Drug Procurement Research Articles

The impact of Chinese volume-based procurement on pharmaceutical market concentration.

Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.

Analysis and discussion on the pharmaceutical centralized procurement implementation - a case study of a large provincial hospital in China.

Unaffordable medical treatment and inflated drug prices have become a challenging issue for lawmakers worldwide. To reduce the financial burden and standardize the pharmaceutical market, the Chinese government has issued several detailed regulations, including the measures of drug recruitment and procurement in one and volume purchasing to not only ensure the high quality of approved drugs but also lower the cost of the production and sell procedure. In this work, to have a thorough overview of the enforcement of these regulations, we attempted to critically analyze the data of our hospital's centralized procurement of drugs from 2019 to 2022. We identified some concerns, such as the difficulty in determining the "quantity" of drug procurement, out-of-stock of collectively procured drugs, difficulty in managing the preallocation of associated funds, incomplete centralized procurement systems, etc. Therefore, it is essential to promote a multidimensional strategy, including the combination of the medical insurance reform and drug centralized procurement policies, strict controlling of the forecast quantity of drugs to ensure stable drug supply, improvement of the relevant policies for retaining the surplus of centralized procurement drug medical insurance funds, secureness of the drug procurement system platform, and available reference and guidance for subsequent centralized quantity procurement of drugs.

Effect of centralized volume-based procurement of drugs on business performance of listed pharmaceutical enterprises

Since March 2018, China has conducted five rounds of negotiations for the inclusion of drugs in the medical insurance system and implemented eight batches of centralized drug procurement. The role of the medical insurance department as a strategic purchaser in the pharmaceutical market has been continuously strengthened, playing a crucial role in controlling the unreasonable growth of medical expenses and reducing the economic burden on patients. The policy of centralized drug procurement, by exchanging quantity for price, can significantly reduce drug prices and lower the profit level of companies. However, being included in the centralized drug procurement catalog can bring a substantial and stable market share to the winning companies. Therefore, the impact of the centralized drug procurement policy on the operational performance of winning companies and how their business decisions should be adjusted remain to be thoroughly explored from both theoretical and empirical perspectives. To assess the impact of the centralized drug procurement policy on the operational performance of companies, this study takes publicly listed pharmaceutical manufacturing companies from 2016 to 2020 as the sample and conducts empirical analysis using methods such as difference in difference (propensity score) matching (PSM-DID). The results showed that the centralized volume-based procurement of drugs policy had a significant negative impact on the business performance of bidding listed pharmaceutical manufacturing companies, indicating that the increase in the sales of bidding drugs could not fully make up for the profit loss caused by the price reduction in the short term. Pharmaceutical manufacturing companies should further adjust their market competition strategies, actively engage in research and development innovation. The government should guide pharmaceutical companies to improve their operational performance while ensuring the quality of drug supply by optimizing the supporting innovative incentive policies in the centralized drug procurement policy.

Analysis of Drug Management at Tegal City Pharmaceutical Installation

Background: Medicine is one of the most essential elements in health service efforts. Good drug management will affect the availability of drugs and improve the degree of health in the community.Objectives: This study aims to determine the effectiveness and efficiency of drug management at the Tegal City Pharmaceutical Installation in 2021 related to compliance with the Indonesian Ministry of Health and WHO indicators.Methods: This research is descriptive research with a quantitative approach. Data was taken retrospectively through document tracing and supplemented with qualitative data through interviews to deepen findings in the field. Data obtained and the results of interviews with the Head of Installation and pharmaceutical personnel, totaling five respondents, will then be compared with standard indicators from the Indonesian Ministry of Health and WHO. Data analysis in this study used indicators of selection, procurement, distribution, and use of drugs. The values of the indicators that have been obtained are subsequently compared with the existing standard values.Results: The results of drug management research at the Tegal City Pharmaceutical Installation are at the selection stage of proposing drugs to Fornas. The procurement stage of drug suitability with Fornas is 96.4%, the fund allocation percentage is 92%, and the planning accuracy is 95.7%. The distribution stage of the level of drug availability 12-18 is 13.92 months, the accuracy of the number of distributions to the Puskesmas is 100%, the percentage of drugs experiencing empty stock, dead stock, and overstock is 0%, the percentage of damaged and expired drugs is 0%. The use stage of drug items per prescription is 3.5 drug items, the percentage of antibiotic use in non-specific patients is 30.7%, the percentage of non-pneumonia Acute Respiratory Infections (ARI) antibiotic use is 34.2%, and myalgia injection use is 0%.Conclusion: The conclusion of drug management at the selection, procurement, distribution, and use stages in 2021 carried out at the Tegal City Pharmaceutical Installation has yet to follow standards. Of the 14 indicators studied, only 8 follow the standard, and 6 other indicators still need compliance to evaluation.

