\documentclass[twocolumn,twoside]{article}
\makeatletter\if@twocolumn\PassOptionsToPackage{switch}{lineno}\else\fi\makeatother

\usepackage{amsfonts,amssymb,amsbsy,latexsym,amsmath,tabulary,graphicx,times,xcolor}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% Following additional macros are required to function some 
% functions which are not available in the class used.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\usepackage{url,multirow,morefloats,floatflt,cancel,tfrupee}
\makeatletter


\AtBeginDocument{\@ifpackageloaded{textcomp}{}{\usepackage{textcomp}}}
\makeatother
\usepackage{colortbl}
\usepackage{xcolor}
\usepackage{pifont}
\usepackage[nointegrals]{wasysym}
\urlstyle{rm}
\makeatletter

%%%For Table column width calculation.
\def\mcWidth#1{\csname TY@F#1\endcsname+\tabcolsep}

%%Hacking center and right align for table
\def\cAlignHack{\rightskip\@flushglue\leftskip\@flushglue\parindent\z@\parfillskip\z@skip}
\def\rAlignHack{\rightskip\z@skip\leftskip\@flushglue \parindent\z@\parfillskip\z@skip}

%Etal definition in references
\@ifundefined{etal}{\def\etal{\textit{et~al}}}{}


%\if@twocolumn\usepackage{dblfloatfix}\fi
\usepackage{ifxetex}
\ifxetex\else\if@twocolumn\@ifpackageloaded{stfloats}{}{\usepackage{dblfloatfix}}\fi\fi

\AtBeginDocument{
\expandafter\ifx\csname eqalign\endcsname\relax
\def\eqalign#1{\null\vcenter{\def\\{\cr}\openup\jot\m@th
  \ialign{\strut$\displaystyle{##}$\hfil&$\displaystyle{{}##}$\hfil
      \crcr#1\crcr}}\,}
\fi
}

%For fixing hardfail when unicode letters appear inside table with endfloat
\AtBeginDocument{%
  \@ifpackageloaded{endfloat}%
   {\renewcommand\efloat@iwrite[1]{\immediate\expandafter\protected@write\csname efloat@post#1\endcsname{}}}{\newif\ifefloat@tables}%
}%

\def\BreakURLText#1{\@tfor\brk@tempa:=#1\do{\brk@tempa\hskip0pt}}
\let\lt=<
\let\gt=>
\def\processVert{\ifmmode|\else\textbar\fi}
\let\processvert\processVert

\@ifundefined{subparagraph}{
\def\subparagraph{\@startsection{paragraph}{5}{2\parindent}{0ex plus 0.1ex minus 0.1ex}%
{0ex}{\normalfont\small\itshape}}%
}{}

% These are now gobbled, so won't appear in the PDF.
\newcommand\role[1]{\unskip}
\newcommand\aucollab[1]{\unskip}
  
\@ifundefined{tsGraphicsScaleX}{\gdef\tsGraphicsScaleX{1}}{}
\@ifundefined{tsGraphicsScaleY}{\gdef\tsGraphicsScaleY{.9}}{}
% To automatically resize figures to fit inside the text area
\def\checkGraphicsWidth{\ifdim\Gin@nat@width>\linewidth
	\tsGraphicsScaleX\linewidth\else\Gin@nat@width\fi}

\def\checkGraphicsHeight{\ifdim\Gin@nat@height>.9\textheight
	\tsGraphicsScaleY\textheight\else\Gin@nat@height\fi}

\def\fixFloatSize#1{}%\@ifundefined{processdelayedfloats}{\setbox0=\hbox{\includegraphics{#1}}\ifnum\wd0<\columnwidth\relax\renewenvironment{figure*}{\begin{figure}}{\end{figure}}\fi}{}}
\let\ts@includegraphics\includegraphics

\def\inlinegraphic[#1]#2{{\edef\@tempa{#1}\edef\baseline@shift{\ifx\@tempa\@empty0\else#1\fi}\edef\tempZ{\the\numexpr(\numexpr(\baseline@shift*\f@size/100))}\protect\raisebox{\tempZ pt}{\ts@includegraphics{#2}}}}

%\renewcommand{\includegraphics}[1]{\ts@includegraphics[width=\checkGraphicsWidth]{#1}}
\AtBeginDocument{\def\includegraphics{\@ifnextchar[{\ts@includegraphics}{\ts@includegraphics[width=\checkGraphicsWidth,height=\checkGraphicsHeight,keepaspectratio]}}}

\DeclareMathAlphabet{\mathpzc}{OT1}{pzc}{m}{it}

\def\URL#1#2{\@ifundefined{href}{#2}{\href{#1}{#2}}}

%%For url break
\def\UrlOrds{\do\*\do\-\do\~\do\'\do\"\do\-}%
\g@addto@macro{\UrlBreaks}{\UrlOrds}



\edef\fntEncoding{\f@encoding}
\def\EUoneEnc{EU1}
\makeatother
\def\floatpagefraction{0.8} 
\def\dblfloatpagefraction{0.8}
\def\style#1#2{#2}
\def\xxxguillemotleft{\fontencoding{T1}\selectfont\guillemotleft}
\def\xxxguillemotright{\fontencoding{T1}\selectfont\guillemotright}

\newif\ifmultipleabstract\multipleabstractfalse%
\newenvironment{typesetAbstractGroup}{}{}%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\AtBeginDocument{\let\citet\cite\let\citep\cite}
\usepackage[numbers,sort&compress,numbers,sort&compress]{natbib}



\newif\ifnokeywords\nokeywordsfalse

\makeatletter\input{size10-pointfive.clo}\makeatother%
\definecolor{kwdboxcolor}{RGB}{242,242,242}
\usepackage[hidelinks,colorlinks=true,allcolors=blue]{hyperref}
\linespread{1}                 
\def\floatpagefraction{0.8}

\usepackage[paperheight=11.69in,paperwidth=8.26in,top=1in,bottom=1in,left=1in,right=.75in,headsep=24pt]{geometry}

\usepackage{multirow-custom}

\makeatletter

\def\hlinewd#1{%
  \noalign{\ifnum0=`}\fi\hrule \@height #1%
  \futurelet\reserved@a\@xhline}
\def\tbltoprule{\hlinewd{1pt}\\[-14pt]}
\def\tblbottomrule{\noalign{\vspace*{6pt}}\hline\noalign{\vspace*{2pt}}}
\def\tblmidrule{\hline\noalign{\vspace*{2pt}}}



\let\@articleType\@empty
\let\@journalDoi\@empty
\let\@journalVolume\@empty
\let\@journalIssue\@empty
\let\@crossMarkLink\@empty
\let\@receivedDate\@empty
\let\@acceptedDate\@empty
\let\@revisedDate\@empty
\let\@publishedDate\@empty
\let\@copyrightYear\@empty
\let\@firstPage\@empty
\def\articleType#1{\gdef\@articleType{#1}}
\def\journalDoi#1{\gdef\@journalDoi{#1}}
\def\crossMarkLink#1{\gdef\@crossMarkLink{#1}}
\def\receivedDate#1{\gdef\@receivedDate{#1}}
\def\acceptedDate#1{\gdef\@acceptedDate{#1}}
\def\revisedDate#1{\gdef\@revisedDate{#1}}
\def\publishedDate#1{\gdef\@publishedDate{#1}}
\def\copyrightYear#1{\gdef\@copyrightYear{#1}}
\def\journalVolume#1{\gdef\@journalVolume{#1}}
\def\journalIssue#1{\gdef\@journalIssue{#1}}
\def\firstPage#1{\gdef\@firstPage{#1}}
\let\@issuelogo\@empty%
\let\@issuelogoex\@empty%
\def\issuelogo#1{\gdef\@issuelogo{#1}}
\def\issuelogoex#1{\gdef\@issuelogoex{#1}}


\def\author#1{%
  \gdef\@author{%
    \hskip-\dimexpr(\tabcolsep)\hskip5pt%
    \parbox{\dimexpr\textwidth-1pt}%
    {\fontsize{11}{13}\selectfont\raggedright #1}%
  }%
}


