THE INTEGRATED ABC/FMR/VED-ANALYSIS OF DRUG CONSUMPTION AMONG HOSPICE PATIENTS

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Received on 29 August, 2013; received in revised form, 15 October, 2013; accepted, 26 December, 2013; published 01 January, 2014

THE INTEGRATED ABC/FMR/VED-ANALYSIS OF DRUG CONSUMPTION AMONG HOSPICE PATIENTS

Sofiya Prokip* and Bohdan Hromovyk

Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Danylo Halytskyi Lviv National Medical University 1, 75 Pekarska str., Lviv, 79010, Ukraine

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ABSTRACT: One of the problematic aspects of palliative-hospice care is pharmaceutical providing of the patients at specialized institutions, hospices. The relevance of the work is due to the lack of research about the medicineconsumption by patients at the hospice in Ukraine. Therefore the aim of the research 15 October, 2013was to study the range, cost, prescription frequency and the cost of patient pharmacotherapy at the hospice.The methods of content and frequency analysis and also,the integrated ABC/FMR/VED-analysis were used for the study.At the first research stagewere analyzed the clinical and basic statistical characteristics of hospice patients. At the second stage, the integrated ABC/FMR/VED analysis of prescribed drugs has been conducted. Then the definition of frequently prescribed medications and main therapeutic groups, using frequency analysis,hasbeen performed. The final step is the calculation of patients pharmacotherapy cost and the individual therapeutic medicationgroups.The analysis of clinical and statistical characteristics of hospice patients has showed that 75.6% of patients at the hospice were women and 48.9% of all diseases present were cardiovascular diseases. 139 medicinal products have beenprescribedto patients. It has been discovered that 20 (14.4%) drugs makean AFV group - the most frequentlyprescribed medications with the largest cost of consumed dose units on the base of the integrated ABC/FMR/VED-analysis. The cost of patient pharmacotherapy has been calculated and there has been found the moderate direct correlation with the time spent atthe hospice.

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Keywords:

Hospice, Drugs, Economic affordability of Pharmacotherapy

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INTRODUCTION:Palliative and hospice care is an important part of the health protection system and social protection of citizens providinga human with the right of respectable end of life and the maximum reduction of patientsuffering from incurable diseases and limited life expectancy. In the field of palliative and hospice care,a general need of a multidisciplinary approach appears, as palliative patients and their families require comprehensive complete support^{1, 2, 3}.    

Pharmaceutical providingis an actual issue of palliative medicine, so relevance of our work is determined by the lack of basic research of the consumption of drugs at the hospice.

The aim of the survey is to study the range, cost, prescription frequency and the cost of patient pharmacotherapy at the hospice.

MATERIALS AND METHODS: The objects of the study were 90 hospital charts(HC) of patients at Lviv City Community Hospital "Hospice" (LCCHH) in 2012.

Content analysis of HC: Each of the chart has been analyzed by the following parameters: sex and age of the patients, the diagnosis, the number of dose units (DU)of prescribed drugs, the cost of pharmacotherapy (PT), the frequency of certain drugs assignment.

Integrated АВС/FMR/VED-analysis: For drugclustering per cost, per frequency of DU prescriptions and due to the formal presence in the State Drug Formulary (SDF)⁴, a computer program Hortor has been designed for management decisions to optimize the assortment balance of drugs conductingan automated and integrated ABC / FMR (XYZ) / VED-analysis^{5, 6}.

The ABC analysis is one of the variants of mathematical and statistical methods used to distribute the existing amount due to the defined three classes of criteria, namely: A, B and C. Class A comprises about 20% of all items from the range with 70-80% of the cost parameter (the cost of DU). Class B comprises almost 30% of all items of drugs with around 10-20% of their value. Other items with a low cost index make up class C.

