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Article: Quality of life assessment & out-of-pocket expenditure in multiple myeloma: An observational study.

Mathew, Anisha / Farooqui, Habib Hasan / Kumar, Lalit

2022 Volume 154, Issue 6, Page(s) 823–832

Abstract: Background & objectives: Prognosis of patients with multiple myeloma (MM) has improved significantly in the past two decades. However, the symptoms burden is high at onset and treatment is generally prolonged with significant financial burden. This ... ...

Abstract	Background & objectives: Prognosis of patients with multiple myeloma (MM) has improved significantly in the past two decades. However, the symptoms burden is high at onset and treatment is generally prolonged with significant financial burden. This study was undertaken to assess the quality of life (QoL) and to analyse out-of-pocket expenditure (OOPE) incurred on MM patients being treated at a tertiary care cancer centre in north India. Methods: This observational, cross-sectional study included 116 patients (aged >18 yr) of MM (both newly diagnosed and those with recurrent disease). For QoL assessment, European Organisation for Research and Treatment of Cancer (EORTC)-validated questionnaire (EORTC QLQ C 30 version 3.0) and disease-specific QLQ MY20 were used. For assessing OOPE incurred on treatment, the National Sample Survey Organisation (NSSO) questionnaire was used. Results: Bone pains (68.1%), fatigue (59.7%) and dyspnoea (54.6%) were common symptoms. The mean global health status/QoL score was 59.62±19.21. International Staging System (ISS) score correlated with global health status score, and gastritis was the main adverse effect. QoL score showed negative correlation to side effects of treatment (-0.53) of MY20 domain. On multivariate analysis, ISS stage (P<0.001) and adverse effects of treatment (P=0.02) were predictive factors. The median OOPE was ₹ 7900 (IQR, ₹ 4950-13,550) towards medical and ₹ 1150 (IQR, ₹ 500-3100) for non-medical expenses for the past one month. Interpretation & conclusions: Regular assessment of QoL in the clinical management of multiple myeloma patients has the potential of improving treatment outcomes. Measures to reduce out-of-pocket expenditure may improve treatment compliance.
MeSH term(s)	Cross-Sectional Studies ; Health Expenditures ; Humans ; Multiple Myeloma/therapy ; Quality of Life ; Surveys and Questionnaires
Language	English
Publishing date	2022-04-30
Publishing country	India
Document type	Journal Article ; Observational Study
ZDB-ID	390883-5
ISSN	0971-5916 ; 0019-5340
ISSN	0971-5916 ; 0019-5340
DOI	10.4103/ijmr.IJMR_4028_20
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Article: Private sector vaccine share in overall immunization coverage in India: Evidence from private sector vaccine utilization data (2012-2015).

Farooqui, Habib Hasan / Zodpey, Sanjay

Indian journal of public health

2020 Volume 64, Issue 1, Page(s) 75–78

Abstract: The objective of this research was to generate the evidence on the private sector's contribution to overall immunization coverage for selected pediatric vaccines in India. Using IMS Health's (now IQVIA) vaccine sales audit data and innovative ... ...

Abstract	The objective of this research was to generate the evidence on the private sector's contribution to overall immunization coverage for selected pediatric vaccines in India. Using IMS Health's (now IQVIA) vaccine sales audit data and innovative methodological approach we estimated private-sector vaccine share in the total immunization coverage across selected pediatric vaccines in India. Our estimates suggest that private sector remains an important contributor to immunization services in India not only for Universal Immunization Program vaccines (Bacillus Calmette-Guérin [19.23%], HiB pentavalent [11.09%], hepatitis B [5.75%], oral poliovirus vaccine [5.48%], Diphtheria-Pertussis-Tetanus [2.66%], and measles [2.17%]) but also for newer vaccines (hepatitis A [4.2%], rotavirus [3.4%], typhoid [3.3%], and pneumococcal conjugate vaccine [2.5%]). As the private sector continues to remain an important access point for immunization services in the country, avenues for potential synergy between public and private sectors should be explored to improve the coverage and quality of immunization services.
MeSH term(s)	Humans ; Immunization Programs/statistics & numerical data ; India ; Private Sector/statistics & numerical data ; Vaccination Coverage/statistics & numerical data
Language	English
Publishing date	2020-03-28
Publishing country	India
Document type	Journal Article
ZDB-ID	800737-8
ISSN	2229-7693 ; 0019-557X
ISSN (online)	2229-7693
ISSN	0019-557X
DOI	10.4103/ijph.IJPH_433_18
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Article: Evaluating the impact of price regulation (Drug Price Control Order 2013) on antibiotic sales in India: a quasi-experimental analysis, 2008-2018.