\usepackage{pharmascope-abs}
\usepackage{caption}
\usepackage{lastpage}
\usepackage{fancyhdr}
\usepackage[noindentafter,explicit]{titlesec}
\usepackage{fontspec}

\setmainfont[%
BoldFont=cambriab.ttf,%
ItalicFont=CAMBRIAI.TTF,%
BoldItalicFont=CAMBRIAZ.TTF]{Cambria.ttf}
\lefthyphenmin = 3

\def\title#1{%
  \gdef\@title{%
      \vspace*{-40pt}%
       \ifx\@articleType\@empty\else{\fontsize{10}{12}\scshape\selectfont\hspace{8pt}\@articleType\hfill\mbox{}\par\vspace{2pt}}\fi%
       \minipage{\linewidth}
         \hrulefill\\[-0.7pt]%%{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}\hfill
         \mbox{~}\hspace{5pt}\parbox{.1\linewidth}{\IfFileExists{images/\@issuelogo.\@issuelogoex}{\includegraphics[width=79pt,height=61pt]{images/\@issuelogo.\@issuelogoex}}{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}}\hfill
         \fcolorbox{kwdboxcolor}{kwdboxcolor}{\parbox{.792\linewidth}{%
          \begin{center}\fontsize{17}{17}\selectfont\scshape\vskip-7pt International Journal of Research in Pharmaceutical Sciences\hfill\end{center}%
          \vspace*{-10pt}\hspace*{4pt}{\fontsize{8}{9}\selectfont Published by JK Welfare \& Pharmascope Foundation\hfill  Journal Home Page: \href{www.ijrps.com}{\color{blue}\underline{\smash{www.ijrps.com}}}}\hspace*{4pt}\mbox{}}}%
       \par\vspace*{-1pt}\rule{\linewidth}{1.3pt}%
       \endminipage%
    \par\vspace*{9.2pt}\parbox{.98\linewidth}{\linespread{.9}\raggedright\fontsize{14}{17}\selectfont #1}%
    \vspace*{-8pt}%
  }
}


\setlength{\parindent}{0pt}
\setlength{\parskip}{0.4pc plus 1pt minus 1pt}

\def\abbrvJournalTitle{Int. J. Res. Pharm. Sci.}

\fancypagestyle{headings}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
}\pagestyle{headings}

                                                         
\fancypagestyle{plain}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}%
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
  \ifx\@firstPage\@empty\else\setcounter{page}{\@firstPage}\fi
}


\def\NormalBaseline{\def\baselinestretch{1.1}}
\usepackage{textcase}
\setcounter{secnumdepth}{0}

\titleformat{\section}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{13}\selectfont}
{\thesection}
{6pt}
{\MakeTextUppercase{#1}}
[]
\titleformat{\subsection}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsection}
{6pt}
{#1}
[]
\titleformat{\subsubsection}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsubsection}
{6pt}
{#1}
[]
\titleformat{\paragraph}[block]{\NormalBaseline\filright\fontsize{10.5}{10}\selectfont}
{\theparagraph}
{6pt}
{#1}
[]
\titleformat{\subparagraph}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubparagraph}
{6pt}
{#1}
[]

\titlespacing{\section}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsubsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\paragraph}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subparagraph}{0pt}{.5\baselineskip}{.5\baselineskip}

\captionsetup[figure]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}
\captionsetup[table]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}

\def\bibyear#1{#1}
%\def\bibjtitle#1{#1}   %%Publisher request
\def\bibauand{}
\setlength\bibsep{3pt}
\setlength\bibhang{8pt}

\makeatother
\date{}


%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% Feature enabled:
%citation-style: unsrt
%citation-type: numbered
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\newcommand{\texttildeapprox}{{\fontfamily{pcr}\selectfont\texttildelow}}

\begin{document}


\def\RunningAuthor{Renuka Munshi and Vivek Singh}
\firstPage{110}
\articleType{Original Article}
\receivedDate{10 Nov 2021}
\acceptedDate{24 Dec 2021}
\revisedDate{13 Dec 2021}
\journalVolume{2022, 13}
\journalIssue{1}
\journalDoi{ijrps.v13i1.28}
\copyrightYear{2022}
\issuelogo{56b7528b-17e5-4fec-a698-9f461f0fd52a-unew-logo}
\issuelogoex{png}
\def\authorCount{2}
\def\affCount{1}

\def\journalTitle{International Journal of Research in Pharmaceutical Sciences}

\title{\textbf{A Cost Comparison and Cost Variation Analysis of Anti Rheumatoid Drugs and Anti-Hypertensive Drugs in Ayurveda and Allopathy}}
\author{Renuka~Munshi\textsuperscript{*}, 
            Vivek~Singh~\\[5pt]{Department of Clinical Pharmacology, TN Medical College \& BYL Nair Charitable Hospital, Mumbai Central, Mumbai 400 008, India}}

\begin{abstract}
Our study aimed to analyze and compare monthly costs along with cost variation between Ayurveda and Allopathy medicines used to treat 2 chronic disease conditions, \textit{viz.} Rheumatoid Arthritis and Hypertension. The prices of Allopathic \& Ayurvedic drugs mentioned in the treatment guidelines for these 2 conditions were obtained from different sources.  The minimum and the maximum cost of a particular drug of the same strength manufactured by various pharmaceutical companies were noted for both Ayurvedic and as Allopathic medicines. Cost Ratio and percent Cost Variation were also calculated. The results showed that the percent Cost Variation Difference (\%CVD) for ayurvedic medicines for Anti-Rheumatoid arthritis ranged from 105\% to 166.33\%. In the case of Allopathic drugs, the \%CVD ranged from 182\% for DMARDs to 1184.39\% for Corticosteroids. In the case of Anti-hypertensive medicines, too, the mean \%CVD ranged from 84.21\% for Rasaushadhi to 353.33\% for Arishta, while \%CVD ranged from 150.70\% for ACE inhibitors to 269.85\% for Calcium channel blockers for Ayurvedic and Allopathic medicines, respectively. A comparison of the monthly medicine cost for Rheumatoid Arthritis in Ayurveda and Allopathy showed that the cost for Ayurveda medicine ranged from \rupee 993.16 to \rupee 1994 while that for Allopathic medicines ranged from \rupee 735.53 to \rupee 2634.57. In the case of hypertension, the monthly medicine cost ranged from \rupee 255.64 to 2136.35 depending on the grade of Hypertension for Ayurvedic medicines and \rupee 312.65 to \rupee 631.15 for Allopathic medicines. Thus, we can conclude that there is a wide difference in the prices of the various brands of the same oral Antihypertensive and Anti-Rheumatoid arthritis drugs available in both Ayurveda and Allopathy in the Indian market. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Allopathy,\newline Ayurveda,\newline brands,\newline cost-analysis,\newline cost variation,\newline monthly cost
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Renuka~Munshi~\\ Phone:\ ~\\  Email:\ renuka.munshi@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
        \textsc{DOI:}\ \href{https://doi.org/10.26452/\@journalDoi}{\textcolor{blue}{\underline{\smash{https://doi.org/10.26452/\@journalDoi}}}}\par%
        \vspace*{-11pt}\hrulefill\\{\fontsize{9.12}{10.12}\selectfont Production and Hosted by}\par{IJRPS |~\href{www.ijrps.com}{www.ijrps.com}}\par%
        \vspace*{-2pt}{\fontsize{9.12}{10.12}\selectfont\textcopyright\ \@copyrightYear\ $|$ All rights reserved.}\par%
        \vspace*{-11pt}\rule{\linewidth}{1.2pt}
        \makeatother
        
    
\section{Introduction}
Consumption of medications from the Alternative Systems of Medicine is on the rise globally. Ayurveda is the most commonly practised Alternative systems of Medicine in India, fulfilling the medical needs of 80\% of the population \unskip~\citep{1317851:24087386}. The debate on the efficacy of therapies in Ayurveda medicine and Allopathic medicine has been going on since decades, as also on the cost of treatment and acceptance of the various treatment modalities. Public interest for the treatment with complementary and alternative medicine is mainly due to the adverse effect profile of synthetic drugs, lack of curative treatment for several chronic diseases, high cost of new drugs, microbial resistance, and emerging diseases, etc. \unskip~\citep{1317851:24087390}. 

