 100 Baldia Town Muslim Mujahid Colony UC-06 16,400 C0100 1,993 185.48 2.01% 6.03% C0278 1,718 131.36 1.73% 5.20% 0.28% 0.83% 101 Baldia Town UC-07 14,787 C0101 2,091 138.26 2.11% 6.33% C0279 1,327 94.19 1.34% 4.02% 0.77% 2.31% 102 Baldia Town UC-08 15,670 C0102 2,041 169.24 2.06% 6.18% C0280 1,273 127.08 1.28% 3.85% 0.77% 2.32% 103 Town UC-01 15,324 C0103 2,052 168.56 2.07% 6.21% C0281 1,573 108.03 1.59% 4.76% 0.48% 1.45% 104 UC-02 16,572 C0104 2,032 189.25 2.05% 6.15% C0282 1,441 78.88 1.45% 4.36% 0.60% 1.79% 105 Orangi Town Hanifabad UC-03 16,196 C0105 2,387 180.91 2.41% 7.22% C0283 1,292 90.54 1.30% 3.91% 1.10% 3.31% 106 Orangi Town UC-04 16,488 C0106 1,690 187.47 1.70% 5.11% C0284 1,546 132.73 1.56% 4.68% 0.15% 0.44% 107 Orangi Town Madina Colony UC-05 15,631 C0107 2,020 168.50 2.04% 6.11% C0285 1,412 126.30 1.42% 4.27% 0.61% 1.84% 108 Orangi Town Ghaziabad UC-06 16,455 C0108 2,289 186.60 2.31% 6.93% C0286 1,688 108.93 1.70% 5.11% 0.61% 1.82% 109 Orangi Town UC-07 15,193 C0109 1,910 165.76 1.93% 5.78% C0287 1,503 145.85 1.52% 4.55% 0.41% 1.23% 110 Orangi Town UC-08 14,718 C0110 1,971 149.39 1.99% 5.96% C0288 1,281 93.46 1.29% 3.88% 0.70% 2.09% 111 Orangi Town Iqbal UC-09 15,407 C0111 1,783 163.62 1.80% 5.39% C0289 1,577 81.81 1.59% 4.77% 0.21% 0.62% 112 Orangi Town Ghabool Town UC-10 16,309 C0112 1,812 190.98 1.83% 5.48% C0290 1,482 106.99 1.49% 4.48% 0.33% 1.00% 113 Orangi Town UC-11 15,372 C0113 2,136 162.94 2.15% 6.46% C0291 1,412 122.21 1.42% 4.27% 0.73% 2.19% 114 Orangi Town UC-12 15,059 C0114 2,064 156.31 2.08% 6.25% C0292 1,523 78.16 1.54% 4.61% 0.55% 1.64% 115 Orangi Town UC-13 16,198 C0115 1,839 180.93 1.85% 5.56% C0293 1,291 105.61 1.30% 3.91% 0.55% 1.66% 116 S.I.T.E. Town Pak Colony UC-01 16,228 C0116 1,994 181.59 2.01% 6.03% C0294 1,264 158.87 1.27% 3.82% 0.74% 2.21% 117 S.I.T.E. Town UC-02 15,805 C0117 1,914 172.27 1.93% 5.79% C0295 1,190 107.63 1.20% 3.60% 0.73% 2.19% 118 S.I.T.E. Town UC-03 14,616 C0118 1,758 147.33 1.77% 5.32% C0296 1,483 110.50 1.50% 4.49% 0.28% 0.83% 119 S.I.T.E. Town Metrovil UC-04 15,829 C0119 2,026 172.69 2.04% 6.13% C0297 1,537 144.04 1.55% 4.65% 0.49% 1.48% 120 S.I.T.E. Town Pathan Colony UC-05 15,983 C0120 2,128 183.48 2.15% 6.44% C0298 1,337 124.83 1.35% 4.05% 0.80% 2.39%

~ 267 ~ Journal of Pharmacognosy and Phytochemistry

