Presence of Information About the Drugs for Sale

In 1999 Armstrong et al [57] found that 55% of their sample included drug information. Several researchers who attempted to evaluate the presence of information on side effects found that a fairly consistent portion of online pharmacies, ranging from a quarter to a third, declared none of them [84,86,90,92,93]. Arruanda [58] found that 35% of his sample provided a service allowing buyers to consult experts about the use of medicine. In the GAO [72] sample, 61% of websites gave drug information. Wagner et al [95] found in all the online pharmacies in their small sample (4 US-based online pharmacies) more comprehensive information than received from the community store. Peterson [87] did not find a statistically significant difference between the types of pharmacies and the provision of drug information, although it should be noted that his sample was small for performing a group comparison (33 online pharmacies). Gernburd and Jadad’s [74] research based on spam offers found that all of the websites in their sample made benefit claims and warned about potential side effects. Interestingly, an attempt to count the declared side effects of 4 drugs tracked in online pharmacies that asked for a prescription and those that did not revealed that no-prescription online pharmacies declared more side effects for amytriptiline, fluoxetine, and tramadol, but fewer for sildenafil, which—probably not by accident—is one of the most widely offered “lifestyle drugs” in online pharmacies [84,86].

Holmes et al [76] evaluated the quality of online pharmacy “ask the pharmacy” services regarding adverse effects, drug interaction, risk factors, drug information, and directions for use. They found that answers were received to only 51% of all questions submitted to the websites, and the percentage of correct answers provided for each of 22 response components ranged from 7% to 96%, with few differences in quality between VIPPS-approved and -unapproved websites.

Prices

Arruanda [58] evaluated the presence of drug price lists (found in 96% of the sample) and of “price comparisons with competitive pharmacies” (1%).

A comparison of online pharmacy and retail pharmacy prices had different results. Drugs offered online were more expensive in Bloom and Iannacone’s studies [61,62], in Tsai and colleagues’ [93] analysis, and in Cicero and colleagues’ [64] purchase. Wagner et al [95], who compared prices of US retail versus US online pharmacies, found that the latter were cheaper for both generic and brand-name medications. Levaggi et al [79] found that drugs bought without a prescription cost more than with one. In Bate and Hess’s [59] purchase, larger orders generally tended to have lower per-tablet/per-capsule prices, and were more prevalent among online pharmacies that had not been approved by the NABP. Interestingly, they found that Viagra offered on noncredentialed websites was on average far more expensive than from credentialed ones, and for all the drugs purchased (Lipitor, Celebrex, Nexium, and Zoloft), except Viagra, prices were higher at physical-location pharmacies. Quon et al [89] compared US retail prices with those of Canadian online pharmacies, and they found savings when purchasing from Canadian online pharmacies for the majority of brand drugs (3 exceptions in the 44-drug sample were medications for erectile dysfunction), whereas generics were more expensive. The same result is confirmed by an aggregate macroeconomic analysis based on IMS Incorporated data on prices, patents, and cross-border Internet pharmacies between online Canada and retail US pharmacies [15]. Memmel et al [83] found lower prices for contraceptives purchased online. Mahé et al [81] found that, with the exception of tazarotene, the average price of all the online psoriasis medicines analyzed was higher than the French retail price.

Additional costs have to be considered: the need to join clubs or member groups and pay a nonrefundable fee, with the risk of not finding the wanted drug after joining [64,80]; and delivery costs, with free delivery in some online pharmacies or for some purchases, but with charges depending on the type of shipping in other cases (standard, express, overnight) [57,58,61,62,66, 74,79,89,95]. Online prescription could be another added cost [57]. It is interesting to note that, although a prescription is not necessary in marketing messages, Levaggi et al [79] found in their price analysis that the prescription has a value on the market; indeed, when you buy a drug without a prescription, the drug costs more.

Date: 2016-03-03; view: 678