Transcript ABC analysis in hospitals of NCT of Delhi :

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
Abstract
Abstract ID: 161
Author Name: Naresh Khanna
Email: [email protected]
Presenter Name: Naresh Khanna
Authors: Tekur U, Bapna JS
Institution: UCMS and GTB Hospital and MAMC and Associated Hospitals Delhi, IIHMR Jaipur Rajasthan,
India.
Title: ABC Analysis in Hospitals of NCT of Delhi: Impact of Drug Policy
Abstract:
Problem Statement: The Delhi state drug policy was formulated for the first time in 1994.
DSPRUD played an important role to ensure an effective and transparent pooled procurement
of drugs.As a result good quality essential drugs were procured at reasonable cost.The
subsequent introduction of essential drug list of Delhi state further improved the scenario of
availability of drugs.However, there was no systematic study to prove these facts.
Objectives: This study was undertaken to conduct an ABC analysis of all the drugs procured
in three hospitals in Delhi.
Design: Consent was obtained from the concerned authorities at the Government and the
local hospital levels. Retrospective data was collected from hospital records for 2 years
before (1993-94 and 1994-95) and 2 years after (2000-01 and 2001-02) the implementation of
the Delhi drug policy. All the drugs procured by the hospital including the number of units
purchased and their total costs were recorded.
Setting and Population: Three government hospitals of Delhi with high (LNH), medium
(DDUH) and low (LBS) bed strengths were selected for this study.
Intervention: To find if there was any change following the implementation of the Drug
Policy (1994-95) in the state of Delhi.
Outcome Measures: ABC analysis was done.This was followed by comparison of data
before and after implementation of the Drug Policy in the three hospitals of Delhi.
Results: It was observed that there was an increase in the total number of drugs from 281 to
352 being procured in LNH and from 147 to 292 in DDUH. Over the ten year period that the
study covered, it was seen that the budget of the LNH increased by less than three times and
that of DDUH by approximately six times. Further, it is seen that the number of drugs in
Category ‘C’ increased dramatically from 177 to 264 drugs in LNH. In DDUH this increase
was from 93 to 201. In category “A” drugs, there was a decrease in drugs being procured in
LNH and an inconsistent change in DDUH. It was also observed that a large portion of the
budget was used in purchase of expensive and non-essential items such as surface and hand
disinfectants in LNH and antibiotics like Cefotaxime and antitussive in DDUH. In the small
colony hospital, complete data was not available.
Conclusions: There is a definitive improvement in the procurement of drugs. However, this
analysis further reveals a need to look into Category ‘A’ drugs to ensure cost effective
procurement of this group of drugs.
Study Funding: : We are grateful to Prof. R.R. Chaudhury President, DSPRUD, for giving us the support for
the project. We also wish to acknowledge the DSPRUD-WHO India EDP for their financial support.
Background and Setting

The Delhi Drug Policy was implemented
in 1994-95. Before this, essential drugs
were not readily available in the hospital.

Drugs available in the hospital 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 1

The study was conducted in 3 hospitals of
Delhi, vis LN, DDU and LBS.

Prior permission was obtained from
Director Health Services, Delhi and MS of
all the three Hospital.

Retrospective data was collected for the
years 1993-94 and 1994-95 (preimplementation 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 in LN & DDU hospitals.
Methods 2
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
Central
Combination
Decentralised
Purchasing
Results 1
Procurement pattern of Drug in Delhi
hospital (1993 to 2002)
400
Number
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
300
100.00%
250
80.00%
200
60.00%
150
40.00%
100
50
20.00%
0
0.00%
1993-94
1994-95
2000-01
2001-02
Year
EDL procurement for LNH
EDL procurement for DDU
% of proc from EDL for LNH
% of proc from EDL for DDU
Percent
Number
EDL procurement
Results 2
ABC of LNH
300
250
200
150
100
50
0
1993-94
1994-95
2000-01
A
B
2001-02
C
ABC of DDU
250
200
150
100
50
0
1993-94
1994-95
2000-01
A
B
2001-02
C
ABC Analysis-DDU-A Comparison
Cumulative %------
120
100
80
60
40
20
0
1
19
37
55
73
91 109 127 145 163 181 199 217 235 253 271 289
No. of Drugs-------
1993-94
1994-95
2000-01
2001-02
Results 3
Non Essential drugs (LNH):A Class
Name of
Drug
Strength
Total
Units
Unit
Cost
Enoxaparin(Cl
exane)
40 mg
Surface
Disinfectant
(Bacillocid)
500 ml
bottle
3000
Erythropoeitin
2000 l.U
1022
928.7
1.36
Cefotaxime
1gm
24079
25.95
0.90
Alcohol based
hand
disinfectant
(Sterillium)
500 ml
bottle
Vancomycin
500 mg
10000
1875
2918
% of
Total
Value
237.6
3.41
359.84
1.55
258.96
162.05
0.70
0.68
Non Essential drug (DDU):A Class
Name of
Drug
Stren
gth
Total
Units
Unit
Cost
% of
Total
Value
Cefotaxime
1 gm
38011
24.92
2.7
Anti D Human
immuno globin
300
mcg
250
1609.2
1.15
Non – ionic
contrast media
(Urograffin)
*
250
615.6
0.44
Results 4
Non EDL drugs in LNH in Class A
Pre drug Policy. No of EDLs = 12
Post drug Policy
Suface disinfectant (Bcilloid)
No of non EDLs = 6
Crotamiton (Crotorax)
Enoxaparin (Clexane)
Pipecuronium
Alcohol based hand disinfectant (Sterillium)
Surface disinfectant
(Baccilocid)
Ciprofloxacin
Erythropoeitin
Ceftriaxone
Cefotaxime
Tripolidine Hcl + Phenylpropanolamine Hcl
Alcohol based hand
disinfectrant (Sterillium)
Chloramphenicol
Vancomycin
Ethmoral Forte
Sulphasalazine
Ethabutol
Netimycin
Non EDL drugs in DDU in Class A
Pre drug Policy. No of EDLs = 6
Post drug Policy
No of non EDLs = 3
Ofloxacin
Cefotaxime
Natamycin
Codeine phosphate
Haemocoagulase (Botropase)
Anti D human immuno
globulin
Chlorquine
Metoclopromide
Hdroxy progesterone caproate
Results 5
Stocks outs : Pre & Post drug policy
LNH
199394
199495
200001
200102
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
199394
199495
200001
200102
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
DDU
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.
We are grateful to
Prof. R.R. Choudhary, President - DSPRUD
WHO India EDP for providing financial assistance.