Optimizing Drug Procurement with the MELIASI Application: A Collaborative Solution for Health Facilities

The problem of drug shortages, where medications are unavailable or difficult to obtain, can significantly impact public health and disrupt the national health insurance system (JKN). This study aims to address this issue by developing the MELIASI (Multiple Link Collaboration) application as a collaborative solution among health facilities within a district. The research method used is qualitative, employing in-depth interviews with stakeholders involved in drug procurement management. The results show that weak collaboration among health facilities leads to suboptimal utilization of available drugs. The MELIASI application, still in the prototype stage, is expected to optimize drug distribution by leveraging surplus stocks from other health facilities. Implementing this application can reduce procurement wait times from an average of 7-14 days to just 2-3 days, enhance distribution efficiency, and ensure better drug availability across various health facilities. This study makes a significant contribution to pharmaceutical information management and offers a model that can be applied in other regions to improve drug availability. Additionally, the findings indicate that digital technology in drug procurement management can provide innovative solutions to address drug shortages and enhance overall public health. Abstrak: Masalah kekosongan obat adalah kondisi di mana obat tidak tersedia atau sulit didapatkan, yang dapat mempengaruhi kesehatan masyarakat dan mengganggu sistem penjaminan kesehatan nasional (JKN). Penelitian ini bertujuan untuk mengatasi masalah tersebut dengan mengembangkan aplikasi MELIASI (Multiple Link Kolaborasi) sebagai solusi kolaboratif antar fasilitas kesehatan di suatu wilayah kabupaten. Metode penelitian yang digunakan adalah kualitatif dengan teknik wawancara mendalam terhadap stakeholder terkait manajemen pengadaan obat. Hasil penelitian menunjukkan bahwa kolaborasi yang lemah antar fasilitas kesehatan menyebabkan tidak optimalnya penggunaan obat yang tersedia. Aplikasi MELIASI, yang masih dalam tahap prototipe, diharapkan dapat mengoptimalkan distribusi obat dengan memanfaatkan stok berlebih dari fasilitas kesehatan lain. Implementasi aplikasi ini dapat mengurangi waktu tunggu pengadaan obat dari rata-rata 7-14 hari menjadi hanya 2-3 hari, meningkatkan efisiensi distribusi, dan memastikan ketersediaan obat yang lebih baik di berbagai fasilitas kesehatan. Penelitian ini memberikan kontribusi penting dalam manajemen informasi kefarmasian dan menawarkan model yang dapat diterapkan di daerah lain untuk meningkatkan ketersediaan obat. Hasil ini juga menunjukkan bahwa penggunaan teknologi digital dalam manajemen pengadaan obat dapat memberikan solusi inovatif untuk mengatasi masalah kekosongan obat dan meningkatkan kesehatan masyarakat secara keseluruhan.

Penerapan Sistem Pendukung Keputusan Berbasis Metode Pareto ABC dan Optimasi Kualitatif untuk Efisiensi Pengadaan Obat

Drug procurement at Amandha pharmacy is still carried out with uncertain considerations, resulting in irregular scheduling, this will have an impact on inventory costs due to the accumulation of inventory in the warehouse or the absence of drug inventory, pharmacy managers have difficulty in making decisions for drug procurement, due to factors that must be considered, namely the number of drug item sales, investment and cost allocation. The purpose of this study is to create software with the application of the Pareto ABC method and qualitative optimization which will be one of the considerations in decision making in ordering drugs. In this new system, the number of drug procurements to be ordered is based on 3 values ​​as considerations, namely use value, investment value and critical index value, with reference to the Pareto ABC method having a class level divided into class A with an investment value of 70%, class B 20% and class C 10%, the system will provide recommendations as considerations for the agency in ordering drugs. The function of this research is as a consideration in solving problems and improving the quality of drug procurement. The results of the research are in the form of software for drug procurement decision support systems as a consideration in preparing a strategic ordering plan that supports increasing efficiency, effectiveness and benefits of the agency.

Cost-effectiveness analysis of tislelizumab plus chemotherapy as the first-line treatment for advanced or metastatic oesophageal squamous cell carcinoma in China.