121 S.I.T.E. Town UC-06 16,507 C0121 1,966 187.85 1.98% 5.95% C0299 1,647 86.17 1.66% 4.98% 0.32% 0.97% 122 S.I.T.E. Town UC-07 16,415 C0122 1,883 178.10 1.90% 5.70% C0300 1,554 116.22 1.57% 4.70% 0.33% 1.00% 123 S.I.T.E. Town UC-08 16,469 C0123 2,085 186.92 2.10% 6.31% C0301 1,528 124.67 1.54% 4.62% 0.56% 1.69% 124 S.I.T.E. Town UC-09 15,634 C0124 2,126 161.50 2.14% 6.43% C0302 1,358 91.30 1.37% 4.11% 0.77% 2.32% 125 UC-01 16,240 C0125 1,939 181.89 1.96% 5.87% C0303 1,314 98.58 1.33% 3.98% 0.63% 1.89% 126 Jamshed Town UC-02 15,131 C0126 1,971 151.31 1.99% 5.96% C0304 1,464 111.82 1.48% 4.43% 0.51% 1.53% 127 Jamshed Town UC-03 14,843 C0127 2,139 145.61 2.16% 6.47% C0305 1,758 120.23 1.77% 5.32% 0.38% 1.15% 128 Jamshed Town UC-04 16,183 C0128 2,290 188.05 2.31% 6.93% C0306 1,328 97.91 1.34% 4.02% 0.97% 2.91% 129 Jamshed Town Mehmoodabad UC-05 16,266 C0129 1,829 182.34 1.84% 5.53% C0307 1,633 144.44 1.65% 4.94% 0.20% 0.59% 130 Jamshed Town P.E.C.H.S. I UC-6 15,920 C0130 2,180 174.80 2.20% 6.60% C0308 1,397 116.53 1.41% 4.23% 0.79% 2.37% 131 Jamshed Town P.E.C.H.S. II UC-07 16,256 C0131 1,845 174.59 1.86% 5.58% C0309 1,386 121.43 1.40% 4.19% 0.46% 1.39% 132 Jamshed Town Jut Line UC-08 16,398 C0132 1,627 185.30 1.64% 4.92% C0310 1,538 146.76 1.55% 4.65% 0.09% 0.27% 133 Jamshed Town Central Jacob Lines UC-09 14,974 C0133 2,217 154.53 2.24% 6.71% C0311 1,597 109.61 1.61% 4.83% 0.63% 1.88% 134 Jamshed Town Jamshed Quarter UC-10 14,717 C0134 2,065 149.38 2.08% 6.25% C0312 1,533 99.63 1.55% 4.64% 0.54% 1.61% 135 Jamshed Town UC-11 15,803 C0135 1,915 164.98 1.93% 5.79% C0313 1,309 129.11 1.32% 3.96% 0.61% 1.83% 136 Jamshed Town Soldier Bazar UC-12 15,894 C0136 1,854 181.35 1.87% 5.61% C0314 1,543 116.19 1.56% 4.67% 0.31% 0.94% 137 Jamshed Town UC-13 16,046 C0137 1,950 184.85 1.97% 5.90% C0315 1,464 133.18 1.48% 4.43% 0.49% 1.47% 138 Gulshan-E-Iqbal Town Delhi Mercentile Society UC-01 14,721 C0138 2,276 149.42 2.30% 6.89% C0316 1,648 105.84 1.66% 4.99% 0.63% 1.90% 139 Gulshan-E-Iqbal Town Civic Centre UC-02 15,483 C0139 1,865 165.20 1.88% 5.64% C0317 1,424 103.27 1.44% 4.31% 0.44% 1.33% 140 Gulshan-E-Iqbal Town P.I.B. Colony UC-03 15,085 C0140 2,132 163.37 2.15% 6.45% C0318 1,687 91.57 1.70% 5.10% 0.45% 1.35% 141 Gulshan-E-Iqbal Town UC-04 14,802 C0141 1,880 144.76 1.90% 5.69% C0319 1,366 107.02 1.38% 4.13% 0.52% 1.56% 142 Gulshan-E-Iqbal Town Gulshan-E-Iqbal I UC-05 15,746 C0142 1,841 171.00 1.86% 5.57% C0320 1,294 99.83 1.31% 3.92% 0.55% 1.66% 143 Gulshan-E-Iqbal Town Gillani Railway Station UC-06 15,538 C0143 1,758 173.40 1.77% 5.32% C0321 1,362 110.94 1.37% 4.12% 0.40% 1.20% 144 Gulshan-E-Iqbal Town UC-07 16,435 C0144 2,082 186.21 2.10% 6.30% C0322 1,678 