October 2014

QuanTB Helps Ensure Medicines Availability, Averts Waste, and Saves Money in Bangladesh

Through a new mechanism for improved coordination and use of the SIAPS-

developed QuanTB tool, the National Tuberculosis Program in Bangladesh improved

pharmaceutical management of tuberculosis medicines which averted medicines

waste, ensured treatment coverage, and saved nearly one million (US) dollars in

unnecessary medicines procurements.

Curbing the spread of tuberculosis (TB) requires that patients have uninterrupted

access to a full course of treatment, frequently a difficult task in developing country

settings considering that each regimen includes multiple medicines taken over the

span of several months which may need to be customized based on the type of TB

being treated and the patient’s reaction to the prescribed combination. The emergence

of multidrug- and extensively drug-resistant TB further complicates how TB

medicines are managed because patients with these types of TB require second-line

medicines, which have additional side effects compared to first-line medicines, and

need to be taken over a longer period of time. Additionally, while a full course of

treatment with first-line TB medicines costs approximately $20, second-line

treatments can cost up to $5,000 per regimen.1

Ensuring that TB medicines are available to use when and where they are needed

requires strong systems that promote effective medicines management. From

forecasting and procurement, to distribution and stock monitoring, these activities

often involve extensive planning, complex analyses, and close coordination between

health facilities, ministries of health, and suppliers like the Global Drug Facility. In

Bangladesh, SIAPS is working with the National Tuberculosis Program (NTP) to

strengthen the management of TB medicines, project future needs, and build capacity

to ensure that TB medicines are readily available to those in Bangladesh who need

them.

Partnering to Improve Supply Monitoring and Planning Recognizing the importance of effective medicines management in decreasing TB

incidence, the NTP, with support from SIAPS, formed a national Procurement and

Supply Management (PSM) unit to ensure accurate forecasting, timely procurement,

and effective stock management of TB medicines across Bangladesh. The unit brings

together partners from the NTP, SIAPS, the World Health Organization, the TB Care

II project, the Damien Foundation, and BRAC to form a single platform for effective

collaboration for the multidisciplinary group.

1 World Health Organization. Drug-resistant tuberculosis now at record levels. 18 March 2010.

Accessed from: http://www.who.int/mediacentre/news/releases/2010/drug_resistant_tb_20100318/en/

2

In March 2014, the PSM unit began using the SIAPS-developed QuanTB tool to

quantify the projected amount of TB medicines that would be required for the

upcoming year. By capturing, collating, and analyzing multiple triangulated sources

of data, and by reassessing previous forecasting assumptions to ensure that the

number of current and projected cases were accurate, the forecasting exercise yielded

better estimates of the number of anticipated TB cases and how many medicines

would be required.

The first quantification

exercise conducted

using QuanTB indicated

two important findings.

The first was that

current stock levels for

first-line TB drugs were

at risk for a potential

stock out which could

have prevented

approximately 1,000

patients from receiving

their medicines. In

contrast, the second

finding indicated that

previous procurement assumptions and unanticipated variations in the number of

patients started on treatment had resulted in an overstock of medicines typically used

to treat extensively drug resistant TB. The exercise also indicated that several of the

overstocked medicines were set to expire in the coming months.

From Analysis to Action: Data driven decision making improves management of TB medicines With QuanTB acting as an early warning system signaling potential stock

management issues, the NTP, with technical support from SIAPS, was able to assess

these issues and take immediate steps to ensure continued availability of TB

medicines while eliminating unnecessary medicines waste.

To address the potential stock out of first-line TB medicines, the NTP was able to

work with the Global Drug Facility to expedite several previously placed orders to

ensure that shipments arrived in time to continue treatment for all current patients as

well as initiate treatment for any new cases.

QuanTB is an electronic forecasting, quantification, and early warning tool designed to improve procurement processes, ordering, and planning for TB treatment. QuanTB, a tool which can be downloaded to any desktop, can help program managers quickly calculate forecasting needs and share key information such as actual versus planned consumption, potential stock out scenarios, and upcoming expiries through a user-friendly dashboard.

Sample dashboard generated using QuanTB, designed to provide early warning information “at a glance”. Green indicates months of stock on hand, yellow indicates stock on order, and red indicates potential stock-outs.

3

“Over 1.5 million

doses of

second-line TB

medicines were

cancelled and

over a million

doses were

reallocated to

other countries

in the region,

saving the NTP

$899,976 USD.”

4301 N. Fairfax Drive, Suite 400 • Arlington, VA 22203 USA Tel: +1 (703) 524-6575 • Fax: +1 (703) 524-7898 • E-mail: siaps@msh.org • Web: www.siapsprogram.org

The NTP team was also able to minimize the extent of overstocked second-line

medicines by cancelling, deferring, and reallocating upcoming orders. Over 1.5

million doses of second-line TB medicines were cancelled and over a million doses

were reallocated to other countries in the region, saving the NTP $899,976 USD.

SIAPS was also able to assist the NTP in addressing the existing excess of second-

line TB medicines already in country by using a feature of QuanTB which allowed

for the development of several alternate treatment regimens within existing standard

treatment guidelines. By quickly carrying out complex dosing calculations, QuanTB

helped to determine that the second-line medicines, originally intended for treatment

of XDR-TB patients, could be used for MDR-TB patients which would allow the

NTP to use up the excess stock before it expires while also ensuring that enough

stock remains to treat current and expected XDR-TB patients.

Partnership and Planning for Stronger Pharmaceutical Management in the Long Term The NTP, along with relevant stakeholders and support from SIAPS, is now

reviewing the procurement data for TB medicines on a regular basis and addresses

any issues through the PSM platform. Through increased collaboration and use of

reliable data for informed decision making, the NTP in Bangladesh now has an early

warning mechanism in place that can monitor and track existing stock levels, alert

key stakeholders to potential stock outs and expiries, and improve the availability of

medicines for TB patients in Bangladesh.