We aimed to investigate the cost-effectiveness of tislelizumab plus chemotherapy compared to chemotherapy alone as a first-line treatment for advanced or metastatic oesophageal squamous cell carcinoma (OSCC). A partitioned survival model was developed to evaluate the cost-effectiveness of tislelizumab plus chemotherapy versus chemotherapy alone in patients with advanced or metastatic OSCC over a 10-year lifetime horizon from the perspective of the Chinese healthcare system. Costs and utilities were derived from the drug procurement platform and published literature. The model outcomes comprised of costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were conducted to address uncertainty and ensure the robustness of the model. Tislelizumab plus chemotherapy yielded an additional 0.337 QALYs and incremental costs of $7,117.007 compared with placebo plus chemotherapy, generating an ICER of $21,116.75 per QALY, which was between 1 time ($12,674.89/QALY) and 3 times GDP ($38,024.67/QALY) per capita. In one-way sensitivity analysis, the ICER is most affected by the cost of oxaliplatin, paclitaxel and tislelizumab. In the probabilistic sensitivity analysis, when the willingness-to-pay threshold was set as 1 or 3 times GDP per capita, the probability of tislelizumab plus chemotherapy being cost-effective was 1% and 100%, respectively. Tislelizumab plus chemotherapy was probably cost-effective compared with chemotherapy alone as the first-line treatment for advanced or metastatic OSCC in China.

The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China

PurposeUnder the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization.MethodA pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated.ResultsAfter policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs.ConclusionThe NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.

Time trends and regional variation in utilization of antidiabetic medicines in China, 2015-2022.

To assess the use of non-insulin antidiabetic medicines in China. We analysed the national procurement data for 29 non-insulin antidiabetic medicines from nine subgroups in China from 2015 to 2022. We estimated the number of defined daily doses (DDDs) procured per year in seven regions of China for nine subgroups and adjusted the data by the number of patients with diabetes. For each subgroup, the regional ratio was calculated by comparing the procurement per patient in each region with the procurement nationwide. The regional disparity was the difference between the highest and lowest regional ratios. We compared the medication patterns across regions. Nationally, between 2015 and 2022, the number of DDDs per patient increased from 14.45 to 47.37. The two most commonly used categories were sulphonylurea and biguanides, which increased from 7.04 to 15.39 (119%) and 3.28 to 11.11 (239%) DDDs per patient, respectively. The procurement of new drugs (dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists) increased quickly and had >5000% relative changes. Particularly for sodium-glucose cotransporter type 2 inhibitors, it increased from 0.08 to 5.03 DDDs (6662%). The southwest region had the highest relative change (319%), while the southern region had the lowest (118%). Biguanide and thiazolidinediones had the lowest (1.19) and highest level (2.21) of regional disparity in 2022, respectively. The procurement of non-insulin antidiabetic medicines in China has increased a lot from 2015 to 2022. In terms of DDDs per patient, sulphonylurea ranked first, followed by metformin. The procurement of new drugs increased greatly. A large regional disparity existed in medicine usage and patterns.

Assessment of coping capacity of public health facilities with health emergency situations during an event of flood in Mumbai.

Floods had been a repeated phenomenon in India, causing considerable losses to properties, life and infrastructure, and public utilities. Floods are found to be a common natural disaster occurring not only in developing countries but also in developed nations. Hospital preparedness against disaster could help in the management of the surge of patients in an effective manner. This study aims to assess the capacity of public health facilities for coping up with health emergency situations during an event of flood in Mumbai. A cross-sectional study was conducted among 38 public health facilities in Mumbai. A purposive sampling technique was used for the selection of the health facilities. Administrative staff, medical officers, and pharmacy in charges were included in the study. The study revealed that surge capacities in hospitals were adequate as they had additional beds for monsoon-related diseases for the preceding flood situation. There was a triage policy, and the staff were trained on the same. Procurement of drugs was easy because of a good networking system between hospitals. Due to this networking system, patients were also transferred to the nearest healthcare facility in a short span of time. The response during an event of a flood in the health facilities of Mumbai city was good as they have regular training sessions to be prepared for the emergency situations during monsoon as they have repeated exposure to floods.