The FMR-analysis is the type of the ABC analysis considering the criterion of the frequency of drug packaging realization. Due to this criterion, the range of drugs is distributed into three groups: class F (Fastest) - the most commonly prescribed drugs (20% of a whole range with 70-80% of the consumed DU), class M (Medium) - less commonly prescribed drugs (30 and 10-20%, respectively) and class R (Rare) - the most rarely prescribed drugs (other items).

A formal VED-analysis enablesclassifying medication into two groups: Vital (V), included in SDF, and Desirable (D), not included into SDF. The group of Essential (E) drugs in this case is not identified.

Frequency analysis: The frequency estimate of eachdrug prescribed in the study population.

Calculation of the PT cost: Since drugmanufacturers and the number of DU in the package are not specifiedin HC, were used trade names of prescribed drugs, preferring national drug manufacturers and the price per pack with a number of DU, sufficient for the course of PT. During the cost calculation of the consumed DU, the lowest wholesale prices of drugs according to database "Program complex Pharmacy" have been used⁷.

RESULTS:

Analysis of HC of patients: Segmentation analysis results of major clinical and statistical characteristics of hospice patients are presented in Figure 1. Three-quarters of hospice patients appeared to be women (75.6%), and the rest - men (24.4%). The range of patientage variation is from 31 to 99 years (with average age – 76 years), the range of female variation is 31-99 years (average – 77 years), men - 56-90 years old (average – 73 years).

FIG. 1: MEDICAL AND SOCIAL PROFILE OF HOSPICE INPATIENTS

 

The duration of staying at the hospice ranges from 1 to 714 days, with average 95 days. A polimorbidity index ranges from 1 to 5, with average 2.2, and the number prescribed drugs to a patient – from 3 to 66 (average 15).

In the total hospitalized morbidity at the hospice the proportion of patients with incurable diseases of the circulatory system (I00 - I99) ⁸ ranked first (48.9%)during the analyzed period. Second place rating (45.6%) took patients with malignant neoplasms (C00 - C97)⁸, nervous system diseases (G00 - G99)⁸ – 5.5%, determiningthe third position.

Integrated АВС/FMR/VED-analysis of drug consumption: The next stage of the research has beenan automated and integrated ABC / FMR / VED-analysis via the computer program Hortor. It has been found that 139 international nonproprietary names (INN) of drugs were prescribed for the patients, and they refer to 11 anatomical groups of the ATCclassification system. These drugs belong to 42 therapeutic groups according to the second classification level.

As it is seen from the data on Table 1, the matrix segment AFV has beencomprised by 20(14.4 %) drugs that provide a basic amount of cost (58.32 %) and DU consumption (45.85 %) of formulary drugs.

According to the cost and quantitative level of consumption, drugs that comprisesegments AMV, BFV and BMV (6, 15 and 21 INN, respectively) are approaching segment AFV. The largest number of drug range (47.5 % - 66 INN of medications) belongs to the segment CRV - formulary drugs with the lowest cost and consumptionfrequency.

It has been discovered that 16 drugs or 11.5 % of 139prescribed for patients at the hospice, belong to group D (desirable), meaning they were not listed in the SDF. Also the absence of non formulary drugs in the segment ARD (high cost – low number of DU) and CFD (low cost – high number of DU) has been detected.
The cost of PT: During the final stage of the research was calculated the PT cost of certain patients, which averaged 51.92 USD, as per one bed-day – 1.36 USD. In addition, it has been found (Table 2) that the highest costs in the PT of hospice patients are associated with the following groups of drugs: N02 - Analgesics (22.0%), N05 - Psycholeptics (16.0%), M01 - Anti-inflammatory and antirheumatic products (9.3%), J01 - Antibacterials for systemic use (5.8%), N06 - Psychoanaleptics (5.5%).