Selvaraj, Sakthivel / Farooqui, Habib Hasan / Mehta, Aashna / Mathur, Manu Raj

Journal of pharmaceutical policy and practice

2022 Volume 15, Issue 1, Page(s) 68

Abstract: Background: In India, due to a lack of population-level financial risk protection mechanisms, the expenditure on healthcare is primarily out-of-pocket in nature. Through Drug Price Control Orders (DPCOs), the Indian Government attempts to keep medicine ... ...

Abstract	Background: In India, due to a lack of population-level financial risk protection mechanisms, the expenditure on healthcare is primarily out-of-pocket in nature. Through Drug Price Control Orders (DPCOs), the Indian Government attempts to keep medicine prices under check. The aim of this study was to measure the potential impact of DPCO 2013 on the utilization of antibiotics under price regulation in India using large nationally representative pharmaceutical sales data. Methods: We used interrupted time series analysis, a quasi-experimental research design to estimate the impact of DPCO 2013 on the utilization of antibiotics in the private sector in India. Indian pharmaceutical sales data set, PharmaTrac from a market research company-All Indian Origin Chemists and Distributors Limited-was used for the study. The data are collected from a panel of around 18,000 stockists across 23 different regions of the country. The primary outcome measure is the percentage change (increase or decrease) in the sales volume of the antibiotics under DPCO 2013, measured in standard units (SUs). Results: Our estimates suggest that post-intervention (after notification of DPCO 2013) there was an immediate reduction (level change) in the sales of antibiotics under DPCO 2013 by 3.7% (P > 0.05), followed by a sustained decline (trend change) of 0.3% (P > 0.05) as compared to the pre-intervention trend at the molecule level, but both changes were statistically insignificant. However, in terms of 'average monthly market share,' the DPCO 2013 notification resulted in a sharp reduction of 579% (P < 0.05) (level change) followed by a sustained increase of 9.5% (P > 0.05) (trend change) in the 'market share of antibiotics under DPCO' as compared to pre-intervention trend. Conclusions: The impact of DPCO 2013 in terms of the overall increase in the utilization of antibiotics under price regulation was limited but there was a switch from non-price controlled antibiotics to price regulated antibiotics (notified under DPCO 2013). We argue that policies on price control need to be complemented with continuous monitoring of market behavior to have a measurable and long-term impact.
Language	English
Publishing date	2022-10-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2734772-2
ISSN	2052-3211
ISSN	2052-3211
DOI	10.1186/s40545-022-00466-4
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Article: Regulatory enforcement of the marketing of fixed-dose combinations in India: a case study of systemic antibiotics.

Brhlikova, Petra / Mehta, Aashna / McGettigan, Patricia / Pollock, Allyson M / Roderick, Peter / Farooqui, Habib Hasan

Journal of pharmaceutical policy and practice

2023 Volume 16, Issue 1, Page(s) 139

Abstract: Background: In India, states have licensed the manufacture of large numbers of fixed-dose combination (FDC) drugs without the required prior approval of the central regulator. This paper describes two major regulatory initiatives to address the problem, ...

Abstract	Background: In India, states have licensed the manufacture of large numbers of fixed-dose combination (FDC) drugs without the required prior approval of the central regulator. This paper describes two major regulatory initiatives to address the problem, which began in 2007 and 2013, and examines whether they have been sufficient to remove centrally unapproved systemic antibiotic FDCs from the market. Methods: Information was extracted from documents published by the central regulator and the ministry of health, including the National List of Essential Medicines (NLEM), and court judgments, and analysed alongside sales volume data for 2008-2020 using PharmaTrac market dataset. Results: The regulatory initiatives permitted 68 formulations to be given de facto approvals ('No Objection Certificates') outside the statutory regime, banned 46 FDCs and restricted one FDC. Market data show that FDCs as a proportion of total antibiotic sales increased from 32.9 in 2008 to 37.3% in 2020. The total number of antibiotic FDC formulations on the market fell from 574 (2008) to 395 (2020). Formulations with a record of prior central approval increased from 86 (2008) to 94 (2020) and their share of the antibiotic FDC sales increased from 32.0 to 55.3%. In 2020, an additional 23 formulations had been permitted de facto approval, accounting for 10.6% of the antibiotic FDC sales. Even in 2020, most marketed formulations (70.4%, 278/395) were unapproved or banned, and comprised a 15.9% share of the antibiotic FDC sales. The share of NLEM-listed antibiotic FDC sales increased from 21.2 (2008) to 26.7% (2020). Conclusion: The initiatives had limited impact. Regulatory enforcement has been slow and weak, with many unapproved, and even banned, FDCs remaining on the market.
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2734772-2
ISSN	2052-3211
ISSN	2052-3211
DOI	10.1186/s40545-023-00644-y
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Article: Universal health coverage in India: Progress achieved & the way forward.