100.91 1.69% 5.08% 0.41% 1.22% 145 Gulshan-E-Iqbal Town Jamil Colony UC-08 16,475 C0145 2,044 187.16 2.06% 6.18% C0323 1,315 148.11 1.33% 3.98% 0.74% 2.21% 146 Gulshan-E-Iqbal Town Gulshan-E-Iqbal II UC-09 15,790 C0146 1,697 171.95 1.71% 5.13% C0324 1,380 129.00 1.39% 4.18% 0.32% 0.96% 147 Gulshan-E-Iqbal Town UC-10 15,592 C0147 2,210 167.61 2.23% 6.69% C0325 1,481 76.87 1.49% 4.48% 0.74% 2.21% 148 Gulshan-E-Iqbal Town Metrovill UC-11 15,403 C0148 1,777 170.36 1.79% 5.38% C0326 1,483 129.54 1.50% 4.49% 0.30% 0.89% 149 Gulshan-E-Iqbal Town Gulzar-E-Hijri UC-12 15,935 C0149 1,998 175.13 2.02% 6.05% C0327 1,429 131.30 1.44% 4.32% 0.57% 1.72% 150 Gulshan-E-Iqbal Town UC-13 15,129 C0150 2,051 170.96 2.07% 6.21% C0328 1,468 138.13 1.48% 4.44% 0.59% 1.76% 151 Town Bilal Colony UC-01 15,389 C0151 2,151 170.05 2.17% 6.51% C0329 1,290 88.49 1.30% 3.90% 0.87% 2.61% 152 UC-02 16,054 C0152 1,885 185.10 1.90% 5.70% C0330 1,522 103.71 1.54% 4.61% 0.37% 1.10% 153 Korangi Town UC-03 15,581 C0153 2,128 167.34 2.15% 6.44% C0331 1,213 125.58 1.22% 3.67% 0.92% 2.77% 154 Korangi Town Mustafa Taj Colony UC-04 15,937 C0154 1,890 175.15 1.91% 5.72% C0332 1,404 116.82 1.42% 4.25% 0.49% 1.47% 155 Korangi Town 100 Quarters UC-05 15,569 C0155 2,107 160.21 2.13% 6.38% C0333 1,578 97.46 1.59% 4.77% 0.53% 1.60% 156 Korangi Town UC-06 16,021 C0156 1,678 169.66 1.69% 5.08% C0334 1,627 125.44 1.64% 4.92% 0.05% 0.15% 157 Korangi Town Korangi Sector 33 UC-07 16,119 C0157 2,054 186.50 2.07% 6.21% C0335 1,276 97.04 1.29% 3.86% 0.78% 2.35% 158 Korangi Town UC-08 15,981 C0158 2,162 176.11 2.18% 6.54% C0336 1,497 110.11 1.51% 4.53% 0.67% 2.01% 159 Korangi Town UC-09 16,276 C0159 1,975 174.97 1.99% 5.98% C0337 1,638 129.39 1.65% 4.96% 0.34% 1.02% 160 Muzaffarabad Colony UC-01 16,520 C0160 2,400 188.16 2.42% 7.26% C0338 1,597 164.70 1.61% 4.83% 0.81% 2.43% 161 Landhi Town Muslimabad UC-02 15,810 C0161 2,141 172.33 2.16% 6.48% C0339 1,306 136.44 1.32% 3.95% 0.84% 2.53% 162 Landhi Town Daud Colony UC-03 14,753 C0162 2,218 156.23 2.24% 6.71% C0340 1,374 81.29 1.39% 4.16% 0.85% 2.55% 163 Landhi Town Moinabad UC-04 15,090 C0163 2,088 156.94 2.11% 6.32% C0341 1,396 111.21 1.41% 4.22% 0.70% 2.09% 164 Landhi Town Shirafi Goth UC-05 15,576 C0164 1,976 174.14 1.99% 5.98% C0342 1,369 111.52 1.38% 4.14% 0.61% 1.84% 165 Landhi Town Bhutto Nagar UC-06 15,665 C0165 2,248 162.13 2.27% 6.80% C0343 1,513 112.79 1.53% 4.58% 0.74% 2.22%