The Ayurveda market in India was valued at INR 300 billion in 2018 and is expected to reach INR 710.87 billion by 2024, expanding at a compound annual growth rate (CAGR) of {\texttildeapprox}16.06\%, during the forecast period (2019-2024) \unskip~\citep{1317851:24087374}.

In recent years, as a holistic healing system, Ayurveda has witnessed an evolution in the form of Ayurveda products and services. Rising awareness about the importance of a healthy lifestyle, increasing preference in favor of chemical-free natural products, as well as favourable government initiatives have led to the expansion of the Ayurveda market in India. In 2018, around 75\% of Indian households used Ayurveda products against only 67\% in 2015. Many a times, people tend to use more than one system of medicine simultaneously. 

In a study conducted in Australia, 50\% of people reported that they used alternative therapy along with conventional medicine \unskip~\citep{1317851:24087394}. About 80\% of the world's population depend largely on traditional plant-derived drugs for their primary health care (PHC) \unskip~\citep{1317851:24087397,1317851:24087385}. 

Although Allopathic treatment is often the best available option in emergency situations and for the treatment of acute medical conditions, in chronic medical conditions, Allopathic medicine has faced some difficulties which has driven people towards alternative medicines for better relief and the belief that ayurvedic medicines are more cost-effective especially for chronic medical conditions. 

This paper aims to determine the cost of medicines used in 2 chronic diseases \textit{viz}. Rheumatoid arthritis (RA) and Essential Hypertension, be it Ayurveda or Allopathic medicine and do a cost comparison to understand which treatment is more cost-effective when used for the management of chronic diseases for prolonged periods of time.  
    
\section{Study objectives}

  
  \begin{enumerate}
  \item \relax To determine the number of brands with their prices of anti-Rheumatic medicines in Ayurveda and Allopathy.
  \item \relax To determine the number of brands and prices of anti-hypertensive medicines in Ayurveda and Allopathy.
  \item \relax To compare the monthly cost of both Ayurveda and Allopathy medicines used in Rheumatoid Arthritis and Hypertension.
  \end{enumerate}
  
    
\section{Materials and Methods}
Initially, the treatment guidelines for both the medical conditions under study were obtained from Central Council for Research in Ayurveda Sciences (CCRAS) \unskip~\citep{1317851:24087395}\unskip~\citep{1317851:24087380}, Ayurveda Medicine textbook \unskip~\citep{1317851:24087379}, API Textbook of Medicine \unskip~\citep{1317851:24087382}, Harrison's Principles of Internal Medicine \unskip~\citep{1317851:24087389} and the Ministry of Health and Family Welfare, Govt of India. Screening, Diagnosis, Assessment, and Management of Primary Hypertension in Adults in India. \unskip~\citep{1317851:24087388}. 

Next, the prices of the Allopathic \& Ayurvedic drugs mentioned in the treatment guidelines were obtained from different sources, both offline and online. 

The offline sources accessed were the latest issues of Drug Today, CIMS and MIMS, Ayurveda Line (Ayurveda Drug Index Book), while the online sources accessed were: "India Drug Index" and "Drug Brands" Drugs Update, and Ayurveda medicines. 

Various websites selling Ayurveda medicines were also referred to, which included from small scale manufacturers to branded companies like Patanjali, Dabur, Baidyanath etc. 

The minimum and the maximum cost in Rupees (INR) of a particular drug manufactured by various pharmaceutical companies in the same strength were noted for both Ayurvedic as well as Allopathic medicines. 

The cost ratio, i.e., the ratio of the cost of the costliest to a cheapest brand of the same drug, was calculated. This determines the difference in the cost between the costliest brand to the cheapest one in each group. 

Percentage cost variation was calculated as follows,
\begin{eqnarray*}\begin{array}{l}\%\;Cost\;variation\;=\;\frac{Maximum\;cost-Minimum\;cost}{Minimum\;cost}\times100\\\end{array} \end{eqnarray*}
As these are chronic disorders and the medications are prescribed for longer periods of time, their monthly cost was calculated as per the treatment guidelines.
    
\section{Results}
The latest prices of the various anti-rheumatic and antihypertensive drugs obtained from various offline and online sources available in the Indian market for both Ayurveda and Allopathic medicine were documented. All the commonly prescribed groups of antihypertensive drugs and anti-rheumatoid arthritis drugs were included. 

The treatment cost for one month for each medicine was calculated according to the standard treatment guidelines. The total monthly cost of treatment was calculated, and a wide cost-variation was found in most of the antihypertensive drugs and the anti-rheumatoid arthritis drugs both in Ayurveda and Allopathy was observed.\textbf{\space }

The following tables give details of the medicines and their monthly costs,

\textbf{Anti-Rheumatoid arthritis Drugs}

The medicines used to treat RA, both in Ayurveda and Allopathy as per the Treatment Guidelines, are listed below\ensuremath{^{}}

\textbf{Ayurveda Treatment Guidelines}

According to Ayurveda, the main cause of the disease is the formation of Ama due to Agnimandya. The general principles of treatment of this disease in Ayurveda lay emphasis on stimulating and normalizing the impaired Agni by the use of Langhana, Deepana, Pachana, and Katu, Tikta Rasa predominant drugs (for the correction of digestion and metabolism). 

For detoxification Swedana (sudation), Virechana (therapeutic purgation) and Vasti (therapeutic enema) are recommended.

\textbf{Modern treatment guidelines}

First and foremost is the recognition that damage and disability accrue rapidly in the first few months to two years. A delay of even as little as 3-4 months in initiating appropriate treatment makes a significant difference in the outcome over long periods. 

The second principle is that accurate objectified assessment of disease activity used as a guide for titrating treatment leads to much-improved outcomes both in the short as well as long-term. 

The third principle is based upon a notable observation that the toxicity of disease-modifying anti-rheumatic drugs (DMARDs; see below), especially the newer ones led by methotrexate (MTX), was actually less than the so-called simple painkillers, non-steroidal anti-inflammatory drugs (NSAIDs). 

Use of glucocorticoids for a short period to control flares, low dose-long term and low dose taper to be used. 

To prevent osteoporosis (calcium + vitamin D\ensuremath{_{3}} supplementation). A topical application containing salicylates, capsaicin and NSAID's in various combinations may provide symptomatic relief.

The costs of the medicines to treat Rheumatoid arthritis as per Ayurveda and the mean monthly cost of the same are summarized in Table~\ref{tw-7348f5369bd1} and Table~\ref{tw-bd28c53be098}. The costs of the medicines as per Allopathy is summarized in Table~\ref{tw-d0551f0bb3bc}, Table~\ref{tw-5e251e231c0f} and Table~\ref{tw-051459fd574f}.


