Abstract
Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed.Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent years.Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, and Control), VEN (Vital, Essential, and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data was extracted from the Medical Records.Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2–14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9–17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% of medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories.Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines where major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries.
Highlights
Medicines have been used across countries to alleviate patients’ suffering and improve their lives with an agreed list of essential medicines to reduce morbidity and mortality (Hogerzeil et al, 2013; Wirtz et al, 2017)
For instance in Kenya, even the cost of one radiotherapy session at US$5 – 10 for patients with cancer in the major public hospital can be prohibitively expensive for disadvantaged Kenyans who have to pay this as they typically live on US$1 per day or less, and the estimated costs of treating patients with cancer of up to US$5000/patient is just unaffordable for the majority of patients and their families (Mbui et al, 2017; Osman, 2017; Atieno et al, 2018)
For each year of the study (2013–2015), annual consumption data along with the related expenditure incurred on each item was retrieved from the pharmaceutical stores of Kenyatta National Hospital (KNH), which are located on the ground floor of the hospital
Summary
Medicines have been used across countries to alleviate patients’ suffering and improve their lives with an agreed list of essential medicines to reduce morbidity and mortality (Hogerzeil et al, 2013; Wirtz et al, 2017). Medicines constitute an appreciable component of total health care costs (Clemente et al, 2008; Lu et al, 2011), comprising up to 20–40% of health care budgets in many developing countries (Cameron et al, 2009; Lu et al, 2011). In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed
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