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166 Landhi Town Khawaja Ajmer Nagri UC-07 16,348 C0166 2,060 184.24 2.08% 6.23% C0344 1,444 99.89 1.46% 4.37% 0.62% 1.86% 167 Landhi Town Landhi UC-O8 15,628 C0167 1,957 161.44 1.97% 5.92% C0345 1,380 105.33 1.39% 4.18% 0.58% 1.75% 168 Landhi Town Awami Colony UC-09 15,295 C0168 2,088 161.21 2.11% 6.32% C0346 1,385 94.06 1.40% 4.19% 0.71% 2.13% 169 Landhi Town Burmi Colony UC-10 15,399 C0169 2,285 163.54 2.30% 6.91% C0347 1,443 109.02 1.46% 4.37% 0.85% 2.55% 170 Landhi Town Korangi UC-11 15,914 C0170 2,119 174.58 2.14% 6.41% C0348 1,211 101.85 1.22% 3.66% 0.92% 2.75% 171 Landhi Town Sherabad UC-12 15,946 C0171 1,787 175.25 1.80% 5.41% C0349 1,450 95.04 1.46% 4.39% 0.34% 1.02% 172 UC-01 14,928 C0172 2,241 153.61 2.26% 6.78% C0350 1,481 76.88 1.49% 4.48% 0.77% 2.30% 173 Shah Faisal Town Pak Sadat Colony UC-02 15,635 C0173 2,070 168.55 2.09% 6.26% C0351 1,260 133.52 1.27% 3.81% 0.82% 2.45% 174 Shah Faisal Town Drigue Colony UC-03 15,865 C0174 1,973 173.56 1.99% 5.97% C0352 1,619 115.81 1.63% 4.90% 0.36% 1.07% 175 Shah Faisal Town Reta Plot UC-04 16,215 C0175 2,035 181.28 2.05% 6.16% C0353 1,321 158.58 1.33% 4.00% 0.72% 2.16% 176 Shah Faisal Town Moria Goth UC-05 14,735 C0176 1,970 143.52 1.99% 5.96% C0354 1,613 87.38 1.63% 4.88% 0.36% 1.08% 177 Shah Faisal Town Rifah Aam UC-06 14,880 C0177 1,834 152.67 1.85% 5.55% C0355 1,336 76.33 1.35% 4.04% 0.50% 1.51% 178 Shah Faisal Town Al Falah Society UC-07 16,407 C0178 2,059 177.85 2.08% 6.23% C0356 1,483 147.01 1.50% 4.49% 0.58% 1.74% Sum 2,791,719 354,912 30,349 - - 258,637 20,194 - - - - Min 14,616.00 1,556.00 138.26 1.57% 4.71% 1,070.00 72.65 1.08% 3.24% 0.02% 0.06% Max 16,745.00 2,459.00 207.24 2.48% 7.44% 1,777.00 166.88 1.79% 5.38% 1.24% 3.72% Mean 15,683.81 1,993.89 170.50 2.01% 6.03% 1,453.02 113.45 1.47% 4.40% 0.55% 1.64% Median 15,755.00 1,976.00 171.18 1.99% 5.98% 1,454.50 111.08 1.47% 4.40% 0.54% 1.62% Mode 16,414.00 2,151.00 186.50 1.99% 5.82% 1,597.00 105.33 1.42% 3.91% 0.74% 1.39%

Percentile 25th 15,171.25 1,880.50 161.27 1.90% 5.69% 1,340.75 99.62 1.35% 4.06% 0.38% 1.13% Percentile 75th 16,192.75 2,130.25 181.97 2.15% 6.45% 1,550.75 126.21 1.57% 4.70% 0.72% 2.15% Standard Deviation (SD) 570.21 181.63 13.54 0.18% 0.55% 139.90 20.85 0.14% 0.42% 0.23% 0.69% Statistical Analysis Analysis Statistical Sample Size 178 178 178 178 178 178 178 178 178 178 178 Square Root of Sample Size 13.34 13.34 13.34 13.34 13.34 13.34 13.34 13.34 13.34 13.34 13.34 Standard Error of Mean (SRM) 42.74 13.61 1.02 0.014% 0.041% 10.49 1.56 0.011% 0.032% 0.017% 0.052%

