Drug Consumption and Expenditure Patterns at Jaramogi Oginga Odinga Teaching and Referral Hospital

Abstract

Background: Efficient drug supply chain systems ensure sustained accessibility, availability and affordability of essential medicines. This may be achieved through rational selection, quantification, procurement, distribution and use of drugs while taking into account consumption and morbidity patterns. Drug Utilization Studies are used to identify irrational medicine use in health facilities and to estimate the extent of current utilization patterns. Assessment of these patterns can be done by aggregate data methods that include Always Better Control (ABC), Vital Essential and Non-essential (VEN) and Therapeutic Category (TC) analyses. The results from the analysis help in setting priority for medicine purchase and stocking. Objective: To determine drug consumption and expenditure patterns at Jaramogi Oginga Odinga Teaching and Referral Hospital for the period of January 2018 to December 2020 using ABC, VEN and Therapeutic category analysis. Methodology: This was a retrospective longitudinal study whereby annual consumption and expenditure data of drugs for 3 years was analyzed using ABC, VEN and TC analysis techniques. Sources of data for the ABC and VEN analysis included bin cards, invoices and delivery notes. Morbidity data was extracted from patient files and the Kenya Health Information System. ABC analysis was done by listing all drugs purchased and their unit costs, calculating consumption, ranking consumption value in descending order, calculating cumulative percentages and eventually choosing cut off points for class A, B and C medicines. VEN classification was based on Kenya Essential Medicine List 2019 and done by ranking all medicines using a pre-designed form and then calculating expenditure for each class. The drugs were assigned to a therapeutic category thereafter total cost of drugs in each category and their expenditure calculated. Results: Annual drug expenditures were Ksh 49,956,278.00, Ksh 64,360,327.00 and Ksh 56,314,585.00 for 2018, 2019 and 2020 respectively adding up to a total expenditure of Ksh 170,631,190.00. Injury Poisoning and Certain other Consequences of External Causes class accounted for the highest number at 13.6% of all cases managed at the hospital. Diseases of the eye and adnexa cases were the lowest at 0.8%. Expenditure was highest for anti-infective therapeutic category at Ksh 45,967,567.00 and lowest for anti-parkinsonism medicines and Ear xv Nose and Throat medicines at 0.01% and 0.04% respectively. The number of class A drugs were 53(18.9%) in 2018 and 56(19.9%) in both 2019 and 2020. Class B drugs were 56(19.9%) in all the three years while class C were 172(61.2%) in 2018 and 169(60.1%) in both 2019 and 2020. Class A consumed 70.2%, 71.7% and 72.7% of drug expenditure in 2018, 2019 and 2020 respectively. Class B consumed 18.7%, 18.2% and 17.3% in 2018, 2019 and 2020 while class C consumed 11.1%, 10.1% and 10.0% in 2018, 2019 and 2020 respectively. Class V drugs were 61.6% and consumed 75.5% of the total expenditure, class E were 23.5% consuming 17.4% of the budget while class N were 14.9% and consuming 7.1%. Category I drugs constituted 67.3% of all medicines and utilized 82.2% of total drug expenditure. Category II were 21.4% and accounted for 12.7% of the expenditure while category III took up 5.1% of the budget and were 11.4% of all drugs. Conclusion: A remarkable percentage of drug expenditure at the hospital was used in procuring class A drugs like Flucloxacillin Capsules 250mg, Vital drugs like Adrenaline 1mg injection and Category I drugs like ephedrine 30mg/ml injection which are crucial in health care provision and are potentially lifesaving. These drugs should always be available in stock demanding a strict inventory control to avert wastage. Anti-infectives category of drugs consumed the highest proportion of the budget with Flucloxacillin 250mg capsules requiring a further Drug Use Evaluation study due to its high expenditure. This study will help guide cyclic stock counts, set purchasing priorities and selection of cost-effective drugs to be procured. 1 1.0 CHAPTER ONE: INTRODUCTION 1.1 BACKGROUND Strong supply chain systems ensure uninterrupted accessibility to life-saving medicines and health technologies for successful achievement of global goals that improve the quality of health outcomes. However, strategies to strengthen key supply chain components are inadequate in scores of low - middle income countries (LMICs) while available systems cannot effectively manage local and global health program demands. Furthermore, the surge of new epidemics, introduction of new medicines and technologies, and the need to adapt to new delivery strategies strain already challenged systems (1). Achievement of equity in accessing essential medicines is enhanced by making them affordable. Affordability is a key pillar for any health care system laboring to actualize Universal Health Coverage, and thus appears markedly on the global agenda. Making informed decisions about pharmaceutical purchases by individuals and health systems is burdensome due to lack of medicine pricing information (2). Health facilities should store a predetermined scope of medicines and aligning ideas to revamp their consumption and reinforce the supply chain to contain emerging concerns (3). Appropriate management of medicines in hospitals promotes availability of drugs that boosts health outcomes of patients thus lessening mortality and morbidity. In this perspective, pharmaceutical stores should be programmed and formulated to result in productive administrative and clinical practice(4). Drug Utilization Studies are used to identify irrational medicine use in health care set ups and to estimate the extent of current utilization patterns. These methods include Always Better Control (ABC), Vital Essential and Non-essential (VEN) and Therapeutic Category (TC) analyses. VEN analysis helps set priority for medicine purchase and stock. In the acronym, V which stands for vital medicines which are potentially lifesaving and central to administration of basic health services; E which means essential are medicines for less severe, significant, but not vital illness; while N which is nonessential are medicines for minor illnesses, are of high cost and low therapeutic advantage (5). ABC analysis determines and compares pharmaceutical costs within 2 the formulary. Class A drugs are between 10 to 20% of all medicines found in health facilities and are responsible for approximately 70 to 80% of the whole budget for pharmaceuticals; Class B make up 10 to 20% of the stock taking up 15 to 20% of the entire budget while Class C constitute the other 60 to 80% but exhaust only 5–10% of the annual pharmaceutical budget (5). Health facilities in resource limited setting do not have requisite funds to procure all drugs in the essential medicine list, notably with pharmaceuticals consumption already taking up a third of total hospital expenditure(6). It is desirable that optimal selection of drugs should be based on available evidence conjoined with priority setting that empowers institutions to promote long-term efficiency of drug use given the growing threats of medicine unavailability and their costs (7). There exists a knowledge gap on efficient medicine use and prioritization among majority of public hospitals in Kenya. This study will determine drugs accounting for the greatest magnitude of the pharmaceutical budget allocation in a referral hospital in Western Kenya.