 

TABLE 2:  THERAPEUTIC DRUG GROUP COST PRESCRIBED FOR PATIENTS AT THE HOSPICE

S. No.	ATC code	Main therapeutic group	Cost
			USD	%
1.	N02	Analgesics	59	22.05
2.	N05	Psycholeptics	744.54	16.02
	M01	Anti-inflammatory and antirheumatic products	430.6	9.27
	J01	Antibacterials for systemic use	267.37	5.75
	N06	Psychoanaleptics	256.06	5.51
	C01	Cardiac therapy	236.68	5.09
	A03	Drugs for functional gastrointestinal disorders	183.76	3.95
	B05	Blood substitutes and perfusion solutions	135.55	2.92
	C09	Agents acting on the renin-angiotensin system	133.71	2.88
	N03	Antiepileptics	126.46	2.72
	R06	Antihistamines for systemic use	111.93	2.41
	B01	Antithrombotic agents	103.18	2.22
	N04	Anti-parkinson drugs	98.51	2.12
	H02	Corticosteroids for systemic use	75.55	1.63
	A05	Bile and liver therapy	75.03	1.61
	V06	General nutrients	72.51	1.56
	C05	Vasoprotectives	69.61	1.5
	G04	Urologicals	55.56	1.2
	A12	Mineral supplements	53.62	1.15
	C03	Diuretics	42.04	0.9
	A11	Vitamins	38.86	0.84
	R03	Drugs for obstructive airway diseases	37.29	0.8
	B02	Antihemorrhagics	35.42	0.76
	C04	Peripheral vasodilators	32.71	0.7
	A16	Other alimentary tract and metabolism products	29.69	0.64
	N07	Other nervous system drugs	26.19	0.56
	J05	Antivirals for systemic use	25.32	0.54
	A09	Digestives, including enzymes	21.45	0.46
	R05	Cough and cold preparations	16.87	0.36
	A06	Laxatives	14.91	0.32
	M03	Muscle relaxants	14.2	0.31
	C10	Lipid modifying agents	13.05	0.28
	A10	Drugs used in diabetes	11.85	0.25
	C07	Beta blocking agents	10.85	0.23
	A07	Antidiarrheals, intestinal anti-inflammatory/anti-infectiveagents	9.16	0.2
	A02	Drugs for acid related disorders	3.17	0.07
	J02	Antimycotics for systemic use	3.4	0.07
	R02	Throat preparations	2.06	0.04
	B03	Antianemic preparations	1.58	0.03
	S01	Ophthalmologicals	1.47	0.03
	N01	Anesthetics	0.43	0.01
	C08	Calcium channel blockers	0.26	0.005
All			4647.05	100.00

 

 

 

DISCUSSION: This study examined the consumption of medicines, which were prescribed for hospice patients. The medical charts analysis of inpatients at LCCH "Hospice" has shown that most of them were women (75.6%), and the dominant diseases among patients (48.9%) were diseases of circulatory system (I00 - I99). An average polimorbidity index was equal 2.2, and the coefficient of polypragmasy - 15. The latter largely depends on the duration of staying at the hospice (so, during 537 days 66 drugs were prescribed tothe patient).

The frequency analysis showed that the most often administered groups of drugs to patients were the following: «N05 Psycholeptics», «C01 Cardiac therapy», «N02 Analgesics», «J01 Antibacterials for systemic use»,  «A03 Drugs for functional gastrointestinal disorders» (Figure 2).

  

FIG.2. TOP-10 MOST COMMONLY PRESCRIBED THERAPEUTIC DRUG GROUPS FOR HOSPICE PATIENTS

 

It was found that investigated drugs have been characterized due to the particle prescription within 1.1 ... 70%. Table 3 shows, that Metamizolesodium was prescribed for 70% of patients, Diphenhydramine and Doxylamine – for two-thirds of patients, and more than one third of patients were treated with Dexamethasone, Chlorpromazine, Theophylline, Corglycone, Potassium and magnesium aspartate, Sulfocamphocain, Ketorolac, Nikethamide, Glucose and Digoxin.