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Conclusion 10. Pakistan Bureau of Statistics, Pocket Book 2006. It is pretty much clear from results of study that if symptoms http://www.pbs.gov.pk/sites/default/files/other/pocket_bo of common cold will be managed by using oral infusion of ok2006/2.pdf. 01 February, 2016. Licorice, an annual savings of Rs.1.51/- billion (US$ 14.52/- 11. Fowler FJ. Applied social research methods series. In million) is possible that could be theoretically equal to five- Survey research methods 1995; 1:163-178. year savings of Rs.7.55/- billion (US$ 72.60/- million). But 12. Groves RM, Fowler Jr FJ, Couper MP, Lepkowski JM, practically, after dual impact of inflation rate in Pakistan (i.e., Singer E, Tourangeau R. Survey methodology John both on acquiring supply of Licorice root against annual Wiley & Sons, 2009; 561:256-281. demand as well as on savings generated by Licorice therapy), 13. DE RADA VD. Internet, Phone, Mail and Mixed-Mode an annual savings of Rs.1.51/- billion (US$ 14.52/- million) Surveys: The Tailored Design Method. Don A. Dillman, could translate into five-year savings of Rs.5.52/- billion (US$ Jolene D. Smyth y Leah Melani Christian.(New Jersey, 53.08/- million). By considering the combination of John Wiley and Sons, 2014). Reis. Revista Española de accumulation of annual savings, the difference in burden of Investigaciones Sociológicas, 2016; (154):161-165. illness, i.e. 57.07 less DALY per 1000 population (less burden 14. Donev D, Zaletel-Kragelj L, Bjegovic V, Burazeri G. of illness) and comparatively less budget impact of Licorice Measuring the burden of illness: disability adjusted life therapy for reducing symptoms of common cold in City of year (DALY). Methods and Tools in Public Health, 2010; Karachi, economically the Licorice therapy proved preferable 30:715. in comparison with Triaminic DM therapy. 15. Juanita A Haagsma, Charline Maertens de Noordhout, Suzanne Polinder, Theo Vos, Arie H Havelaar, Acknowledgements Alessandro Cassini et al., Assessing disability weights We are thankful to Mr. Aseer Khan and Prof. Naeem Janjua based on the responses of 30,660 people from four for providing their deep insight and analytical support for the European countries, Population Health Metrics 2015; study. 13:10, DOI 10.1186/s12963-015-0042-4.

Conflict of Interest The authors declare no conflict of interest regarding the publication of this paper.

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