Application of ABC VEN Method in Procurement Management and Its Impact on Internal Business Processes that Impact General Patient Customer Retention in 2022 (Case study at RS X)

ABSTRACT X Hospital wants to increase the efficiency of pharmaceutical services by replacing the consumption-based drug procurement method with the ABC VEN method to overcome challenges such as out-of-stock, direct purchases from other vendors, and the use of multiple vendors, with a potentially positive impact on customer retention and compliance with relevant regulations and research. This study aims to examine the application of the ABC VEN method to improve inventory procurement planning at X Hospital, compare its effectiveness with the consumption method on internal business processes, and measure its impact on customer retention. This study uses a non-experimental approach with quantitative descriptive and observational retrospective, analyzes drug procurement January-July 2022, and evaluates the ABC VEN method from December 2022 through informant interviews at X Hospital to analyze internal business processes and retention of customers using the Balanced Scorecard approach. The number of samples used was 175 samples. The analysis of validation and reliability tests showed that most of the indicators on the satisfaction aspect were in the high category, while overall patient satisfaction was in the sufficient category. The indicators on the assurance and tangible dimensions are included in the sufficient category, showing attention to the availability of drugs and seating facilities to increase customer retention. The application of the ABC VEN Method at X Hospital from August to December 2022 has a higher realization rate (87%) than the Consumption Method (66%), with a direct procurement efficiency of 57% or IDR 64,816,401. Despite payment constraints, related parties consider implementing the ABC VEN Method more effective and can improve internal business performance and customer retention. Keywords: X Hospital, ABC VEN Method, Pharmacy Services

Operational complexities in international clinical trials: a systematic review of challenges and proposed solutions

ObjectiveInternational trials can be challenging to operationalise due to incompatibilities between country-specific policies and infrastructures. The aim of this systematic review was to identify the operational complexities of conducting international...

IJCM_412A: Self Medication Practices Among Patient Attending Fever Opd At Tertiary Care Hospital In Mumbai.

Background: Self-medication is defined as the use of drugs to treat self- diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. The practice of self-medication is common worldwide in both developed and developing countries which often leads to dangerous unwarranted adverse effects, antimicrobial resistance, ultimately increasing cost burden due to health care. Objective: The study aimed to determine the prevalence of self-medication among patients; to identify risk factors that could influence self-medication practices; to identify sources of information about medications used; and to identify reasons for self-medication. Methodology: cross-sectional study was carried out among patient, information regarding self-medication use in the past six months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected. The data were obtained using a validated pretested self-administered questionnaire. The collected data will be analyzed using SPSS for descriptive and inferential statistics. Results: In our study the prevalence of Self Medication practices were observed to be 45.6%. The practice was noticed more among individuals from lower middle class family with a prevalence rate of 26%. Telling the symptoms to pharmacist was the commonest method adopted to procure drugs by the users i.e. 61%Majority of the self-medication users expressed that self-medication is harmless and 32.2 % found it effective and 88.9% said they had never experienced any adverse effects, 81.3 % consider it as acceptable practice. Conclusion: Prevalence of SM practices are high. Most common reason being poverty, confidence in self – diagnosis, In order to mitigate the negative effects of SM behaviours, additional prompt measures are required.

Drug procurement and coordination decision under non‐directed donation behavior

AbstractThe frequent occurrence of public emergencies seriously threatens human health. As the supplier of drugs, besides producing drugs, pharmaceutical manufacturers also actively launch drug donations. However, whether this donation will affect the procurement decisions of hospital pharmacies and help relieve the supply pressure is worthy of attention. This paper aims to analyze the procurement and donation decisions under non‐directed donation scenario. Besides, we extend the application of collaborative decisions in the pharmaceutical supply chain. Our results point out that donations made by the pharmaceutical manufacturer always benefit the hospital pharmacy and the pharmaceutical supply chain system, and only in certain circumstances can it make itself more profitable. In non‐directed donation scenario, drug donation and procurement quantities under centralized decision are always higher than that under decentralized decision. The social collaborative decision has more advantages in improving members' decisions and profits. The coordination effect of collaborative decisions is often better when there are significant fluctuations in the wholesale price. Through our analysis, it can provide a reference for pharmacies and pharmaceutical manufacturers to make appropriate procurement and donation decisions.

The Evaluation of Drug Management and Improvement Strategies Using the Hanlon Method in the Pharmacy Installation of the Bahteramas Hospital Southeast Sulawesi

Drug management is a drug management cycle which includes these stages as follows: selection, procurement, distribution and use. Ineffectiveness and inefficiency may negatively impact hospitals both medically and economically. This study aims to evaluate drug management in the selection, procurement, distribution and use of drugs at the Bahteramas Hospital, Southeast Sulawesi,&#x0D; with Hanlon method as strategic improvement. This study has done with a descriptive method with data collected retrospectively in 2022 and prospectively, both primary (management record) and secondary (interviews). Results of this study about drug management showed there were 4 indicators that do not comply with standards. Meanwhile, other 10 indicators could comply with the standards. The improvement strategy using the Hanlon method in drug management is to prioritize repairing problems sequentially starting from the average percentage of drug waiting time, suitability of the national formulary and hospital formulary, as well as the percentage of dead stock.

