Pharmacoeconomics focuses on evaluating the costs and benefits of drug therapy. Four techniques are used for economic evaluation: cost minimization analysis, cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Cost effectiveness analysis compares the costs of two or more alternatives relative to outcomes measured in natural units. Cost utility analysis is a subset that measures outcomes in quality-adjusted life years. Pharmacoeconomic evaluations provide a basis for resource allocation and utilization of healthcare expenditures.

1. PHARMACOECONOMICS

2. • Pharmacoeconomics focuses on the costs and benefits
of drug therapy and pharmacoeconomic evaluations
provide a basis for resource allocation and utilization.
• Four techniques are used for economic evaluation,
namely
Cost minimization analysis (CMA)- Identifies intervention
cost differences between similar alternatives(outcome
not measured)
Cost benefit analysis (CBA)- Identifies net cost impact of
an intervention(cost Vs Benefit)
Cost effectiveness analysis (CEA)- Compares costs of two
or more alternatives versus outcomes measured in
natural units
Cost utility analysis (CUA)- Subset of cost effectiveness
analysis -outcomes are measured in utility units(QALY-
factor of life expectancy and utility)

3. Drug name cost(Rs)/
Unit(mg)
Dose(mg)/Frequen
cy
Acetaminophen 0.50 / 500 1000 / QID
Aspirin 0.25 / 350 1050 /TID
Ibuprofen 1.00/ 600 600/TID
Indomethacin 1.00 / 25 25/TID
Diclofenac 0.75 / 50 50/TID
1. In acute musculoskeletal disorders (tendinitis, bursitis,
rheumatoid arthritis),one among the following NonSteroidal
Antiinflammatory drugs is used. The cost per unit of each
drug is provided.
Questions:
1.Work out the cost for each drug per day.
2. Which among the following drugs cause the least
gastrointestinal adverse effect ?

4. S.
No
Name/strength
of the drug
Dose
required
per day
(mg)
Duratio
n of
treatme
nt
(days)
Total
dose
requir
ed
(mg)
No.of
tablets
required
Cost
per
unit
in Rs
Tota
l
cost
in
Rs
1 Acetaminophe
n 500mg
4000
(1000x4)
1 4000 8(4000/50
0)
0.50 4.00
2 Aspirin 350
mg
3150
(1050x3)
1 3150 9(3150/35
0)
0.25 2.25
3 Ibuprofen
600mg
1800
(600x3)
1 1800 3(1800/60
0)
1.00 3.00
4 Indomethacin
25 mg
75
(25x3)
1 75 3(75/25) 1.00 3.00
5 Diclofenac 150
(50x3)
1 150 3(150/50) 0.75 2.25
1. Work out the cost for each drug.

5. 2. Which among the following drugs cause the
least gastrointestinal adverse effect?
Acetaminophen cause least GI effect but
has poor Anti inflammatory effect. Ibuprofen
causes the least gastrointestinal adverse effect
among the anti-inflammatory agents.

6. 2. A 60yr old diabetic female from a middle class family has to be
treated with Inj .insulin.
Regimen: A: Inj. Isophane Insulin 80 unit /day
Regimen: B: Inj. Lente insulin 80unit /day
Regimen: C: Inj. Human insulin 20unit / day
Price:
Inj. Isophane Insulin 40unit / ml , Rs. 34.00/ 10ml vial
Inj. Lente insulin 40unit /ml, Rs 35.00/10ml vial
Inj. Human insulin 40unit / ml , Rs.145.00/10ml vial.
Questions:
1. Work out the cost for 1month for each drug.
2. Suggest the preferred regimen and justify your opinion.

