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Drug and Therapeutics Committee. Discuss the use of aggregate data including defined daily dose in analyzing the consumption of medicines Perform ABC analysis and explain how it can be used to identify medicine use problems, reduce cost, and improve efficiency in the pharmaceutical supply system

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Presentation Transcript
objectives
Discuss the use of aggregate data including defined daily dose in analyzing the consumption of medicines

Perform ABC analysis and explain how it can be used to identify medicine use problems, reduce cost, and improve efficiency in the pharmaceutical supply system

Discuss how VEN system for setting priorities will assist the DTC in medicine selection, purchasing, and inventory management

Objectives
outline part b
Introduction

Aggregate data

DDD

VENABC Analysis

Activities 3–5

Summary

Outline—Part B
methods to investigate medicine use
Indicator study methods

Use data collected at the individual level—patient, health facility

Data insufficient to make judgments about appropriateness of a medicine for a specific diagnosis

Aggregate data methods

Use routine data (e.g., stock records) not collected at the individual patient level

Gives overview of medicine use and can highlight problem areas

In-depth investigation of medicine use

Prescription audit, patient record review

Drug use evaluation (DUE) (discussed in session 11)

Qualitative methods to understand causes of a medicine use problem (discussed in session 8)

Methods to Investigate Medicine Use
aggregate data 1
Medicine use aggregate data sources

Procurement records

Warehouse medicine records

Pharmacy stock and dispensing records

Adverse drug reaction (ADR) and medication error reports

Patient medical records

Aggregate Data (1)
aggregate data 2
Data that can be retrieved

Medicine consumption

Medicine availability

Medicine cost data

Frequency of use

Per capita use of specific product

Prevalence of ADRs

Prevalence of medication errors

Aggregate Data (2)
defined daily dose 1
The DDD methodology converts and standardizes readily available product quantity data, such as packages, tablets, injection vials, bottles, into crude estimates of clinical exposure to medicines, such as the number of daily doses

A methodology that allows comparison of consumption of pharmaceutical products across hospitals, regions, and countries

Combines different medicine strengths and doses to provide one unit of consumption for each medicine for comparison of use

Defined Daily Dose (1)
defined daily dose 2
Defined globally by the WHO Collaborating Center for Drug Statistics Methodology, Oslo, Norway http://www.whocc.no/atcddd/

Typically expressed as follows

DDD per 1,000 inhabitant per day for total medicine consumption

DDD per 100 beds per day (100 bed-days), for hospital use

Defined Daily Dose (2)
defined daily dose example 1 captopril
District hospital and clinics use of captopril with 2,700,000 population

22,500,000 tablets yearly of captopril 25 mg

3,000,000 tablets yearly of captopril 50 mg

Quantity of medicine used in 1 year multiplied by strength of the product

= (22,500,000 × 25 mg) + (3,000,000 × 50 mg) = 712,500,000 mg

Divide total quantity by assigned DDD for that medicine (captopril = 50 mg ) = 712,500,000 / 50 mg = 14,250,000 DDDs

Divide total quantity by 2,700,000 population and multiply by 1,000 (this is the population denominator for this method)

= (14,250,000 / 2,700,000 ) x 1,000 inhabitants

= 5,278 DDD / 1,000 inhabitants / year

5,278 / 365 = 14.5 DDD / 1,000 inhabitants / day

Defined Daily Dose Example 1: Captopril
defined daily dose example 2 carbamazepine use in south africa 2001
Annual consumption = 100 million x 200 mg tablets

= 20,000,000,000 mg = 20,000,000 g

Assigned DDD for carbamazepine = 1 g

No. DDDs consumed = 20,000,000/1

= 20,000,000 per year = 20,000,000/365

= 54,795 per day for population of 48,000,000

= 54,795 / 48,000,000 = 0.0011 per person per day

= 1.1 DDD per 1,000 population per day

Defined Daily Dose Example 2:Carbamazepine Use in South Africa, 2001
ven analysis
Method to prioritize for medicine purchase and stock

V–Vital

Potentially lifesaving

Crucial to providing basic health services

E–Essential

Effective against less severe but significant illness, but not vital

N–Nonessential

For minor illnesses

High cost and low therapeutic advantage

VEN Analysis
conducting a ven analysis
Step 1. Classify all medicine on the list as V, E, or N.

