Post on 31-Dec-2015
description
ABC analysis in hospitals of NCT of Delhi :
Impact of drug policy
Khanna N*, Tekur U*, Bhooi N** and Bapna J S*** Deptt. of Pharmacology, UCMS and MAMC , Delhi **IIMHR , Jaipur
Introduction
The Delhi Drug Policy was implemented in 1994-95. Before this, essential drugs were not readily available in Delhi hospitals.
Drugs available in the hospitals were not cost effective.
Unnecessary medicines, including herbal drugs were stocked.
EDL was published in 1994. Pooled procurement of drugs in all the Govt. hospitals started from 1995.
EDL has been revised every two years. 2002 was the latest one. Work is on for 2004.
Study Aims
To conduct an ABC analysis of all the drugs procured in three hospitals of Delhi.
* LNH: Lok Nayak Hospital
* DDUH: Deen Dayal Upadhyay Hospital
* LBSH: Lal Bahadur Shastri Hospital
Methods Prior permission was obtained from Director Health Services,
Delhi and MS of all the three Hospitals.
Retrospective data was collected for the years 1993-94 and
1994-95 (pre-implementation period) and 2000-01 and 2001-02
(post implementation period). Details of data collected included
name of drugs, dosage form, quantity procured and the total
cost incurred by the hospital.
The drugs were further categorized as those belonging to the
EDL of NCT of Delhi or not part of this EDL.
Data was subsequently analyzed according to ABC analysis.
ABC Analysis
Examines the annual consumption of drugs & expenditures for procurement
Divides the drugs consumed into 3 categories Class A (10 % of items : 75% of exp) Class B (15 % of items : 15% of exp) Class C (75 % of items : 10% of exp)
Uses of ABC Degree to which actual consumption reflects public health
needs Reduce inventory levels and costs Seek cost reductions by finding lower prices on class A items Ensure that large orders of class A items are handled
expeditiously
DecentralizedCombinationCentralPurchasing
Bulk orderingOne in 3 months
Frequent ordering
Ordering
LowModerate HighControl
LowModerateHighConsumption Value
C
B
A
Features of ABC Items
Procurement pattern of Drugs in Delhi hospital(1993 to 2002)
0
100
200
300
400
Year
Nu
mb
er
LNH 280 282 352 352
DDU 144 150 286 298
LBS 92 107 263 266
1993-94 1994-95 2000-01 2001-02
0
50
100
150
200
250
300
1993-94 1994-95 2000-01 2001-02
Year
Nu
mb
er
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Perc
en
t
EDL procurement for LNH EDL procurement for DDU
% of proc from EDL for LNH % of proc from EDL for DDU
EDL Procurement
ABC of LNH
0
50
100
150
200
250
300
1993-94 1994-95 2000-01 2001-02
A B C
ABC Analysis of L.N.H - A Comparison
0
20
40
60
80
100
120
1 21
41
61
81
101
121
141
161
181
201
221
241
261
281
301
321
341
No. of Drugs--------
Cu
mu
lati
ve %
----
1993-94 1994-95 2000-01 2001-02
ABC of DDU
ABC Analysis of D.D.U - A Comparison
0
20
40
60
80
100
120
1 18
35
52
69
86
103
120
137
154
171
188
205
222
239
256
273
290
No. of Drugs-------
Cu
mu
lati
ve
%--
----
1993-94 1994-95 2000-01 2001-02
0
50
100
150
200
250
1993-94 1994-95 2000-01 2001-02
A B C
Non EDL drugs in LNH in Class APre drug Policy No of EDLs = 12 Post drug Policy
No of non EDLs = 6
Netimycin
Ethabutol
Sulphasalazine
Ethmoral Forte
Chloramphenicol
Tripolidine Hcl + Phenylpropanolamine Hcl
Ceftriaxone
Ciprofloxacin
Alcohol based hand disinfectant (Sterillium)
Pipecuronium
Crotamiton (Crotorax)
Suface disinfectant (Bcilloid)
Vancomycin
Alcohol based hand disinfectrant (Sterillium)
Cefotaxime
Erythropoeitin
Surface disinfectant (Baccilocid)
Enoxaparin (Clexane)
Non EDL drugs in DDU in Class APre drug Policy No of EDLs = 6
Hdroxy progesterone caproate
Metoclopromide
Chloroquine
Haemocoagulase (Botropase)
Natamycin
Ofloxacin
Post drug Policy
No of non EDLs = 3
Anti D human immuno globulin
Codeine phosphate
Cefotaxime
Non Essential drugs (LNH):A Class
162.052918500 mgVancomycin
258.961875500 ml bottleAlcohol based hand disinfectant (Sterillium)
25.95240791gmCefotaxime
928.710222000 l.UErythropoeitin
359.843000500 ml bottle
Surface Disinfectant (Bacillocid)
237.61000040 mgEnoxaparin (Clexane)
0.68
0.70
0.90
1.36
1.55
3.41
% of Total ValueUnit CostTotal UnitsStrengthName of Drug
Non Essential drug (DDU):A Class
615.6250*Non – ionic contrast media (Urograffin)
1609.2250300 mcg
Anti D Human immuno globin
24.92380111 gmCefotaxime
0.44
1.15
2.7
% of Total ValueUnit CostTotal UnitsStrengthName of Drug
Budget on EDL for LNH & DDU
0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
80000000
1993-94 1994-95 2000-01 2001-02
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
LNH DDU EDL for LNH % EDL for DDU %
Number of Patients Treated in LN & DDU
0
200000
400000
600000
800000
1000000
1200000
1993 1994 1995 2000 2001 2002
-10.00%
-5.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
LNH DDU %change LNH %change DDU
Stocks outs : Pre & Post drug policy
16191728Number of drugs out of stock
23.938.929.856.81Average number of stock out days
958115911922272Total Number of Stock out days
2001-022000-011994-951993-94
LNH
DDU
481315Number of drugs out of stock
7.8241.7394.95147.2Average number of stock out days
17291818992944Total Number of Stock out days
2001-022000-011994-951993-94
Summary ABC analysis was done to determine the impact of Drug Policy
in Hospitals of Delhi.
There was an increase in the %age procurement of drugs from the EDL after the implementation of drug policy.
Number of Non EDL drugs in the Class A category has reduced after the implementation of the drug policy
Stock outs have decreased Implies increased availability of drugs Improved service delivery Leading to economic gains for the hospital
Conclusions and Policy Implications Drugs which appear very commonly in A
Category should be included in the EDL.
Large amount of money has been spent on procuring Cefotaxime in all the hospitals. This could be taken into consideration while updating the EDL in future.