\begin{table*}[!htbp]
\caption{\boldmath {Cost of Medicines for Rheumatoid Arthritis in Ayurveda} }
\label{tw-7348f5369bd1}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.14709999999999999\linewidth-2\tabcolsep}p{\dimexpr.13410000000000002\linewidth-2\tabcolsep}p{\dimexpr.14350000000000001\linewidth-2\tabcolsep}p{\dimexpr.11639999999999999\linewidth-2\tabcolsep}p{\dimexpr.12699999999999996\linewidth-2\tabcolsep}p{\dimexpr.134\linewidth-2\tabcolsep}p{\dimexpr.1979\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Drug & \cAlignHack Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & \cAlignHack Range in terms of monthly expenses of the medicines\\
\tblmidrule 
Shunthi Churna &
  3gm BD &
  \cAlignHack 100 gm &
  \cAlignHack 52 &
  \cAlignHack 180 &
  \cAlignHack 246 &
  \cAlignHack 93.6-324\\
Simhanaad guggulu &
  500mg BD &
  \cAlignHack 60 tabs &
  \cAlignHack 56 &
  \cAlignHack 149 &
  \cAlignHack 166 &
  \cAlignHack 112-298\\
Vaisvanar Churna &
  3gm BD &
  \cAlignHack 60 gm &
  \cAlignHack 72 &
  \cAlignHack 96 &
  \cAlignHack 33 &
  \cAlignHack 216-288\\
Maharasnadi Kadha &
  30ml BD &
  \cAlignHack 450 ml &
  \cAlignHack 170 &
  \cAlignHack 350 &
  \cAlignHack 105 &
  \cAlignHack 680-1400\\
Aamvaatari Ras &
  250mg BD &
  \cAlignHack 60 tabs &
  \cAlignHack 54 &
  \cAlignHack 135 &
  \cAlignHack 150 &
  \cAlignHack 108-270\\
Yograaj guggulu &
  500 mg BD &
  \cAlignHack 60 tabs &
  \cAlignHack 65 &
  \cAlignHack 180 &
  \cAlignHack 176 &
  \cAlignHack 130-360\\
Chitrakadi Vati &
  250 mg BD &
  \cAlignHack 60 tabs &
  \cAlignHack 50 &
  \cAlignHack 160 &
  \cAlignHack 220 &
  \cAlignHack 100-360\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Mean Monthly Cost ofthe Ayurvedic medicines} }
\label{tw-bd28c53be098}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2044\linewidth-2\tabcolsep}p{\dimexpr.2956\linewidth-2\tabcolsep}p{\dimexpr.26240000000000002\linewidth-2\tabcolsep}p{\dimexpr.23759999999999998\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Type of medicine & \cAlignHack Name & \multicolumn{2}{p{\dimexpr(.50\linewidth-2\tabcolsep)}}{\cAlignHack Mean Monthly Cost of medicine}\\
\rowcolor{kwdboxcolor} &  & \cAlignHack Min (INR) & \cAlignHack Max (INR)\\
\tblmidrule 
Deepan &
  Vaisvanar churna, Shunthi Churna, Chitrakadi Vati &
  \cAlignHack 136.50 &
  \cAlignHack 304\\
Guggulu or Vati &
  Simhanaad Guggulu, Yograaj Guggulu, Aamvatari Vati &
  \cAlignHack 116.66 &
  \cAlignHack 290\\
Kadha &
  Maharasnadi kadha &
  \cAlignHack 680 &
  \cAlignHack 1400\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
Thus, the mean cost of Ayurveda medicines for the treatment of Rheumatoid arthritis for a period of 30 days ranged from \rupee 933.16 to \rupee 1994.


\begin{table*}[!htbp]
\caption{\boldmath {Cost of Disease Modifying Anti Rheumatic Drugs } }
\label{tw-d0551f0bb3bc}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2099\linewidth-2\tabcolsep}p{\dimexpr.1424\linewidth-2\tabcolsep}p{\dimexpr.10680000000000001\linewidth-2\tabcolsep}p{\dimexpr.10920000000000002\linewidth-2\tabcolsep}p{\dimexpr.13169999999999998\linewidth-2\tabcolsep}p{\dimexpr.1187\linewidth-2\tabcolsep}p{\dimexpr.18130000000000003\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Drug & \cAlignHack Dosage & \cAlignHack Formula   -tion & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & \cAlignHack Monthly expenses of the medicines\\
\tblmidrule 
Sulfasalazine &
  500mg BD &
  \cAlignHack 10 &
  \cAlignHack 37.74 &
  \cAlignHack 65.09 &
  \cAlignHack 72\% &
  \cAlignHack 226.44 {\textendash} 390.54\\
\multicolumn{1}{p{\dimexpr(.2099\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Leflunomide}} &
  10mg BD &
  \cAlignHack 10 &
  \cAlignHack 80 &
  \cAlignHack 112 &
  \cAlignHack 40\% &
  \cAlignHack 240 {\textendash} 336\\
 &
  20mg BD &
  \cAlignHack 10 &
  \cAlignHack 160 &
  \cAlignHack 223 &
  \cAlignHack 42.94\% &
  \cAlignHack 480 {\textendash} 669\\
Hydroxychloroquine &
  200mg BD &
  \cAlignHack 10 &
  \cAlignHack 34.00 &
  \cAlignHack 72.00 &
  \cAlignHack 238\% &
  \cAlignHack 204 {\textendash} 432\\
\multicolumn{1}{p{\dimexpr(.2099\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Methotrexate}} &
  2.5mg weekly once &
  \cAlignHack 10 &
  \cAlignHack 14.00 &
  \cAlignHack 57.85 &
  \cAlignHack 378\% &
  \cAlignHack 16.8 {\textendash} 69.42\\
 &
  5mg weekly once &
  \cAlignHack 10 &
  \cAlignHack 32.00 &
  \cAlignHack 67 &
  \cAlignHack 156.25\% &
  \cAlignHack 25.6 {\textendash} 65.6\\
 &
  7.5mg weekly once &
  \cAlignHack 10 &
  \cAlignHack 47.20 &
  \cAlignHack 90.00 &
  \cAlignHack 141\% &
  \cAlignHack 18.88 {\textendash} 28.5\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of NSAIDs } }
\label{tw-5e251e231c0f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.16129999999999995\linewidth-2\tabcolsep}p{\dimexpr.13530000000000003\linewidth-2\tabcolsep}p{\dimexpr.14709999999999999\linewidth-2\tabcolsep}p{\dimexpr.1317\linewidth-2\tabcolsep}p{\dimexpr.1246\linewidth-2\tabcolsep}p{\dimexpr.1294\linewidth-2\tabcolsep}p{\dimexpr.1706\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Drug & \cAlignHack Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Ibuprofen &
  400mg BD &
  \cAlignHack 10 &
  \cAlignHack 8.89 &
  \cAlignHack 11.33 &
  \cAlignHack 27.44 &
  53.34 {\textendash} 67.98\\
Diclofenac &
  50mg BD &
  \cAlignHack 10 &
  \cAlignHack 9.63 &
  \cAlignHack 94.50 &
  \cAlignHack 881 &
  57.78 {\textendash} 567\\
Naproxen &
  500mg BD &
  \cAlignHack 10 &
  \cAlignHack 28.00 &
  \cAlignHack 135 &
  \cAlignHack 382 &
  168 {\textendash} 810\\
Acetaminophen &
  500mg BD &
  \cAlignHack 10 &
  \cAlignHack 6.91 &
  \cAlignHack 38 &
  \cAlignHack 450 &
  41.46 {\textendash} 228\\
Duloxetine &
  20mg BD &
  \cAlignHack 10 &
  \cAlignHack 43.30 &
  \cAlignHack 91.25 &
  \cAlignHack 110 &
  259.8 {\textendash} 547.5\\
Tramadol &
  50mg BD &
  \cAlignHack 10 &
  \cAlignHack 29 &
  \cAlignHack 102.4 &
  \cAlignHack 251 &
  174 {\textendash} 614.4\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Glucocorticoids} }
\label{tw-051459fd574f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.153\linewidth-2\tabcolsep}p{\dimexpr.1282\linewidth-2\tabcolsep}p{\dimexpr.14350000000000001\linewidth-2\tabcolsep}p{\dimexpr.13650000000000002\linewidth-2\tabcolsep}p{\dimexpr.13169999999999998\linewidth-2\tabcolsep}p{\dimexpr.1341\linewidth-2\tabcolsep}p{\dimexpr.173\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Drug & \cAlignHack Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.153\linewidth-2\tabcolsep)}}{\multirow{4}{\linewidth}{Prednisolone}} &
  5mg TDS &
  \cAlignHack 10 &
  \cAlignHack 4.12 &
  \cAlignHack 156 &
  \cAlignHack 3686\% &
  24.72 {\textendash} 936\\
 &
  10 mg TDS &
  \cAlignHack 10 &
  \cAlignHack 9.84 &
  \cAlignHack 66.62 &
  \cAlignHack 577\% &
  29.52 {\textendash} 199.86\\
 &
  20 mg TDS &
  \cAlignHack 10 &
  \cAlignHack 17.2 &
  \cAlignHack 90.00 &
  \cAlignHack 423.25\% &
  25.8 {\textendash} 41.02\\
 &
  40 mg TDS &
  \cAlignHack 10 &
  \cAlignHack 33.81 &
  \cAlignHack 51.17 &
  \cAlignHack 51.34\% &
  13.52 {\textendash} 20.68\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Calcium Supplements} }
\label{tw-815b10f4bd74}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.15420000000000002\linewidth-2\tabcolsep}p{\dimexpr.10329999999999998\linewidth-2\tabcolsep}p{\dimexpr.13410000000000002\linewidth-2\tabcolsep}p{\dimexpr.14350000000000001\linewidth-2\tabcolsep}p{\dimexpr.14950000000000003\linewidth-2\tabcolsep}p{\dimexpr.1554\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Calcium Carbonate  &
  500 mg OD &
  \cAlignHack 10 &
  \cAlignHack 29.90 &
  \cAlignHack 140 &
  \cAlignHack 368.22 &
  89.7 - 420\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Vitamin D\ensuremath{_{3}} Supplements} }
\label{tw-ff94dc6007b0}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1601\linewidth-2\tabcolsep}p{\dimexpr.14240000000000002\linewidth-2\tabcolsep}p{\dimexpr.1377\linewidth-2\tabcolsep}p{\dimexpr.1281\linewidth-2\tabcolsep}p{\dimexpr.1317\linewidth-2\tabcolsep}p{\dimexpr.1293\linewidth-2\tabcolsep}p{\dimexpr.1707\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Alfacalcidol &
  0.25 \ensuremath{\mu}g OD  &
  \cAlignHack 10 &
  \cAlignHack 48 &
  \cAlignHack 169 &
  \cAlignHack 252 &
  144 {\textendash} 507\\
Cholecalciferol &
  60k IU weekly once &
  \cAlignHack 4 &
  \cAlignHack 70 &
  \cAlignHack 116 &
  \cAlignHack 65.71 &
  70 - 116\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Topicalagents used for Rheumatoid arthritis} }
\label{tw-92d2ec2de3ba}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1305\linewidth-2\tabcolsep}p{\dimexpr.172\linewidth-2\tabcolsep}p{\dimexpr.1329\linewidth-2\tabcolsep}p{\dimexpr.11400000000000002\linewidth-2\tabcolsep}p{\dimexpr.1245\linewidth-2\tabcolsep}p{\dimexpr.1377\linewidth-2\tabcolsep}p{\dimexpr.1884\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Capsaicin &
  3gm BD or TDS &
  \cAlignHack 30g &
  \cAlignHack 35 &
  \cAlignHack 95 &
  \cAlignHack 171.42 &
  140 - 380\\
Diclofenac diethylamine &
  3gm BD or TDS &
  \cAlignHack 30 g &
  \cAlignHack 70 &
  \cAlignHack 190.46 &
  \cAlignHack 172.08 &
  280 {\textendash} 761.84\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Mean cost of the monthly Allopathic medicines used for the treatment of Rheumatoid arthritis} }
\label{tw-a09cef1a47a8}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.33\linewidth-2\tabcolsep}p{\dimexpr.33\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Medicines & Mean minimum \mbox{}\protect\newline monthly cost (INR) & Mean Maximum \mbox{}\protect\newline monthly Cost (INR)\\
\tblmidrule 
NSAIDs &
  125.73 &
  476.98\\
Local Gel &
  240 &
  1141.84\\
Calcium &
  89.70 &
  420\\
Vitamin D\ensuremath{_{3}} &
  107 &
  311.5\\
DMARD's &
  173.10 &
  284.43\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
Thus, the mean cost of treating Rheumatoid arthritis with allopathic medicines for a period of 30 days ranged from \rupee 735.53 to \rupee 2634.57.