Zodpey, Sanjay / Farooqui, Habib Hasan

The Indian journal of medical research

2018 Volume 147, Issue 4, Page(s) 327–329

MeSH term(s)	Delivery of Health Care ; Health Expenditures ; Health Services ; India ; Universal Health Insurance
Language	English
Publishing date	2018-06-14
Publishing country	India
Document type	Editorial
ZDB-ID	390883-5
ISSN	0971-5916 ; 0019-5340
ISSN	0971-5916 ; 0019-5340
DOI	10.4103/ijmr.IJMR_616_18
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Article ; Online: Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017-18.

Karan, Anup / Farooqui, Habib Hasan / Hussain, Suhaib / Hussain, Mohammad Akhtar / Selvaraj, Sakthivel / Mathur, Manu Raj

BMC health services research

2022 Volume 22, Issue 1, Page(s) 1151

Abstract: Background: The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure.: Methods: We ... ...

Abstract	Background: The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. Methods: We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. Results: Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. Conclusions: Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
MeSH term(s)	Health Expenditures ; Humans ; India/epidemiology ; Morbidity ; Multimorbidity ; Noncommunicable Diseases ; Self Report
Language	English
Publishing date	2022-09-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08509-x
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Article ; Online: Systemic antibiotic sales and WHO recommendations, India.

Mehta, Aashna / Brhlikova, Petra / McGettigan, Patricia / Pollock, Allyson M / Roderick, Peter / Farooqui, Habib Hasan

Bulletin of the World Health Organization

2022 Volume 100, Issue 10, Page(s) 610–619

Abstract: Objective: To analyse sales of fixed-dose combination and single antibiotics in India in relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales.: Methods: We extracted data on sales ... ...

Abstract	Objective: To analyse sales of fixed-dose combination and single antibiotics in India in relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales. Methods: We extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics. Findings: There were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended. Conclusion: The sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Commerce ; Drugs, Essential ; Humans ; India ; World Health Organization
Chemical Substances	Anti-Bacterial Agents ; Drugs, Essential
Language	English
Publishing date	2022-08-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	80213-x
ISSN	1564-0604 ; 0042-9686 ; 0366-4996 ; 0510-8659
ISSN (online)	1564-0604
ISSN	0042-9686 ; 0366-4996 ; 0510-8659
DOI	10.2471/BLT.22.287908
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Article ; Online: Antibiotic prescriptions for oral diseases in India: evidence from national prescription data.

Mathur, Manu Raj / Nagrath, Deepti / Mishra, Vijay Kumar / Harris, Rebecca / Saeed, Syed Saif / Selvaraj, Sakthivel / Mehta, Aashna / Farooqui, Habib Hasan

BMC oral health

2023 Volume 23, Issue 1, Page(s) 170

Abstract: Introduction: The key objective of this research was to describe the prescription rate of various antibiotics for dental problems in India and to study the relevance of the prescriptions by analysing antibiotic types associated with different dental ... ...