7. Answers:
1. Work out the cost for 1month for each drug.
Re
gi
me
n
Name/strength
of the drug
Dose
require
d per
day
(units)
Duration
of
treatment
(days)
Total
dose
require
d
(units)
No.of
vials
required
Cost
per
unit in
Rs
Total
cost
in Rs
A Inj Isophane
Insulin 40unit
10ml vial(40
units/ml)
80 30 2400
(60ml)
6
(60/10)
34.00 204.
00
B Inj. Lente
insulin 10ml vial
(40 units/ml)
80 30 2400
(60 ml)
6
(60/10)
35.00 210.
00
C Inj. Human
insulin 10 ml
vial (40
units/ml)
20 30 600
(15ml)
1.5
(15/10)
145.00 217.
50

8. 2. Suggest the preferred Regimen and justify your
opinion
Regimen C (Human Insulin) is preferable.
Regimen A &B even though cheaper, due to possibility
of occurrence of allergic reactions, they are not
preferred.

9. 3. An Adult male is suffering from uncomplicated
chlamydial urethritis. The cost of various regimen is
given below
Regimen A: C.Doxycycline 100mg bd  7 days
Regimen B:T. Azithromycin 1gm single dose  3 days
Regimen C:C. Amoxycilllin 500 mg tds  7days
Price:
C.Doxycycline 100mg - Rs 4.00
T. Azithromycin 500 mg - Rs 35.00
C. Amoxycilllin 500 mg - Rs 6.50
Questions:
1. Work out the cost for each schedule
2. Which Regimen will you suggest? Why?

10. Answers:
1. Work out the cost for each schedule
Regi
men
Name/strengt
h of the drug
Dose
requir
ed per
day
(mg)
Duratio
n of
treatme
nt
(days)
Total
dose
requir
ed
(mg)
No.of
tablets
require
d
Cost
per
unit
in Rs
Total
cost
in Rs
A C.Doxycyclin
e 100mg
200 7 1400 14 4.00 56.00
B T.
Azithromycin
500 mg
1000 3 3000 6 35.00 210.0
0
C C.Amoxycilll
in 500 mg
1500 7 10500 21 6.50 136.5
0

11. 2. Which Regimen will you suggest? Why?
Regimen A is preferred because it is
cheaper and effective.

12. 4. You have been provided with a list of drugs for
neuralgic pain due to diabetic neuropathy. Cost
of each drug is given
Questions
1. Work out the cost for each regimen for one week
2. Which is the preferred regimen for this patient?
Regi
men
Drug Dose / day Cost /unit
I Amitryptyline 10 mg tds 1.00 /10mg
II Pregabalin 75mg bd 7.00 / 75mg
III Gabapentin 300mg od 9.80 / 300mg
IV Duloxetine 20mg od 3.90 / 20 mg

13. Answers
1. Work out the cost for each regimen for one week
Regime
n
Name/streng
th of the
drug
Dose
requir
ed per
day
(mg)
Duratio
n of
treatme
nt
(days)
Total
dose
require
d
(mg)
No.of
tablets
require
d
Cost
per
unit
in Rs
Total
cost
in Rs
A Amitryptylin
e
10mg
30 7 210 21 1.00 21.00
B Pregabalin
75mg
150 7 1050 14 7.00 98.00
C Gabapentin
150 mg
300 7 2100 7 9.80 68.60
D Duloxetine
20mg
20 7 140 7 3.90 27.30

14. 2. Which is the preferred regimen for this
patient?
Regimen C is the preferred regimen for this
patient because regimen B and C have better
safety profile compared to other
regimens..Among B and C, Regimen C is
preferred as it is cost effective.

15. 5. Given below is the list of drugs useful for the management of
epilepsy. Cost of each drug has been given.
Drug Dose in mg/day Cost(rs) Unit(mg)
Phenytoin 400 0.70 100
Carbamazepine 1200 0.90 200
Valproic acid 2000 1.80 200
Phenobarbitone 180 0.50 30
Questions:
1. work out the total cost of each drug.
2. Which among the following drugs is best avoided in a 10yrs old
school boy for the chosen indication. Why?