\textbf{Anti-Hypertensive Drugs}

The medicines used to treat hypertension, both in Ayurveda \unskip~\citep{1317851:24087380} and Textbook of Kayachikitsa \unskip~\citep{1317851:24087379} and in Modern medicine \unskip~\citep{1317851:24087388}, are listed below

Ayurvedic treatment for Hypertension has both single drugs as well as compound formulations, the details of which are listed below

\textbf{Single Drugs}

Sarpagandha churna, Ashwagandha churna, Jatamamsi churna, Arjuna twaka churna

\textbf{Compound Formulations}

Sarpgandha ghana vati, Brahmi vati, Prabhakara vati, Arjunarishta, Pravala pishti, Sveta parpati, Nagarjunabhra rasa, Hridayarnava rasa, Mukta bhasma, Akika pishti

Treatment in Ayurveda for Hypertension according to Central Research Council of India\ensuremath{^{}} and Textbook of Kayachikitsa\ensuremath{^{}} is as follows: 

Grade 1 Hypertension - Churna or Vati or kadha

Grade 2 Hypertension - Churna + Vati, Vati + kadha, Churna + kadha

Grade 3 Hypertension - Churna + Kadha + Rasaushadhi, Vati + kadha + Rasaushadhi

\textbf{Churna}

Sarpagandha churna, Ashwagandha churna, Jatamansi churna, Arjuna twaka churna

\textbf{Vati}

Sarpgandha ghana vati, Brahmi vati, Prabhakara vati

\textbf{Kadha}

Arjunarishta

\textbf{Ras Aushadi}

Pravala pishti, Sveta parpati, Nagarjunabhra rasa, Hridayarnava rasa, Mukta bhasma, Akika pishti

\textbf{The Treatment Guidelines for Hypertension}

According to the Ministry of Health \& Family Welfare Government of India, 2021 are as follows:\textbf{\space }

\textbf{Drug classes}

\textbf{A: }Angiotensin-converting enzyme (ACE) inhibitors, (e.g., enalapril) or Angiotensin II receptor blockers (ARBs) (e.g., losartan) if intolerance to ACE inhibitors, 

\textbf{B :} Beta-blockers (e.g., atenolol), 

\textbf{C}: Calcium channel blockers (e.g., amlodipine), 

\textbf{D}: thiazide diuretics (e.g., hydrochlorothiazide), 

\textbf{MRA}: mineralocorticoid receptor antagonist (e.g., spironolactone).

\textbf{Grade 1 hypertension }(SBP 140-159 mm, DBP 90-99mm) 

\textbf{Drug therapy {\textendash} A or C or D}

\textbf{Add the second drug - A+C or C+D or A+D }if a response is not adequate within 2-4 weeks, 

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks.

\textbf{Grade 2 Hypertension (}SBP 160-179, DBP 100-109)

\textbf{Drug therapy {\textendash} A or Cor D, }

\textbf{Add the second drug - A+C or C+D or A+D }if a response is not adequate within 2-4 weeks,

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks. 

\textbf{Grade 3 Hypertension }(SBP \ensuremath{\geq }180, DBP \ensuremath{\geq }110)

\textbf{Use two drugs - A+C or C+D or A+D. }

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks. 

The costs of the medicines to treat Hypertension as per Ayurveda and the mean monthly cost of the same are summarized in Table~\ref{tw-051459fd574f}, Table~\ref{tw-815b10f4bd74} and Table~\ref{tw-5e251e231c0f}. 

The costs of the medicines as per Modern medicine is summarized inTable~\ref{tw-ff94dc6007b0}, Table~\ref{tw-92d2ec2de3ba}, Table~\ref{tw-a09cef1a47a8}, Table~\ref{tw-2e8002e7f279} and Table~\ref{tw-161a6a43ba61}. 