Compulsory license threats in a signaling game of drug procurement

Compulsory license threats in a signaling game of drug procurement

Can single disease payment impact hospitalization expenses and quality in district hospital? A case study in Fujian, China

BackgroundChina is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals.MethodsData was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members.ResultsThe implementation of SDP decreased the medical expenses decreased significantly (P < 0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality (P < 0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as “insufficient coverage of disease types”.ConclusionAfter the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records.

Analysis of Current Situation and Countermeasures of Drug Supply Chain of Centralized Procurement in China

After the implementation of centralized drug bidding and procurement, drug prices showed a downward trend, but also exposed some problems, based on the centralized procurement process, aiming at the problems existing in the operation of the supply chain of centralized drug procurement in the current market, put forward corresponding suggestions for the shortcomings of the operation mode of the supply chain of centralized drug procurement, and effectively under the bidding and procurement system, Make pharmaceutical enterprises responsible for patients, the environment and the government, and provide reference for the construction of China's drug supply chain management system.

The evaluation of drug management (selection, procurement, and lead time of drug order) in hospital during COVID-19 in Indonesia

In the current COVID-19 era, one of the critical factors influencing the quality of hospital services is drug management, with planning and procurement being particularly pivotal to avoid drug shortages. This study aimed to examine the selection, procurement, and lead time aspects of drug management at the pharmacy installation hospital in Jakarta during the COVID-19 pandemic. Conducted as a descriptive study with retrospective data, total sampling was utilized to collect data, incorporating 1,413 drugs. The data, collected on observation sheets, underwent univariate analysis using Microsoft Excel. Results indicated that out of the seven measurable indicators, two met the standards: the percentage of allocated funds for drug procurement at 70.5%, and the frequency of errors in orders occurring five times. However, five indicators fell below the standards: the suitability of drug items with the National Formulary at 14.15%, the suitability of drug items with the Hospital Formulary at 68.15% (with an 80% benchmark), the frequency of each item's procurement in a year at a low category of 43.45%, the percentage of conformity between planning and reality at 99.61%, and the achievement of lead time for ordering drugs at 5.08 days. In conclusion, the selection, procurement, and lead time aspects of drug management at the "X" Hospital Pharmacy Installation did not fully meet the established standards. Therefore, it is recommended that healthcare management implements and adheres to robust drug management system regulations, particularly during pandemic situations, to ensure optimal hospital services.

Development of the Emirates Multi-Criteria Decision Analysis Tool for Orphan Drugs.

Background The number of orphan drug approvals is currently increasing globally. This creates a significant burden on payers and healthcare systems. This study aimed to create a multi-criteria decision analysis (MCDA) tool for evaluating orphan drugs within the United Arab Emirates (UAE). The intended result of the tool is to provide evidence-based guidance to decision-makers in reimbursement and procurement decisions. Methods We conducted a literature search and local expert interviews to identify relevant preliminary criteria for the MCDA tool. Then we conducted a structured consensus-building session for healthcare experts and decision-makers in the UAE to develop the Emirati MCDA tool for orphan drugs. The experts voted for the criteria to be included in the tool and their ranking according to importance, as well as the weight of each criterion and its scoring function. To improve understanding and facilitate the voting process, experts were provided with a brief illustration of similar tools conducted in other countries before the voting sessions. Finally, the tool was developed in a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States), and it was validated and tested based on real case studies, then it was fine-tuned accordingly based on the experts' discussions. The final tool was provided to the attendees to guide their decisions in the reimbursement and procurement of orphan drugs. Results The created tool provides a score for each analyzed orphan drug based on its value. Ten criteria were included in the final MCDA tool. These were cost-effectiveness (25.1% of the weight), magnitude of health gain (20.1%), availability of therapeutic alternative (14.3%), disease severity (11%), budget impact (7.9%), disease rarity (5.6%), strength of clinical evidence (5.6%), burden on households (4.5%), indication uniqueness (3.2%), and patients' age (2.6%). Conclusions Implementation of evidence-based healthcare necessitates assessing the fair value of each health technology. Addressing the high unmet medical needs and improving healthcare for patients with rare diseases are priorities within the UAE. The created Emirates MCDA tool for orphan drugs has the potential to help decision-makers implement value-based and evidence-based reimbursement decisions for orphan drugs.