16. Answers;
1. Work out the total cost of each drug for a period of 1 month.
Regi
men
Name/stre
ngth of
the drug
Dose
required
per day
(mg)
Duratio
n of
treatme
nt
(days)
Total
dose
require
d
(mg)
No.of
tablets
require
d
Cost
per
unit in
Rs
Total
cost in
Rs
A Phenytoin
100 mg
400 30 12000 120 0.70 84.00
B Carbamaze
pine
200mg
1200 30 36000 180 0.90 162.00
C Valproic
acid
200mg
2000 30 60000 300 1.80 540.00
D Phenobarb
itone 30mg
180 30 5400 180 0.50 90.00

17. 2. Which among the following drugs is least
preferred in a 10yrs old school boy for the chosen
indication?why?
Phenobarbitone is least preferred. Long term
administration in children may produce side
effects like behavioral abnormalities, diminution
of intelligence, impairment of learning , memory
and hyperactivity in children.

18. 6. A patient with hypertension has to be treated with one of the
following schedule.
Schedule A: T. Propranolol 80mg bd
Schedule B: T. Enalapril 5mg od
Schedule C: T. Atenolol 50 mg od
Price:
1. T. Propranolol 40mg Rs 1.60
2. T. Enalapril 2.5 mg Rs 2.30
3. T. Atenolol 50 mg Rs 1.80
Questions:
Work out the cost for one month
Which Regimen Is suitable for patients with hypertension
& diabetes mellitus

19. Answers :
Work out the cost for one month
Regi
men
Name/stre
ngth of
the drug
Dose
required
per day
(mg)
Duratio
n of
treatme
nt
(days)
Total
dose
require
d
(mg)
No.of
tablets
require
d
Cost
per
unit in
Rs
Total
cost in
Rs
A T.
Propranolo
l 40mg
160 30 4800 120 1.60 192.00
B T.
Enalapril
2.5mg od
5 30 150 60 2.30 138.00
C T. Atenolol 50 30 1500 30 1.80 54.00

20. 2. Which Regimen is suitable for patients with
hypertension & diabetes mellitus?
Regimen B (Enalapril) Is suitable .ACE inhibitors
delay progression of Diabetic nephropathy

21. 7. 60 year old male a known case of cirrhotic liver with pedal
edema & ascites was planned to be treated with diuretics.
SCHEDULE A: T. Frusemide 40 mg OD / morning for 5 days
SCHEDULE B: T. Hydrochlorothiazide 25 mg OD / morning
for 5 days
SCHEDULE C: T. Frusemide 20 mg + T.Spironolactone 50mg
BD for 5 days
Price :
1. T.Frusemide 40 mg : RS 2.00 / unit
2. T.Hydrochlorothiazide 25 mg ; RS 3.75 / unit
3. T. Frusemide 20 mg + T.Spironolactone 50mg ; RS 4.00 /
unit
Questions :
1. Work out the cost for each schedule.
2. Which Schedule is preferred for this patient? Justify

22. Answers
1. Work out the cost for each schedule.
Reg
ime
n
Name/strength of
the drug
Dose
require
d per
day
(mg)
Duratio
n of
treatme
nt
(days)
No.of
tablets
required
Cost
per unit
in Rs
Total cost
in Rs
A T.Frusemide 40
mg
40x1 5 5 2.00 10.00
B T.Hydrochlorothi
azide 25 mg
25 x1 5 5 3.75 18.75
C T. Frusemide 20
mg +
T.Spironolactone
50mg
(20+
50) x2
5 10 4.00 40.00

23. 2. Which Schedule is preferred for this patient? Justify
SCHEDULE C is preferred for this patient. Cirrhosis
patients have High Aldosterone levels.
Since,Spironolactone is an Aldosterone Antagonist, It
will decrease the sodium retention and edema by
decreasing aldosterone levels.

24. 8. You are provided with a list of drugs used in Diabetes. The
cost of drug per unit is also given.
S.n
o
Drug Dose(mg) dose/Day Cost/unit(
Rs/mg)
1. Glibenclamide 5 15 0.45/5
2. Glipizide 5 20 0.80/5
3. Gliclazide 40 240 0.25/40
4. Metformin 500 2000 0.65/50
0
Questions:
1. Work out the cost of each drug for one month?
2. Select a suitable drug from the Table given above for an obese
Diabetic patient. Justify