 

TABLE 3: TOP-20 DRUGSMOST OFTEN PRESCRIBED FOR PATIENTS AT THE HOSPICE

S. No.	INN of drug	Dosage form		Code АТС	Number of drug prescriptions
					abs.	%
1	Metamizole sodium		inj.a 50% 2.0 №10	N02BB02	63	70
2	Diphenhydramine		1% 1.0№10	R06AA02	61	67.8
3	Doxylamine		f/c tab.c 15 mg №10	N05CM50	60	66.7
4	Dexamethasone		inj. 0,4%, 1.0 №10	H02AB02	38	42.2
5	Chlorpromazine		inj. 2,5% 2.0 №10	N05AA01	37	41.1
6	Theophylline		inj. 2% 5.0 №10	R03DA04	36	40
7	Corglycone		inj. 0,06% 1.0 №10	C01AX04	34	37.8
8	Potassium and magnesium aspartate		b №50	A12CC55	33	36.7
9	Sulfocamphocain		inj. 10% 2.0 №10	C01EB02	33	36.7
10	Ketorolac		inj. 3% 1.0 №10	M01AB15	32	35.6
11	Nikethamide		inj.25% 2.0 №10	C01AX04	30	33.3
12	Glucose		IV inf.d 5% 200.0	V06DC01	29	32.2
13	Digoxin		tab.0.25 mg №50	C01AA05	29	32.2
14	Potassium and magnesium aspartate		inj. 10.0 №10	A12CC55	27	30
15	Furosemide		inj. 1% 2.0 №10	C03CA01	24	26.7
16	Metoclopramide		inj. 0,5% 2.0 №10	A03FA01	23	25.6
17	Captopril and diuretics		tab. №20	C09BA01	23	25.6
18	Platyphylline		inj. 0,2% 1.0 №10	A03AX12	23	25.6
19	Papaverine		inj. 2% 2.0 №10	A03AD01	22	24.4
20	Inosine		inj. 2%  10.0 №10	C01EB14	21	23.3
a  inj. – injection b tab. – tablets c f/c tab. – film-coated tablets d IV inf. – intravenous infusion

 

The integrated ABC / FMR / VED-analysis has discovered that 20 (14.4%) of drugs maked a basic amount of cost (58.32%) and DU consumption (45.85%) of formulary drugs. Among them were the following items: Morphine hydrochloride, Metamizole sodium, Ketorolac, Donepezile, Gabapentin, and others. The presence of Morphine in this segment is not accidental, since this drug by the DU consumption takes 12^th place, and by the cost of consumption – the first one. Also was found that 16 of drugs were non-formulary (belong to group D (desirable)).

As a result of the calculation of PT cost it has been found that the cost variation was from 0.85 to 503.27 USD, as PT per one bed-day – from 0.06 and 6.37 USD. Those indicators are, to some extent, due to the direct moderate correlation with the duration of patient staying at the hospice (correlation coefficient is 0.47). The highest expenses are associated with analgesics (22.05%) and psycholeptics (16.02%), which according to the frequency of prescribing takes third and first ranking position respectively.

CONCLUSIONS: This research shows that139 international non-proprietary names of drugs from 42 therapeutic groups of ATC classification system were used in pharmacotherapy of patients. The study of drug consumption was based on integrated ABC / FMR / VED-analysis, which is irreplaceable and useful for the management decisions in order to optimize the assortment balance of medicines.

It has been found that the highest expenses in the pharmacotherapy of hospice patients are associated with analgesics and psycholeptics, which is related to the ranking position of those groups of drugs by the frequency of prescribing.

ACKNOWLEDGMENTS:             No financial support has been used for this study. The authors declare no conflicts of interest.

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   How to cite this article:

   Prokip S and Hromovyk B: The integrated ABC/FMR/VED-analysis of drug consumption among Hospice patients. Int J Pharm Sci Res 2014; 5(1): 104-09.doi: 10.13040/IJPSR. 0975-8232.5(1).104-09

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