Step 2. Analyze the “N” items. Where possible, reduce quantities to purchase or eliminate them.

Step 3. Identify and limit therapeutic duplications.

Step 4. Reconsider proposed purchase quantities.

Step 5. Find additional funds if needed or possible.

Conducting a VEN Analysis
ven applications for dtc
Identifies high-priority medicines for procurement

Identifies low-priority medicines that the DTC should analyze carefully for deletion from the formulary

VEN Applications for DTC
ven analysis activity and discussion

Description

VEN

1

AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15\'S

2

AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG

3

BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES

4

CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84\'S

5

CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML

6

CLOXACILLIN SODIUM FOR INJECTION500MG

7

CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20\'S

8

DIAZEPAM TABLETS 5MG ;1000\'S

9

ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100\'S

10

GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML

11

IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML

12

INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML

13

ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000\'S

14

LITHIUM CARBONATE TABLETS 250MG; 1000\'S

15

LOPERAMIDE 2MG TABLETS;6\'S

16

MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML

17

NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML

18

PARACETAMOL AND CODEINE TABLETS500MG;8MG;20\'S

19

PARACETAMOL TABLETS 500MG;500\'S

20

PERINDOPRIL TABLET 4MG;28\'S

21

RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14\'S

22

TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50\'S

23

THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML

24

VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE

25

VITAMIN B6 TABLETS 25MG;500\'S

26

WATER FOR INJECTION PLASTIC;10ML

VEN Analysis, Activity, and Discussion
abc analysis
Method for determining and comparing pharmaceutical costs within the formulary system

“Separating the vital few from the trivial many”— Pareto principle

Tool for identifying many medicine use problems

Utilizes computer and appropriate software to run analysis

ABC Analysis
abc analysis a b and c medicines 1
ABC Analysis: A, B, and C Medicines (1)

Percentage of

Percentage of

Category

Budget

Medicines Ordered

A medicines

70–80%

10–20%

B medicines

15–20%

10–20%

C medicines

5–10%

60–80%

abc analysis a b and c medicines 2
A medicines—High percentage of funds spent on large-volume or high-cost items

Greatest potential for savings

Greatest potential for identifying expensive medicines that are overused

B medicines—Moderate cost and moderate number of items; important items

C medicines—Small amount of funds spent on the majority of the inventory

ABC Analysis: A, B, and C Medicines (2)
applications of abc analysis for a dtc
Measures the degree to which actual consumption reflects public health needs and morbidity

Reduces inventory levels and costs by arranging for more frequent purchase or delivery of smaller quantities of class A items

Seeks major cost reductions by finding lower prices on class A items

Reduces inventory of items that have limited use in the system, but costs the system large amounts of money

Provides information for choosing the most cost-effective alternatives and finding opportunities for therapeutic substitution

Gathers information for pharmacoeconomic analysis

Applications of ABC Analysis for a DTC
steps in performing abc analysis
Step 1. List all items purchased and enter the unit cost.

Step 2. Enter consumption quantities for each item.

Step 3. Calculate the value of consumption for each item.

Step 4. Sort the list in descending order by total value.

Step 5. Calculate the percentage of total value represented by each item.

Step 6. Calculate the cumulative percentage of total value for each item.

Step 7. Choose cutoff points for A, B, and C.

Steps in Performing ABC Analysis
abc steps 2 and 3 calculate consumption quantities and values sort list by descending values
ABC Steps 2 and 3. Calculate consumption quantities and values—sort list by descending values.
abc step 7 choose cut off points for abc analysis chart

100%

90%

80%

70%

60%

Cumulative Items Value (%)

50%

40%

30%

20%

10%

0%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

Cumulative No. of Items (%)

ABC Step 7. Choose cut-off points for ABC analysis chart.
activities 3 4 and 5
Activity 3. VEN Analysis—Performing a VEN analysis

Activity 4. Performing an ABC analysis—Identifying high-cost medicines using an ABC analysis

Activity 5. Performing an ABC/VEN analysis using participants’ data

Activities 3, 4, and 5
summary
A major function of a DTC is to identify medicine use problems and to implement corrective measures

Aggregate methods are a useful way to gain an overview of medicine use problems using routine data not collected at the individual patient level.

Examples of a aggregate data methods include—

DDD

VEN analysis

ABC analysis

Summary
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