Drug and Therapeutics Committee

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Drug and Therapeutics Committee
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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

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OutlinePart B

• Introduction
• Aggregate data
• DDD
• VENABC Analysis
• Activities 35
• Summary

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Methods to Investigate Medicine Use

• Indicator study methods
• Use data collected at the individual
  levelpatient, 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)

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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

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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

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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

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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

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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

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Defined Daily Dose Example 2Carbamazepine 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

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VEN Analysis

• Method to prioritize for medicine purchase and
  stock
• VVital
• Potentially lifesaving
• Crucial to providing basic health services
• EEssential
• Effective against less severe but significant
  illness, but not vital
• NNonessential
• For minor illnesses
• High cost and low therapeutic advantage

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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.

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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

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VEN Analysis, Activity, and Discussion
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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

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ABC Analysis A, B, and C Medicines (1)
Percentage of
Percentage of
Category
Budget
Medicines Ordered
A medicines
7080
1020
B medicines
1520
1020
C medicines
510
6080
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ABC Analysis A, B, and C Medicines (2)

• A medicinesHigh 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 medicinesModerate cost and moderate number of
  items important items
• C medicinesSmall amount of funds spent on the
  majority of the inventory

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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

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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.

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ABC Step 1. List items and unit costs.
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ABC Steps 2 and 3. Calculate consumption
quantities and valuessort list by descending
values.
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ABC Step 4. Calculate the percentage of total
value represented by each item.
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ABC Step 5. Rank items in descending order.
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ABC Step 6. Calculate the cumulative percentage
of total value for each item.
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ABC Step 7. Choose cut-off points for ABC
analysis chart.
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Activities 3, 4, and 5

• Activity 3. VEN AnalysisPerforming a VEN
  analysis
• Activity 4. Performing an ABC analysisIdentifying
  high-cost medicines using an ABC analysis
• Activity 5. Performing an ABC/VEN analysis using
  participants data

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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