The monthly cost of the medicines used for the treatment of Hypertension in Ayurveda when treated as per the Standard Treatment Guidelines are as follows: 

\textbf{Grade 1 Hypertension} - Min \rupee 255.64 to Max \rupee 789.17, 

\textbf{Grade 2 Hypertension} is Min \rupee 511.28 to Max \rupee 1578.33 and

\textbf{Grade 3 Hypertension} - Min \rupee 683.27 to Max \rupee 2136.35.


\begin{table*}[!htbp]
\caption{\boldmath {Costs of Ayurveda Anti-Hypertensive medications} }
\label{tw-2e8002e7f279}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.17080000000000002\linewidth-2\tabcolsep}p{\dimexpr.13759999999999996\linewidth-2\tabcolsep}p{\dimexpr.14830000000000004\linewidth-2\tabcolsep}p{\dimexpr.1223\linewidth-2\tabcolsep}p{\dimexpr.12459999999999997\linewidth-2\tabcolsep}p{\dimexpr.1234\linewidth-2\tabcolsep}p{\dimexpr.173\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. Cost (INR) & \cAlignHack Max. Cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines (INR)\\
\tblmidrule 
Sarpagandha ghan vati &
  250 mg BD &
  60 tabs &
  \cAlignHack 87 &
  \cAlignHack 199 &
  \cAlignHack 118 &
  174 {\textendash} 380\\
Bhramhi Vati &
  250 mg OD &
  60 tabs &
  \cAlignHack 48.33 &
  \cAlignHack 250 &
  \cAlignHack 417.27 &
  96.66 {\textendash} 500\\
Prabhakar vati &
  250 mg BD &
  60 tabs &
  \cAlignHack 120 &
  \cAlignHack 250  &
  \cAlignHack 108.33 &
  240 {\textendash} 500\\
Arjunarishtha &
  30 ml BD &
  450 ml &
  \cAlignHack 75 &
  \cAlignHack 340 &
  \cAlignHack 353.33 &
  300 {\textendash} 1360\\
Pravala Pishti &
  125 mg BD &
  5 g &
  \cAlignHack 120 &
  \cAlignHack 196 &
  \cAlignHack 63 &
  180 {\textendash} 294\\
Shveta Parpati &
  250 mg BD &
  10 g &
  \cAlignHack  48 &
  \cAlignHack 110 &
  \cAlignHack 186 &
  57.6 {\textendash} 165\\
Nagarjunabhra rasa &
  250 mg BD &
  40 tabs &
  \cAlignHack 65 &
  \cAlignHack 108 &
  \cAlignHack 4.61 &
  97.5 {\textendash} 162\\
Hridayarnava ras &
  125 mg BD &
  60 tabs &
  \cAlignHack 70 &
  \cAlignHack 182.40 &
  \cAlignHack 160 &
  140 {\textendash} 361.8\\
Mukta bhasma &
  30 mg BD &
  1 g &
  \cAlignHack 290 &
  \cAlignHack 485 &
  \cAlignHack 67.24 &
  290 {\textendash} 485\\
Akika pishti &
  125 mg BD &
  10 g &
  \cAlignHack 90 &
  \cAlignHack 112 &
  \cAlignHack 24.44 &
  135 {\textendash} 168\\
Sarpagandha churna &
  2 g BD &
  100 g &
  \cAlignHack 180 &
  \cAlignHack 285 &
  \cAlignHack 58.33 &
  432 {\textendash} 684\\
Ashwagandha churna  &
  6 g BD &
  100 g &
  \cAlignHack 123 &
  \cAlignHack 210 &
  \cAlignHack 70.73 &
  442.8 {\textendash} 756\\
Jatamansi churna &
  2g BD &
  100 g &
  \cAlignHack 185 &
  \cAlignHack 325 &
  \cAlignHack 75.67 &
  222 {\textendash} 390\\
Arjun twaka churna &
  3g BD &
  100 g &
  \cAlignHack 50 &
  \cAlignHack 200 &
  \cAlignHack 300 &
  90 {\textendash} 360\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Monthly cost of Ayurvedic medicines to treat Hypertension} }
\label{tw-161a6a43ba61}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.19\linewidth-2\tabcolsep}p{\dimexpr.23490000000000002\linewidth-2\tabcolsep}p{\dimexpr.1983\linewidth-2\tabcolsep}p{\dimexpr.1768\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Hypertension Grade & Ayurvedic Medicines  & \cAlignHack Mean Min Cost (INR) & \cAlignHack Mean Max Cost (INR) & Mean Cost for 1 month (INR)\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.19\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Grade 1 Hypertension}} &
  Churna or &
  \cAlignHack 296.7 &
  \cAlignHack 547.5 &
  \multicolumn{1}{p{\dimexpr(.20\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Min 255.64  \mbox{}\protect\newline Max 789.17}}\\
 &
  Vati or &
  \cAlignHack 170.22 &
  \cAlignHack 460 &
  \\
 &
  Kadha &
  \cAlignHack 300 &
  \cAlignHack 1360 &
  \\
\multicolumn{1}{p{\dimexpr(.19\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Grade 2 Hypertension}} &
  Churna + Kadha &
  \cAlignHack 596.7 &
  \cAlignHack 1907.5 &
  \multicolumn{1}{p{\dimexpr(.20\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Min 511.28 \mbox{}\protect\newline Max 1578.33}}\\
 &
  Vati + Kadha &
  \cAlignHack 470.22 &
  \cAlignHack 1820 &
  \\
 &
  Churna+ Vati &
  \cAlignHack 466.92 &
  \cAlignHack 1007.5 &
  \\
\multicolumn{1}{p{\dimexpr(.19\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Grade 3 Hypertension}} &
  Churna + Kadha + Rasaushadhi or &
  \cAlignHack 746.71 &
  \cAlignHack 2180.1 &
  \multicolumn{1}{p{\dimexpr(.20\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Min 683.27 \mbox{}\protect\newline Max 2136.35}}\\
 &
  Vati + Kadha + Rasaushadhi &
  \cAlignHack 620.32 &
  \cAlignHack 2092.6 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Angiotensin-Converting Enzyme Inhibitors (ACEIs) \ensuremath{^{}}} }
\label{tw-b4421908cc01}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1175\linewidth-2\tabcolsep}p{\dimexpr.11979999999999997\linewidth-2\tabcolsep}p{\dimexpr.13410000000000004\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.13530000000000001\linewidth-2\tabcolsep}p{\dimexpr.13879999999999999\linewidth-2\tabcolsep}p{\dimexpr.2145\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Captopril &
  25mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 9.07 &
  \cAlignHack 37.50 &
  \cAlignHack 313.45 &
  27.21-112.5\\
Enalapril &
  5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 28.00 &
  \cAlignHack 99.60 &
  \cAlignHack 255.71 &
  84-298.8\\
Lisinopril &
  5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 45.00 &
  \cAlignHack 270.90 &
  \cAlignHack 502 &
  135-812.7\\
Perindopril &
  4mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 65.00 &
  \cAlignHack 123.91 &
  \cAlignHack 90.63 &
  195-371.73\\
Ramipril &
  5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 30.00 &
  \cAlignHack 185.00 &
  \cAlignHack 516.66 &
  90-555\\
Fosinopril &
  10mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 25.00 &
  \cAlignHack 60.00 &
  \cAlignHack 140 &
  75-180\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Angiotensin Receptor Blockers (ARBs)} }
\label{tw-be6f32609e1c}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1314\linewidth-2\tabcolsep}p{\dimexpr.1284\linewidth-2\tabcolsep}p{\dimexpr.10009999999999998\linewidth-2\tabcolsep}p{\dimexpr.1347\linewidth-2\tabcolsep}p{\dimexpr.11989999999999998\linewidth-2\tabcolsep}p{\dimexpr.1055\linewidth-2\tabcolsep}p{\dimexpr.1117\linewidth-2\tabcolsep}p{\dimexpr.1683\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage  & Dosage & \cAlignHack Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Losartan &
  50mg OD &
  50mg &
  \cAlignHack 10 tabs &
  \cAlignHack 19:00 &
  \cAlignHack 67.70 &
  \cAlignHack 256.31 &
  57 {\textendash} 203.1\\
Candesartan &
  8mg OD &
  8mg &
  \cAlignHack 10 tabs &
  \cAlignHack 38.00 &
  \cAlignHack 61.80 &
  \cAlignHack 62.63 &
  114 {\textendash} 185.4\\
Irbesartan &
  150mg OD &
  150mg &
  \cAlignHack 10 tabs &
  \cAlignHack 69.30 &
  \cAlignHack 246.15 &
  \cAlignHack 255.19 &
  207.9 {\textendash} 738.45\\
Telmisartan &
  40mg OD &
  40mg &
  \cAlignHack 10 tabs &
  \cAlignHack 43.50 &
  \cAlignHack 85.33 &
  \cAlignHack 96.16 &
  130.5 {\textendash} 255.99\\
Valsartan &
  80mg OD &
  80mg &
  \cAlignHack 10 tabs &
  \cAlignHack 69.00 &
  \cAlignHack 440.00 &
  \cAlignHack 537.68 &
  207 {\textendash} 1320\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Beta-Blockers} }
\label{tw-12ad548b1cd6}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1459\linewidth-2\tabcolsep}p{\dimexpr.1341\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Dosage & \cAlignHack Formulation & \cAlignHack Min. Cost (INR) & \cAlignHack Max. Cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Propranolol &
  40mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 9.37 &
  \cAlignHack 39.00 &
  \cAlignHack 316.22 &
  28.11 {\textendash} 117\\
Atenolol &
  50mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 8.00 &
  \cAlignHack 23.14 &
  \cAlignHack 189.25 &
  24 {\textendash} 69.42\\
Metoprolol &
  50mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 18.00 &
  \cAlignHack 89.00 &
  \cAlignHack 394.44 &
  54 {\textendash} 267\\
Bisoprolol &
  2.5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 16.50 &
  \cAlignHack 40.00 &
  \cAlignHack 142.42 &
  49.5 {\textendash} 120\\
Nebivolol &
  5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 52.00 &
  \cAlignHack 70.00 &
  \cAlignHack 34.61 &
  156 {\textendash} 210\\
Labetalol &
  100mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 29.57 &
  \cAlignHack 110.00 &
  \cAlignHack 271.99 &
  88.71 {\textendash} 330\\
Carvedilol &
  12.5mg OD &
  \cAlignHack 10 tabs &
  \cAlignHack 22.00 &
  \cAlignHack 86.00 &
  \cAlignHack 290.90 &
  66 {\textendash} 258\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Calcium channel blockers (CCBs)} }
\label{tw-e53bf7f1a3c0}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.1329\linewidth-2\tabcolsep}p{\dimexpr.14469999999999995\linewidth-2\tabcolsep}p{\dimexpr.1341\linewidth-2\tabcolsep}p{\dimexpr.1683\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Strength & Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Amlodipine &
  2.5 mg OD &
  10 tabs &
  \cAlignHack 9 &
  \cAlignHack 34.6 &
  \cAlignHack 284.44 &
  27-103.8\\
 &
  5 mg OD &
  10 tabs &
  \cAlignHack 9.00 &
  \cAlignHack 56 &
  \cAlignHack 522.22 &
  27-168\\
 &
  10 mg OD &
  10 tabs &
  \cAlignHack 25.03 &
  \cAlignHack 103.04 &
  \cAlignHack 313.1 &
  75.9-309.12\\
Nifedipine &
  5 mg OD &
  10 tabs &
  \cAlignHack 8.50 &
  \cAlignHack 11.34 &
  \cAlignHack 33.41 &
  25.5-34.02\\
 &
  10 mg OD &
  10 tabs &
  \cAlignHack 1.13 &
  \cAlignHack 30.00 &
  \cAlignHack 2554 &
  3.39-90\\
 &
  20 mg OD &
  10 tabs &
  \cAlignHack 20 &
  \cAlignHack 26.50 &
  \cAlignHack 32.5 &
  60-79.5\\
 &
  30 mg OD &
  10 tabs &
  \cAlignHack 18.42 &
  \cAlignHack 102.47 &
  \cAlignHack 456.29 &
  55.26 {\textendash} 307.41\\
Cilnidipine  &
  5 mg OD &
  10 tabs &
  \cAlignHack 25.00 &
  \cAlignHack 88.00 &
  \cAlignHack 252 &
  75-264\\
 &
  10 mg OD &
  10 tabs &
  \cAlignHack 40.00 &
  \cAlignHack 127.10 &
  \cAlignHack 217.75 &
  120-381.3\\
Diltiazem &
  30 mg OD &
  10 tabs &
  \cAlignHack 14.75 &
  \cAlignHack 36.57 &
  \cAlignHack 147.93 &
  44.25-109.71\\
 &
  60 mg OD &
  10 tabs &
  \cAlignHack 29.00 &
  \cAlignHack 74.40 &
  \cAlignHack 156.55 &
  87-223.2\\
 &
  90 mg OD &
  10 tabs &
  \cAlignHack 30.00 &
  \cAlignHack 107.00 &
  \cAlignHack 256.66 &
  90-321\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Cost of Diuretics} }
\label{tw-344448798549}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.20879999999999995\linewidth-2\tabcolsep}p{\dimexpr.13650000000000002\linewidth-2\tabcolsep}p{\dimexpr.13040000000000001\linewidth-2\tabcolsep}p{\dimexpr.11389999999999999\linewidth-2\tabcolsep}p{\dimexpr.12339999999999998\linewidth-2\tabcolsep}p{\dimexpr.12469999999999999\linewidth-2\tabcolsep}p{\dimexpr.1623\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drug & Strength & Formulation & \cAlignHack Min. cost (INR) & \cAlignHack Max. cost (INR) & \cAlignHack \% Cost variation & Monthly expenses of the medicines\\
\tblmidrule 
Hydrochlorothiazide &
  12.5mg OD &
  10 tabs &
  \cAlignHack 6.00 &
  \cAlignHack 13.00 &
  \cAlignHack 116.66 &
  18 {\textendash} 39\\
Indapamide &
  2.5mg OD &
  10 tabs &
  \cAlignHack 24.10 &
  \cAlignHack 88.70 &
  \cAlignHack 268.04 &
  72.3 {\textendash} 266.1\\
Torsemide &
  10mg OD &
  10 tabs &
  \cAlignHack 19.50 &
  \cAlignHack 36.74 &
  \cAlignHack 88.41 &
  58.5 {\textendash} 110.82\\
Furosemide &
  40mg OD &
  10 tabs &
  \cAlignHack 4.21 &
  \cAlignHack 13.60 &
  \cAlignHack 223.04 &
  12.63 {\textendash} 40.8\\
Acetazolamide &
  12.5mg OD &
  10 tabs &
  \cAlignHack 16.60 &
  \cAlignHack 58.00 &
  \cAlignHack 249.39 &
  49.8 - 174\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Grade 1 hypertension }(SBP 140-159 mm, DBP 90-99mm) 

