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Introduction

Introduction. Drugs accounts for 30% of health expen ditur es in Thailand. Public hospitals are major health service providers including pharmaceutical services.

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Introduction

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  1. Introduction Drugs accounts for 30% of health expenditures in Thailand. Public hospitals are major health service providers including pharmaceutical services. In each hospital, drug database (such as purchase and utilization records) has been kept accumulating for many years. However, these drug databases have limited utility for national policy-making due to the lack of standard structure and code as well as inadequateinformation technology in data management. Hospital and health care administrators need to use these available data as monitoring tools for decision making and management at both national and facility levels.

  2. Objective To determine key performance indicators for drug utilization monitoring: 1. Trend monitoring • Total purchase, ratio ED:NED • Total purchase by drug group, etc. 2. Price monitoring • Unit price* statistics (mean, standard deviation, min, max, percentile 50, 75, 90, 95) of generically equivalent drug products. *Unit price is net purchase price per unit (tablet, bottle).

  3. Methodology Study design: retrospective, time-series design. Study Procedure I. Construction of Standard Drug Code (25 digits) • Type (Single* or combinations), 1 digit • Drug Name, Paracetamol, 10 digits • Dosage form, Tablet, 3 digits • Strength, 500 mg., 4 digits • Company, GPO, 4 digits • Package size, 100 tab, 3 digits *Only single chemical entity drug code is available for this study.

  4. Methodology II. Data collection Sample:26 public hospitals (10-1000 bed) were puposesively selected. They had complete records and were willing to provide a copyof Electronic Drug Purchasing Database of the year 2000-2002. III. Data transformation Different drug codes (of the same drug product) from different hospitalsare changed into the same standard codes. IV. Data consolidation and analysis All the transformed drug purchasing data from 26 hospitals were consolidated and then analyzed using Microsoft Access, Excel and SQL.

  5. Results: Key performance indicators I. Total drug purchase(million baht)of 26 hospitals in 2000-2002. ----------------------------------------------------------- Year Purchase%change (adjusted*) (adjusted*) ----------------------------------------------------------- 2000 817.8 2001 908.3(898.4)11.0(9.9) 2002 978.4(947.7)7.7(5.6) ---------------------------------------------------- Notes: *adjusted for inflation of 1.1% in 2001 and 1.9% in 2002 (NESDB).

  6. II. Drug Purchase as % of Total Operating Expenses in 2002 ------------------------------------------------------------- Type of Hospital (bed) N Range % Avg. ------------------------------------------------------------- Regional (500-1000) 7 15.6-29.4 20.7 General (200-500) 14 11.2-27.2 18.3 Community (10-90) 5 12.5-19.6 17.5 ------------------------------------------------------------- (The bigger the hospitals, the more drug used)

  7. III. Total Purchase Ratio of Non-Essential Drug (NED) and Essential Drug (ED) --------------------------------------------- Year Ratio (NED:ED) --------------------------------------------- 2000 15 : 85 2001 17 : 83 2002 18 : 82 ---------------------------------------------

  8. IV. Ranking of Drug Purchase (%) by Pharmacological Groups ------------------------------------------------------------- Rank Group* 2002 2001 2000 ------------------------------------------------------------- 1 Anti-bacterials21.6 23.8 26.6 3 Anti-asthma 4.0 4.4 3.9 4 Anti-diabetics 3.9 3.3 3.0 5 Hypo-lipidemic 3.3 2.8 2.4 6 Anti-anaemic 3.3 2.7 2.1 8 NSAIDS 2.5 2.6 2.0 10 Cytostatic 2.2 1.7 1.4 ------------------------------------------------------------- Total (million) 824 779 730 ------------------------------------------------------------- *A total of 125 groups

  9. V. Unit Purchase Price (baht) Statistics of Generically Equivalent Products of 2002 --------------------------------------------------------------- Drug # Min Max Avg p50 p75 --------------------------------------------------------------- Aledronate 10 mg tab 48 45.9 81.7 49.0 48.2 48.2 Alprazolam .25 mg tab 44 0.2 5.0 0.7 0.5 0.8 Atorvastatin 20 mg tab 32 50.3 58.4 52.3 50.3 52.3 Captopril 25 mg tab 27 1.4 26.3 6.1 7.5 7.5 Cefoperazone 1 g inj 65 220 487 422 486 486 Ceftriaxone 1 g inj 22 20.2 124 36.6 31.0 38.0 Ciprofloxacin 250 mg tab 59 1.2 14.1 4.2 3.8 5.4 Simvastatin 10 mg tab 66 2.0 8.9 4.7 4.2 5.4 Rosiglitazone 4 mg tab 12 57.3 87.9 59.9 57.3 57.3 ---------------------------------------------------------------- Notes: Italics are single-source drugs

  10. Discussions Lesson learned An urgent need for data management of available hospital database to be utilized for drug system management and policy implementation. Policy implications Structure - A central data warehouse under the Ministry of Public Health, with capability for huge data management. - An agency for determination and maintaining of standard drug codes(possibly FDA?). Process - In addition of Quantity indicators of drug purchase as shown, Quality indicators of drug use are necessary to guarantee good outcomes for the patients and economic outcomes for providers.

  11. Conclusions Though not standardized, hospital drug database can be a valuable source for improving system efficiency and effectiveness of drug use. Recommendations More research to be pursued: • Quality of drug use and cost consequences of an illness, particularly chronic diseases such as diabetes or asthma. • Quality of drug use and outcomes of treatment. • Systematic management of drugs (selection, procurement, utilization and outcomes). This study is supported by the National Health Security Office.

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