Exclusive I Indians spend Rs 35,820 crore a year on minor ailments, finds novel survey by pharma body

A first of its kind Value of Over-the-Counter (OTC) drugs in India survey has revealed that Indians spend nearly Rs 36,000 crore annually on treatment of 27 ailments that can be defined as “minor”.

A large part of the spending, shows the study carried out by the Organisation of Pharmaceutical Producers of India (OPPI) in collaboration with Havas Life Sorento, a healthcare communication firm, goes towards consultation fees to doctors.

The findings have prompted pharma companies to pitch for a robust OTC drug policy in India so that self-treatment gets promoted and dependence on doctors for minor health conditions is reduced.

‘Need for a robust self-medication policy’

The findings were based on responses from 9,797 participants across 25 cities and towns in 2020-21 which was then extrapolated for a population of 12.3 crore Indians aged above 12 years, belonging to New Consumer Classification System A and B, the two highest socio-economic categories of households.

Susan Josi, managing partner of Havas Life Sorento, who spearheaded the study, said during the OPPI annual summit on March 24 that the results should be used to advocate a strong and responsible self-medication policy in the country.

“The findings indicate that there is an enormous potential for consumer behaviour to change positively and help increase the savings on healthcare spend by diverting treatment of minor ailments to self-medication,” S Sridhar, OPPI president and managing director of Pfizer India, said in the study report.

Respiratory ailments, aches most common

The study highlighted that respiratory ailment such as cough, cold and fever were the most common minor ailments apart from aches and pain followed by gastrointestinal ailments such as stomach ache, indigestion, acidity and constipation.

Considering the healthcare spends based on the responses, the average cost per incidence was found to be Rs 796 per person irrespective of the treatment method, healthcare practitioner consultation, self-medication or pharmacist advice.

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With an average occurrence of each ailment at 3.66 times a year, the total spend across 27 ailments amounts to Rs 35,820 crore annually, when projected to the universe of 123 million consumers, said the report.

“Considering the fact that this is out-of-pocket expenditure, it is a huge burden on the population,” the study said.

Doctor, medicine related expenses constituted lion’s share

Healthcare professional-related (HCP) spends, at Rs 30,730 crore, accounted for 86 percent of the total healthcare spends while self-medication accounted for only 10 percent.

The HCP spends included Rs 11, 623 crore as medicine cost and Rs 9,710 crore as doctor or paramedic consultation fee, Rs 4,035 crore spent on diagnostics and Rs 5,358 on transportation, communication and productivity.

By doctor-related cost, the top 10 ailments included backache, joint pain, fever, acidity, weakness/ tiredness, dental pain, menstrual pain, headache, bone health and anaemia.

The study goes on to say that in ailments such as cold, cough and fever where a higher proportion of people self-medicate, there is a saving to the tune of 43 percent from healthcare practitioners’ spend while there was saving was up to 37 percent in the case of ailments where a higher number of people sought pharmacists’ advice.

No OTC policy now

Unlike countries like the US, UK and China, India does not have an OTC policy even though a large number of drugs, including those which are not to be sold without a doctor’s prescription, are retailed over the counter in the country.

Neither the Drugs and Cosmetics Act, 1940, nor the Drugs & Cosmetic Rules, 1945, explicitly categorises OTC drugs.

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Officials in the Central Drugs Standard Control Organisation said that its Drugs Technical Advisory Board had recently come up with a draft OTC policy which will soon be put out for public comments and feedback, after consultation with the health ministry.

A list of drugs that can be officially sold without a prescription has also been tentatively prepared, officials added.

‘Double-edged sword’

Dr Rajeev Jayadevan, a public health expert from Kerala, said that OTC sales of drugs is a double-edged sword in India because the process by which people get medication is so unregulated that practically anyone can get any medication at any point.

Most of the time, pharmacists are just an occasional visitor to a pharmacy and the medicine shops may be managed by non-qualified people,” said Dr Jayadevan, who is also co-chairman of the Indian Medical Association’s COVID-19 task force.

He said that if drugs are made OTC, there is going to be symptom-based therapy, which is not the same as treating a disease.

“For example, take headache, which is a symptom—it may come from something as mild as watching a movie till late at night and waking up too early or it can be something as serious as meningitis,” he said.

“So unless someone diagnoses the cause of the headache, it makes no sense in taking a painkiller which is typically what happens most of the time.”

‘Dangerous for a country like India’

 He explained that with a symptom-based treatment, the symptom may go away temporarily, making the person falsely believe that it has been cured while in many cases it can lead to delayed or missed diagnoses.

“Therefore, I would disagree strongly with any move to increase the OTC menu and suggest that there should be a restriction on authorised prescription dispensation of drugs such as antibiotics,” he said.

Dr Chandra M Gulhati, editor of the Monthly Index of Medical Specialities, agreed that any move to make OTCC drugs more liberal will be counterproductive and dangerous for a country like India.

“Even in developed countries like US the OTC list is extremely restricted,” Dr Gulati pointed out, adding that there should instead be checks on chemists dispending drugs without prescriptions.