\textbf{Drug therapy {\textendash} A or C or D, }Mean monthly cost {\textendash} Min 136 to Max 394.3 or Min 56.24 to Max 208.445 or Min 42.25 to Max 126.14 respectively. Mean cost {\textendash} Min 78.16 to Max 243.

\textbf{Add the second drug - A+C or C+D or A+D }if response not adequate within 2-4 weeks, Mean monthly cost Min 192.24 to Max 602.7 or Min 98.49 to Max 346.44 or Min 178.25 to Max 520.44 respectively. Mean cost {\textendash} Min cost 156.33 to Max 489.86.

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks. Mean monthly cost {\textendash} Min 234.49 to Max 772.44.

\textbf{\textbf{Grade 2 hypertension (}SBP 160-179, DBP 100-109)}

\textbf{Drug therapy {\textendash} A or Cor D, }Mean monthly cost {\textendash} Min 136 to Max 394.3 or Min 56.24 to Max 208.445 or Min 42.25 to Max 126.14 respectively.

\textbf{Add the second drug - A+C or C+D or A+D }if response not adequate within 2-4 weeks, Mean monthly cost Min 192.24 to Max 602.7 or Min 98.49 to Max 346.44 or Min 178.25 to Max 520.44 respectively. 

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks. Mean monthly cost {\textendash} Min 234.49 to Max 772.44. 

\textbf{Grade 3 hypertension }(SBP \ensuremath{\geq }180, DBP \ensuremath{\geq }110)

\textbf{Use two drugs - A+C or C+D or A+D. }Mean monthly cost Min 192.24 to Max 602.7 or Min 98.49 to Max 346.44 or Min 178.25 to Max 520.44 respectively. Mean cost {\textendash} Min cost 156.33 to Max 489.86.