25. Answers :
Work out the cost of each drug for one month?
Regi
men
Name/strength
of the drug
Dose
required
per day
(mg)
Duratio
n of
treatme
nt
(days)
No.of
tablets
required
Cost
per unit
in Rs
Total cost
in Rs
A Glibenclamide
5 mg
5 x3 30 90 0.45 40.50
B Glipizide 5 mg 5 x4 30 120 0.80 96.00
C Gliclazide 40
mg
40 x 6 30 180 0.25 45
D Metformin
500mg
500 x 4 30 120 0.65 78

26. 2. Select a suitable drug from the Table given above for
an obese Diabetic patient. Justify
Metformin is the preferred drug as it has insulin sparing
effect and reduction in appetite. Its main benefit is
prevention of weight gain in contrast to
sulfonylureas.

27. 9. A 25 yr old male patient with signs and symptoms of upper
respiratory infection was suggested the following regimens.
Schedule 1:
C.Amoxicillin 500mg tds X 7 days
T. Chlorpheniramine maleate 4mg OD x 7 days
Schedule 2:
C.Cephalexin 500mg BD x7 days
T.Levocetrizine 5 mg OD x 7 days
Price list:
C.Amoxicillin 500 mg RS.6/cap
T. Chlorpheniramine maleate 4mg Rs.3/tab
C.Cephalexin 500mg Rs.13.50/ cap
T.Levocetrizine 5mg Rs.4.2 /tab
Questions
1. Work out the cost of the given schedule
2. Which schedule is preferred for the patient? Why?

28. Answers
Work out the cost of the given schedule
Re
gi
m
en
Name/strength of
the drug
Dose
require
d per
day
(mg)
Duratio
n of
treatme
nt
(days)
No.of
tablets
required
Cost
per unit
in Rs
Total cost
in Rs
A C.Amoxicillin
500mg
T.Chlorpheniramin
e maleate 4mg
500 x 3
4 x 1
7
7
21
7
6
3
126
21
147
B C.Cephalexin
500mg
T.Levocetrizine
5 mg
500 x 2
5 x 1
7
7
14
7
13.50
4.2
189
29.4
218.4

29. 2. Which schedule is preferred for the patient? Why?
Schedule B is preferred for the patient.
Chlorpheniramine maleate is a first generation
Antihistamine which has frequent CNS side effects
like sedation, diminished alertness, motor
incoordination. Levocetrizine (second generation
antihistamine) has less CNS depressant properties

30. 10. Two different regimens used in Bronchial
asthma are given below.
Regi
men
Name Of
The Drug
Required
Dose
Frequ
ency
Cost Of Drug (Rs)
/Unit
I Salbutamol
Beclomethasone
100µg 2 puffs
100µg 2 puffs
QID
QID
75.00/ 200puffs
150.00/ 200puffs
II Salbutamol
Prednisolone
4mg oral
5mg oral
QID
QID
0.60
0.80
QUESTIONS:
1. Find out the cost for each regimen per day
2. which regimen is preferred?Why?

31. Answers
• Find out the cost for each regimen per day
Reg
ime
n
Name/strength of
the drug
Dose
required per
day
(mg)
Durati
on of
treatm
ent
(days)
No.of
puffs
requir
ed
Cost per puff in
Rs
Total
cost in
Rs
A
Salbutamol
100 µg
Beclomethasone
100 µg
100µg x2 x4
100µg x2x4
1
1
8
8
(75/200)=0.38
(150/200)= 0.75
Total
3.00
6.00
9.00
B Salbutamol 4mg
Prednisolone 5mg
4x4
5 x 4
1
1
4
4
0.60
0.80
Total
2.40
3.20
5.60
2. Which regimen is preferred? Why?
Regimen I is preferred as it has rapid therapeutic effect and least
systemic side effects

32. 11. You have been provided with a list of drugs and regimens used
in the treatment of malaria. Cost / unit of each drug is given.
REGI
MEN
DRUG ROUTE DOSE(mg)/
FREQUENCY
COST
(Rs)/UNIT
I T.Chloroquine
phosphate
PO 500( 2TAB.STAT,
1 TAB.AT 6,24 & 48
HRS)
1.75/500 mg
II T.Quinine Sulfate +
C.Doxycycline
PO 600TID × 3 DAYS
+100BID × 3 DAYS
10.00/600 mg
3.00/100 mg
III T.Artesunate +
T.sulfadoxine +
pyrimethamine
PO 100BID × 3 DAYS
1500mg +75 mg single
dose
20.00/50 mg
5.25/500+25
Questions
• Find out the cost effective regimen for an adult patient suffering
• from chloroquine sensitive malaria
2. Which regimen is preferred in case of chloroquine resistant
falciparum malaria?

