Drug database and performance indicators for utilization monitoring by Petcharat Pongcharoensuk, et al. Faculty of Pharmacy, Mahidol University e-mail: pyppn@mahidol.ac.th Sponsor: The National Health Security Office 4/1/04 ICIUM2004_CM

Introduction Drugs, 30% of health expenses Drug database in hospitals (purchasing and dispensing) Limited utility Lack standard format and code Insufficient information technology “Drug information for decision making” 4/1/04 ICIUM2004_CM

Objective To determine key performance indicators for drug utilization monitoring Total purchase ratio ED:NED by drug group, etc. Unit price statistics 4/1/04 ICIUM2004_CM

Methodology Sample: 26 public hospitals (10-1000 bed) 5 small, 21 medium and large Source: Electronic purchase database (2000-2002) Data transformation (mapping different codes into standard code) Data consolidation and analysis 4/1/04 ICIUM2004_CM

Results: Key performance indicators 4/1/04 Results: Key performance indicators I. Total drug purchase (million baht) -------------------------------------------- Year Purchase %change (adjusted*) (adjusted*) --------------------------------------------- 2000 817.8 2001 908.3 (898.4) 11.0 (9.9) 2002 978.4 (947.7) 7.7 (5.6) ----------------------------------------- Notes: *adjusted for inflation of 1.1% in 2001 and 1.9% in 2002 (NESDB). 4/1/04 ICIUM2004_CM ICIUM2004_CM

II. Drug as % total expenses, 2002 ----------------------------------------------- Type of Hospital (bed) N Range % Avg. Regional (500-1000) 7 15.6-29.4 20.7 General (200-500) 14 11.2-27.2 18.3 Community (10-90) 5 12.5-19.6 17.5 4/1/04 ICIUM2004_CM

III. Ratio NED:ED ----------------------------------------- Year Ratio (NED:ED) 2000 15 : 85 2001 17 : 83 2002 18 : 82 4/1/04 ICIUM2004_CM

IV. Pharmacological sub-groups (%) ----------------------------------------------- Rank Group 2002 2001 2000 1 Anti-bacterials 21.6 23.8 26.6 3 Anti-asthma 4.0 4.4 3.9 4 Anti-diabetics 3.9 3.3 3.0 5 Hypo-lipidemic 3.3 2.8 2.4 6 Anti-anaemic 3.3 2.7 2.1 8 NSAIDS 2.5 2.6 2.0 10 Cytostatic 2.2 1.7 1.4 Total (million) 824 779 730 4/1/04 ICIUM2004_CM

V. Unit price statistics --------------------------------------------------- Drug N Min Max Avg. p50 p75 Aledronate 10 mg tab 48 45.9 81.7 49.0 48.2 48.2 Alprazolam .25 mg tab 44 0.2 5.0 0.7 0.5 0.8 Atorvastatin 20 mg tab 32 50.3 58.4 52.3 50.3 52.3 Captopril 25 mg tab 27 1.4 26.3 6.1 7.5 7.5 Cefoperazone 1 g inj 65 220 487 422 486 486 Ceftriaxone 1 g inj 22 20.2 124 36.6 31.0 38.0 Ciprofloxacin 250 mg tab 59 1.2 14.1 4.2 3.8 5.4 Simvastatin 10 mg tab 66 2.0 8.9 4.7 4.2 5.4 Rosiglitazone 4 mg tab 12 57.3 87.9 59.9 57.3 57.3 4/1/04 ICIUM2004_CM

Discussions Lesson learned Policy implications Urgent need for data management and policy implementations Policy implications Central data warehouse (MoPH?) Agency for standard drug code (FDA?) Quantity and quality indicators 4/1/04 ICIUM2004_CM

Recommendations Research Systematic management of drugs Cost of illness and quality of drug use Outcomes of treatment Systematic management of drugs 4/1/04 ICIUM2004_CM

Ms Pornpimol Chantarakunopars Acknowledgement Team Mr Mungorn Angsanant Ms Pornpimol Chantarakunopars Preeyaporn Phutong Siritorn Kongsawat Etc. 4/1/04 ICIUM2004_CM