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.

We are grateful toProf. R.R. Choudhary, President – DSPRUD &

WHO India EDP for providing financial assistance.

Thank

You