Transcript Oral Presentation 1

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
Features of ABC Items
A
B
C
Consumption Value
High
Moderate
Low
Control
High
Moderate
Low
Ordering
Frequent
ordering
One in 3
months
Bulk
ordering
Purchasing
Central
Combination Decentralized
Procurement pattern of Drugs in Delhi hospital(1993 to 2002)
Number
400
300
200
100
0
1993-94
1994-95
2000-01
2001-02
LNH
280
282
352
352
DDU
144
150
286
298
LBS
92
107
263
266
Year
EDL Procurement
300
100.00%
90.00%
Number
200
80.00%
70.00%
60.00%
150
50.00%
40.00%
100
50
30.00%
20.00%
10.00%
0
0.00%
1993-94
1994-95
2000-01
2001-02
EDL procurement for LNH
EDL procurement for DDU
Year
% of proc from EDL for LNH
% of proc from EDL for DDU
Percent
250
ABC of LNH
300
250
200
150
100
50
0
1993-94
1994-95
2000-01
A
B
2001-02
C
ABC Analysis of L.N.H - A Comparison
100
80
60
40
20
No. of Drugs-------1993-94
1994-95
2000-01
2001-02
341
321
301
281
261
241
221
201
181
161
141
121
101
81
61
41
21
0
1
Cumulative %----
120
ABC of DDU
250
200
150
100
50
0
1993-94
1994-95
2000-01
A
B
2001-02
C
120
100
80
60
40
20
No. of Drugs-------
1993-94
1994-95
2000-01
2001-02
290
273
256
239
222
205
188
171
154
137
120
103
86
69
52
35
18
0
1
Cumulative %------
ABC Analysis of D.D.U - A Comparison
Non EDL drugs in LNH in Class A
Pre drug Policy No of EDLs = 12
Suface disinfectant (Bcilloid)
Crotamiton (Crotorax)
Pipecuronium
Alcohol based hand disinfectant (Sterillium)
Ciprofloxacin
Ceftriaxone
Tripolidine Hcl + Phenylpropanolamine Hcl
Chloramphenicol
Ethmoral Forte
Post drug Policy
No of non EDLs = 6
Enoxaparin (Clexane)
Surface disinfectant (Baccilocid)
Erythropoeitin
Cefotaxime
Alcohol based hand disinfectrant
(Sterillium)
Vancomycin
Sulphasalazine
Ethabutol
Netimycin
Non EDL drugs in DDU in Class A
Pre drug Policy No of EDLs = 6
Ofloxacin
Natamycin
Haemocoagulase (Botropase)
Chloroquine
Metoclopromide
Hdroxy progesterone caproate
Post drug Policy
No of non EDLs = 3
Cefotaxime
Codeine phosphate
Anti D human immuno globulin
Non Essential drugs (LNH):A Class
Name of Drug
Strength
Enoxaparin (Clexane)
40 mg
Surface Disinfectant
(Bacillocid)
Total Units
Unit Cost
% of Total Value
10000
237.6
3.41
500 ml bottle
3000
359.84
1.55
Erythropoeitin
2000 l.U
928.7
1.36
Cefotaxime
1gm
1022
24079
25.95
0.90
Alcohol based hand
disinfectant (Sterillium)
Vancomycin
500 ml bottle
500 mg
1875
258.96
0.70
2918
162.05
0.68
Non Essential drug (DDU):A Class
Name of Drug
Cefotaxime
Anti D Human immuno
globin
Non – ionic contrast
media (Urograffin)
Strength
Total Units
Unit Cost
% of Total Value
1 gm
38011
24.92
2.7
300 mcg
250
1609.2
1.15
*
250
615.6
0.44
Budget on EDL for LNH & DDU
80000000
100.00%
70000000
80.00%
60000000
50000000
60.00%
40000000
40.00%
30000000
20000000
20.00%
10000000
0
0.00%
1993-94
LNH
1994-95
DDU
2000-01
EDL for LNH %
2001-02
EDL for DDU %
Number of Patients Treated in LN & DDU
1200000
30.00%
25.00%
1000000
20.00%
800000
15.00%
600000
10.00%
5.00%
400000
0.00%
200000
-5.00%
0
-10.00%
1993
LNH
1994
DDU
1995
2000
%change LNH
2001
2002
%change DDU
Stocks outs : Pre & Post drug policy
LNH
1993-94
1994-95
2000-01
2001-02
Total Number of Stock out days
2272
1192
1159
958
Average number of stock out days
56.81
29.8
38.9
23.9
Number of drugs out of stock
28
17
19
16
DDU
1993-94
1994-95
2000-01
2001-02
Total Number of Stock out days
2944
1899
918
172
Average number of stock out days
147.2
94.95
41.73
7.82
Number of drugs out of stock
15
13
8
4
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.
Thank
You
We are grateful to
Prof. R.R. Choudhary, President – DSPRUD &
WHO India EDP for providing financial assistance.