\textbf{Add third drug {\textendash} A+C+D }if response not adequate within 2-4 weeks. Mean monthly cost {\textendash} Min 234.49 to Max 772.44.

Thus, the mean cost of Allopathic medicines for the treatment of essential Hypertension for a period of 30 days when given as per the STGs is as follows: 

In the case of Grade I~Hypertension, the monthly cost of drug therapy with a single drug \textit{viz.} A {\textendash} Min \rupee 136 to Max \rupee 394.3 or C {\textendash} Min \rupee 56.24 to Max \rupee 208.445 or D - Min \rupee 42.25 to Max \rupee 126.14 respectively. Thus, the mean monthly cost of medicines ranged from \rupee 78.16 to \rupee  243. The addition of a second drug raised the monthly costs which depended on the drug added, for example, A+C - mean monthly cost ranged from \rupee 192.24 to \rupee 602.7 or C+D - \rupee 98.49 to \rupee 346.44 or A+D - \rupee 178.25 to \rupee 520.44 respectively. Thus, the mean cost varied from \rupee 156.33 to \rupee \rupee 489.86. Addition of a third drug {\textendash} A+C+D if response was not adequate within 2-4 weeks increased the mean monthly cost to a range from \rupee 234.49 to \rupee 772.44. (Table~\ref{tw-b4421908cc01}, Table~\ref{tw-be6f32609e1c}, Table~\ref{tw-12ad548b1cd6}, Table~\ref{tw-e53bf7f1a3c0}, and Table~\ref{tw-344448798549})

The same trend was seen in the case of Grade 2 \& Grade 3 Hypertension. Use of two drugs - A+C or C+D or A+D gave a mean monthly cost varying from \rupee 192.24 to \rupee 602.7 or \rupee 98.49 to \rupee 346.44 or \rupee 178.25 to \rupee 520.44 respectively. Thus, the mean cost varied from \rupee 156.33 to \rupee 489.86. The addition of a third antihypertensive drug {\textendash} A+C+D in case of poor response within 2-4 weeks increased the mean monthly cost to \rupee 234.49 to \rupee 772.44. 
    
\section{Discussion}
Ayurveda being a holistic system of medicine, views the body as a whole and tries to improve or modify the body's healing ability \textit{via} its immune system. Herbal medicines are prescribed as personalized medications such that the treatment is tailored as per the requirement of the individual patient. On the other hand, Allopathy is a reductionist system of medicine wherein the treatment of a particular disease or disorder is based on its signs and symptoms, rarely taking into consideration the psychological and emotional aspects of the patient and rarely individualizes the therapy. 

Thus, although Allopathy has been the most acceptable system of medicine over the years, people are gradually shifting back to alternative systems of medicine, mainly due to the side effect profile of allopathic medicines and the costs, especially for chronic medical conditions. Herbal medicine like Ayurveda and Homeopathy are preferred in these types of settings mainly because of the belief in the minds of people that these medicines are less expensive and more reasonable, more accessible and acceptable, time-tested, considered natural and safer and with less or no side effects \unskip~\citep{1317851:24087375,1317851:24087383}. 

Our study thus aimed to compare the monthly costs of Ayurvedic and Allopathic medicines used in 2 chronic medical disorders \textit{viz}. Rheumatoid arthritis (RA) and Essential Hypertension to determine which treatment is more cost-effective when used for a prolonged duration.  

The comparison of the monthly medicine cost for Rheumatoid Arthritis in Ayurveda and Allopathy, when treated as per Standard Treatment Guidelines, showed that the medicine cost for Ayurveda medicine ranged from \rupee 993.16 to \rupee 1994 while that of Allopathic medicines ranged from \rupee 735.53 to \rupee 2634.57, which is comparable. The cost of medical treatment of RA has varied with time and the use of biologics. Tiwari et al.\unskip~\cite{1317851:24087392} estimated the monthly direct medical cost of treatment of RA to be \rupee 623\ensuremath{\pm}31 with DMARDs in 2007. 

Another study by Shini et al. \unskip~\cite{1317851:24087396} has shown the mean monthly cost to be \rupee 696.57\ensuremath{\pm}218.39.\ensuremath{^{}} A study conducted at a tertiary care hospital at Mumbai, India, in 2011 estimated the mean total cost per prescription as \rupee 763.39 \unskip~\citep{1317851:24087384}, while another study conducted at AIMS, Kochi, India, estimated the direct drug cost for the treatment of RA with sDMARDs in 2013 to be \rupee 737.49 per month \unskip~\citep{1317851:24087391}. A recent study conducted in 2016 by Syngle et al. \unskip~\cite{1317851:24087387} has reported the mean monthly medicine cost of RA to be \rupee 997.05. 

However, considerable cost variation difference was found among the different brands of the same anti-rheumatoid arthritis and antihypertensive drugs both in Ayurveda and Allopathy. The percent cost variation difference (\%CVD) for anti-rheumatoid arthritis ayurvedic medicines was 166.33\% for Deepan drugs, 164\% for Vati and Guggulu and 105\% for kadhas. 

A literature search did not find any other similar publications on the same topic with respect to Ayurvedic medicines. In the case of Allopathic anti-rheumatoid arthritis drugs, the percent difference in cost variation was 182\% for DMARDs, 350\% for NSAIDs and 1184.39\% for Corticosteroids. 

In the case of Anti-hypertensive Ayurveda medicine, the Percent Cost Variation Difference was 214.53\% for Vati, 353.33\% for Arishta, 84.21\% for Rasaushadhi and 126.18\% for Churna. As there is no other cost variation analysis of the anti-hypertensive drugs in Ayurveda, we could not compare the costs with previous literature. 

The Mean Cost Variation Difference of Allopathic anti-hypertensive drugs were found out to be 150.70\% for ACE inhibitors, 241.59\% for ARB, 234.23\% for Beta Blockers, 269.85\% for Calcium channel blockers and 189.10\% for Diuretics. 

Karve and Chattar; Kamath and Satish \unskip~\cite{1317851:24087393,1317851:24087377} found that the percentage price variation of the commonly used anti-hypertensive drugs was above 100\% \textit{viz.} amlodipine (2.5 \& 5 mg), Atenolol (12.5 \& 50 mg), Enalapril \& Ramipril (10mg) and Telmisartan (20 \& 40 mg). Mir \unskip~\citep{1317851:24087376}  showed that the cost variation was as high as 2337.50 \% for Hydralazine. 

Similarly, \unskip~\citep{1317851:24087378,1317851:24087381} showed that of 32 drugs most commonly prescribed, the percentage price variation was very wide, with Amlodipine (5 mg) showing a maximum price variation of 1128.57\% and Olmesartan (10 mg) showing a minimum variation of 25.64\%. Similar findings were observed with the combination form of antihypertensive drugs. 

The monthly cost of treating Hypertension ranged from \rupee 255.64 to 2136.35 depending on the grade of Hypertension for Ayurvedic medicines and \rupee 312.65 to \rupee 631.15 for Allopathic medicines. Thus, it can be seen that the monthly cost of medicines in Ayurveda is much higher than in Allopathy. Thus, although the belief is that Ayurvedic medicines are cost-effective, our results show that this is not the case in both Rheumatoid arthritis and essential hypertension, 2 chronic medical conditions which need prolonged therapy. 
    
\section{Conclusions}
Based on the results of the findings, we can conclude that there is a wide difference in the percentage price variation of various brands of the same oral antihypertensive drugs and Anti-Rheumatoid arthritis drugs available in both Ayurveda and modern Medicine in the Indian market. Switching to alternative modes of treatment has gained popularity nowadays, the main reason being the belief that these medicines are safe with fewer adverse effects. However, the prices of the monthly cost of medicines used in both Ayurveda and Allopathy are more or less similar or sometimes the Ayurvedic medicine cost is higher. For the successful treatment of chronic disorders like hypertension and Rheumatoid arthritis, compliance plays a major role. Increased adherence to the treatment ca be ensured only by decreasing the cost of therapy and increasing awareness among physicians regarding switching to more cost-effective medicines to decrease the economic burden on patients.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

\bibliographystyle{unsrt}

\bibliography{\jobname}
\end{document}
