OBJECTIVES: To evaluate the costs and benefits of chiral drugs and their importance in public health.

METHODS: In this study four chiral drugs were evaluated and compared with their racemic drugs.(Levocetrizine, levofloxacin, esomeprazole and arformoterol). literature searches were conducted in Cochrane, clinicaltrials.gov, pubmed and Embase. All the RCTs and meta-analysis examining and comparing the safety and efficacy of levocetrizine, levofloxacin, esomeprazole and arformoterol with their racemic drugs were included. Drug prices has been collected from authenticated government source and Cost benefit analysis was performed.

RESULTS: Levocetrizine : one meta analysis and one RCT was included in the study in which both concluded no significance difference between levocetrizine and cetirizine comparing sedation. But the price of levocetirizine (INR 4) is twice the price of cetirizine (INR 2).

Levofloxacin : 2 RCTs were included in which both of them concluded no significant difference between levofloxacin and ofloxacin considering overall clinical efficacy as an outcome. The cost to benefit ratio of these drugs is 0.79 (cost INR 16 and 12.20).

Esomeprazole : Three RCTs comparing the efficacy were included in this study in which one concluded no significance difference when Esomeprazole and omeprazole given in same dose (20mg). And remaining 2 trials showed that Esomeprazole shows significant difference only when given in double potency (40mg). the cost benefit ratio of same doses is 0.42 and for double potency is 0.16(cost INR 16.50 and 8.49).

Arformoterol : 3 RCTs comparing the efficacy of arformoterol and formoterol showed no significance difference between these drugs comparing FEV1. The cost to benefit ratio of these drugs is 0.015 (cost INR 24.17 and 21.52).

CONCLUSIONS: These chiral drugs are not cost effective compared to the parent compound. Besides, the benefits of these are not substantial. It may be important to relook them and their use in public health.