33. Answers
• Find out the cost effective regimen for an adult patient suffering
from chloroquine sensitive malaria
Regi
men
Name/strength of the
drug
Dose
required
(mg)
Durati
on of
treatm
ent
(days)
No.of
tablet
s
requir
ed
Cost per
unit in
Rs
Total cost in
Rs
I Chloroquine phosphate
500mg
500x5 1 5 1.75 8.75
II T.Quinine Sulfate 600mg
+ C.Doxycycline 100 mg
600x3
100 x 2
3
3
9
6
10
3
Total
90
18
108
III T.Artesunate 50 mg +
T.sulfadoxine 500mg +
pyrimethamine 75mg
50x2x2
(500+25)
x3
3
Single
dose
12
3
20
5.25
Total
240
15.75
255.75

34. • Regimen I is the preferred cost effective
regimen
• Which regimen is preferred for Acute
uncomplicated Falciparum malaria ?
• Regimen III is preferred in Acute
uncomplicated falciparum malaria as it has
rapid clinical and parasitological cure and low
recrudescence rate.

35. 12. A 30 yrs female who presented with complaints of fever, burning
micturition. Urine culture and sensitivity showed E.Coli growth, which
was highly sensitive to cephalexin,ampicillin, cotrimoxazole and
norfloxacin.The following options are given below.
OPTIONS-
Tab.Cotrimoxazole 160mg +800mg 1 BID for 7 days
Cap.Ampicillin 500mg QID for 7 days
Cap.Cephalexin 500mg QID for 7 days
Tab.Norfloxacin 400mg BID for 7 days
PRICE LIST:
Tab.Cotrimoxazole -Rs.1.50/ 160 +800mg
Cap.Ampicillin -Rs.5.60/ 500mg
Cap.Cephalexin -Rs.11.00/500mg
Tab.Norfloxacin -Rs.4.70/400 mg
Questions ;
1.Work out the cost and suggest the economical schedule
2. Suggest the commonly used schedule for empirical therapy

36. Answers;
1.Work out the cost and suggest the economical schedule
Sche
dule
Name/strength
of the drug
Dose
required
(mg)
Duration of
treatment
(days)
No.of
tablets
required
Cost per
unit in
Rs
Total
cost in
Rs
A T.Cotrimoxazo
le(160+800)mg
(160+800)
X 2
7 14 1.50 21.00
B C.Ampicillin
500 mg
500X 4 7 28 5.60 156.80
C C.Cephalexin
500 mg
500 X 4 7 28 11.00 308.00
D T. Norfloxacin
400 mg
400 X 2 7 14 4.70 65.80
Schedule A is economical
2. Suggest the commonly used schedule for empirical therapy
Schedule D is the commonly used schedule for empirical therapy as it has
high cure rate and low systemic toxicity.

37. 13.Following are the drug regimens used in the management of peptic
ulcer. The cost of each drug unit is also provided.
Regimen 1
Drug/strength/ Dose/frequency Duration (weeks) cost(rs/unit)
1.Lanzoprazole 30 mg,1 cap,BID 2 6.00
2.Amoxicillin 500mg,2 cap, BD 2 6.00
3.Clarithromycin 500mg, BD 2 55.00
Regimen 2:
1.Colloidal bismuth subcitrate 2 2.00
120 mg,QID
2.Tetracycline 500mg QID 2 2.50
3.Metronidazole 200mg, 2 tab, TID 2 0 .50
4. C. Omeperazole 20mg BD 2 4.25
Questions:
1. Work out the total cost for each regimen.
2. Why are proton pump inhibitors/H2 blockers combined with antibiotics
in these regimen?