Abstract	Introduction: The key objective of this research was to describe the prescription rate of various antibiotics for dental problems in India and to study the relevance of the prescriptions by analysing antibiotic types associated with different dental diagnoses, using a large-scale nationally representative dataset. Methods: We used a 12-month period (May 2015 to April 2016) medical audit dataset from IQVIA (formerly IMS Health). We coded the dental diagnosis provided in the medical audit data to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) and the prescribed antibiotics for the diagnosis to the Anatomic Therapeutic Chemical (ATC) -2020 classification of the World Health Organization. The primary outcome measure was the medicine prescription rate per 1,000 persons per year (PRPY Results: Our main findings were-403 prescriptions per 1,000 persons per year in the year 2015 -2016 for all dental ailments. Across all ATC level 1 classification, 'Diseases of hard tissues' made up the majority of the prescriptions. 'Beta-lactam', 'Penicillin,' and 'Cephalosporins' were the most commonly prescribed antibiotics for dental diagnoses followed by 'Macrolides' and 'Quinolones'. 'Dental caries', 'Discoloration of tooth', and 'Toothache' were the most common reasons for 'Beta-Lactams' and 'Penicillin' prescriptions. Conclusion: To conclude our study reports first ever country (India) level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-11 classification for dental ailments.
MeSH term(s)	Humans ; Anti-Bacterial Agents/therapeutic use ; Drug Prescriptions ; Cephalosporins ; Penicillins ; India/epidemiology
Chemical Substances	Anti-Bacterial Agents ; Cephalosporins ; Penicillins
Language	English
Publishing date	2023-03-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2091511-1
ISSN	1472-6831 ; 1472-6831
ISSN (online)	1472-6831
ISSN	1472-6831
DOI	10.1186/s12903-023-02889-0
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Article ; Online: Does price regulation affect atorvastatin sales in India? An impact assessment through interrupted time series analysis.

Selvaraj, Sakthivel / Farooqui, Habib Hasan / Mehta, Aashna

BMJ open

2019 Volume 9, Issue 1, Page(s) e024200

Abstract: Objective: The objective of this study was to examine the impact of medicines price regulation (Drug Price Control Order, 2013) on the market share of atorvastatin in the Indian retail market for statins.: Setting: All Indian states, January 2012 to ... ...

Abstract	Objective: The objective of this study was to examine the impact of medicines price regulation (Drug Price Control Order, 2013) on the market share of atorvastatin in the Indian retail market for statins. Setting: All Indian states, January 2012 to December 2015. Design: Quasi-experimental-interrupted time series analysis. Data: Pharmaceutical sales audit data set from IMS Health (now IQVIA) for the 48-month period from January 2012 to December 2015. Outcome measure: Share of atorvastatin (in percentage) in the Indian market for statins in terms of sales volumes. Results: We observed that the price regulation notification (Drug Price Control Orders, 2013) was associated with 0.12% (p<0.001; 95% CI 0.06 to 0.18) increase in the trend of the average monthly market share of atorvastatin (5 mg and 10 mg). After 31 months of price ceilings notification, the average market share of atorvastatin was 3.41% higher than would have been expected had the price ceilings not been notified. In sensitivity analysis, with a control, our findings remain robust, we observed a 0.16% (p<0.001; 95% CI 0.08 to 0.24) rise in the trend of average monthly market share of atorvastatin (5 mg and 10 mg) as compared with the change in the control. Conclusions: Price control as a public intervention did improve the relative sales of atorvastatin in the statin market in India.
MeSH term(s)	Atorvastatin/economics ; Atorvastatin/therapeutic use ; Commerce/statistics & numerical data ; Costs and Cost Analysis/legislation & jurisprudence ; Drug Industry ; Health Expenditures ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/economics ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; India ; Interrupted Time Series Analysis ; Legislation, Drug
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Atorvastatin (A0JWA85V8F)
Language	English
Publishing date	2019-01-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2018-024200
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Article ; Online: Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data.

Farooqui, Habib Hasan / Mehta, Aashna / Selvaraj, Sakthivel

PloS one

2019 Volume 14, Issue 11, Page(s) e0224848

Abstract: The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health) ...

Abstract	The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health). We coded the diagnosis provided in the medical audit data to International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the prescribed antibiotics for the diagnosis to Anatomic Therapeutic Chemical (ATC) classification of World Health Organization (ATC index-2016). We calculated and reported antibiotic prescription rate per 1,000 persons per year, by age groups, antibiotic class and disease conditions. Our main findings are-approximately 519 million antibiotic prescriptions were dispensed in the private sector, which translates into 412 prescriptions per 1,000 persons per year. Majority of the antibiotic prescriptions were dispensed for acute upper respiratory infections (J06) (20.4%); unspecified acute lower respiratory infection (J22) (12.8%); disorders of urinary system (N39) (6.0%); cough (R05) (4.7%); and acute nasopharyngitis (J00) (4.6%) and highest antibiotic prescription rates were observed in the age group 0-4 years. To conclude our study reports first ever country level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-10 mapped disease conditions.
MeSH term(s)	Adolescent ; Age Distribution ; Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Drug Prescriptions ; Humans ; India ; Infant ; Infant, Newborn ; Medical Audit ; Outpatients ; Private Sector ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-11-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0224848
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