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Abstract

To evaluate the pharmacoeconomic burden of antihypertensive therapy and assess the cost-saving impact of pharmacist-led brand substitution among patients in Abbottabad, Pakistan. This descriptive cross-sectional study included 120 hypertensive patients from clinical settings in Abbottabad. Data on demographics, comorbidities, and prescribed antihypertensive regimens were collected. Monthly medication costs were calculated using market prices. Pharmacists then identified lower-cost alternatives with equivalent dosage and therapeutic value. Cost differences pre- and post-substitution were analyzed.   Patients were predominantly aged 51–60 years, with a slight male predominance. Diabetes mellitus, ischemic heart disease, and dyslipidemia were common comorbidities. Most patients were prescribed diuretics, beta-blockers, vasodilators, or ACE inhibitors. The average monthly cost of anti-hypertensive medication was PKR 2,444. After pharmacist-led substitution, 65% of patients fell into the lowest cost category (PKR 0–300), compared to 21.7% before intervention. Cost savings ranged from 50% to 70% per patient. Antihypertensive pharmacotherapy imposes a considerable financial burden in Pakistan. Pharmacist-led brand substitution significantly reduces medication costs, improving affordability without compromising efficacy. These findings support policy reforms to empower pharmacists and encourage rational generic prescribing in similar low-resource settings.