38. S.N
O
Drug/strength
Dose/frequency
Dose
required
per day
(mg)
Dura
tion
(Day
s)
No.O
f
tablet
s
requir
ed
Cost
per unit
Total
cost
Schedule
A
1.Lanzoprazole30mg
2.Amoxicillin 500mg
3.Clarithromycin 500mg
30x2
500x4
500 x 2 14
28
56
28
6.00
6.00
55.00
TOTAL
168.00
336.00
1540.00
2044.00
ule
B
1.Colloidal bismuth subcitrate
120 mg
2.Tetracycline 500mg
3.Metronidazole 200mg
4. T. Omeperazole 20mg
120 x 4
500 x 4
200x2x3
20 x 2
14
56
56
84
28
2.00
2.50
0.50
4.25
TOTAL
112.00
140.00
42.00
119.00
413.00

39. 2. Why are proton pump inhibitors/H2 blockers combined
with antibiotics in these regimen?
Acid suppression by PPIs/H2 blockers enhances
effectiveness of anti-H. pylori antibiotics, and optimum
benefits are obtained when gastric pH is kept >5 for at
least 16–18 hours per day.
The PPIs benefit by altering the acid environment for H.
pylori as well as by direct inhibitory effect.
•

40. 14. You have been provided with a list of drugs used in
the treatment of Parkinsonism. Cost of each drug is
given
Sche
dule.
no
S.no Drug Dosage Cost /unit
A 1 T.Trihexyphenidyl 2 mg bd 1.40
B 2 T.Levodopa
+T.Carbidopa
L(500 mg)
C(100 mg) bd
3.60
C 3 T.Selegiline 5mg bd 4.90
D 4 T.Ropinirole 0.25mg tds 1.50
Questions ;
1. Work out the total cost for each regimen for one month
2. Which Schedule is effective in drug induced parkinsonism

41. • Answers ;
• 1. Work out the total cost for one month
S.
N
o
Name/strength of drug Dose
required
per day
Duratio
n
(days)
No.of
tablets
require
d
Cost
/unit
Total
cost
A T.Trihexyphenidyl 2mg 2 x 2 30 60 1.40 84.00
B T.Levodopa (500mg)+
T.Carbidopa (100mg)
(500+100
) x2
30 60 3.60 216.00
C T.Selegiline 5mg 5x 2 30 60 4.90 294.00
D T.Ropinirole 0.25mg 0.25 x 3 30 90 1.50 135.00
2. Which Schedule is effective in drug induced parkinsonism?
Schedule A (Central anticholinergics) is effective in drug induced
parkinsonism

42. 15. A 60yr old diabetic male came to skin OPD with itchy patches in
abdomen. He was diagnosed as tinea corporis & was started on
antifungal drugs.
SCHEDULE A: T.Griseofulvin 250mg BD for 4 weeks
SCHEDULE B: T.Fluconazole 150 mg OD once a week for 4 weeks
SCHEDULE C: T.Terbinafine 250mg OD for 4 weeks
Price : T.Griseofulvin 250mg – RS 2.60 / 250 mg tab
T.Fluconazole 150 mg – RS 28.00 / 150 mg tab
T.Terbinafine 250mg – RS. 20.00 / 250 mg tab
Questions :
1. Work out the cost for each schedule. Which schedule is economical?
2. Among the following schedules, which one is not effective against
Pityriasis Versicolor?

43. ANSWERS
Work out the cost for each schedule. Which schedule is economical?
S.N
o
Name/strength
of drug
Dose
required per
day
Durati
on
(days)
No.of
tablets
requir
ed
Cost
/unit
Total
cost
A T.Griseofulvin
250mg
250 X2 30 60 2.60 156.00
B T.Fluconazole
150 mg
150mg once
a week
4 4 28.00 112.00
C T.Terbinafine
250mg
250 x 1 30 30 20.00 600.00
Schedule B is economical
2. Among the following schedules, which one is not effective against Pityriasis Versicolo
Griseofulvin is not effective against P.versicolor