APTI ijopp - Indian Journal of Pharmacy Practice

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Indian J. Pharm. Pract. 1(2), Jan-Mar, 2009APTIINTRODUCTIONGrowing expenditure on pharmaceuticals is one of thedriving factors that resulted in initiating Pharmacy andTherapeutics Committee (PTCs) in developed countrieslike Germany, Australia, Canada, Ireland, and Holland,along with other countries that have utilized PTCseffectively to optimise therapeutic health outcomes forpatients as well as economic benefits for hospitals(Thurmann et al, 1997; Weekes and Brooks, 1996; Feld,1986; Ferrando and Henman, 1986; Mannebach in Fijn etal, 1994). Developed countries have traditionally usedPTCs to initiate and maintain rational use of medicinesprograms at hospitals. Internationally, hospitals indeveloped countries have had PTCs for over 70 yearswith built-in methods to monitor and evaluate theirperformance (Thurmann et al, 1997; Summers andSzeinbach,1993; Bochner et al, 1994; Rucker, 1988;Mehr 2006). The individual activities of PTCs differwhile maintaining a common theme and approach ofadvisory and educational activities to maximize therational use of medicines. The beneficial effect ofhospital PTCs in monitoring and promoting quality useof medicines and containing costs in hospitals and otherinstitutional settings has been generally well-accepted inIndian Journal of Pharmacy PracticeReceived on 02/03/2009 Modified on 13/03/2009Accepted on 16/03/2009 © APTI All rights reservedijoppPharmacy and Therapeutics Committee in Bangalore Institute ofOncology - Promoting Rational Pharmaceutical ManagementDivya Hariharaputhran, Sunitha C. Srinivas, Ramesh S. Billimaga, Ajai Kumar B.S1, 3Bangalore Institute of Oncology, Bangalore, India2Rhodes University, South Africa4HealthCare Global Enterprises Ltd, Bangalore, India*Address for correspondence: s.srinivas@ru.ac.zaAbstractBangalore Institute of Oncology (BIO), a Comprehensive Cancer Center operating since 1989 has initiatedPharmacy and Therapeutics Committee (PTC) in 2007 as a forward looking step in promoting rational use ofmedicines. The first step in establishing role of PTC was to carry out ABC Analysis of Anti-Cancer Drugs procured atBIO for the period of October 2006 to September 2007, according to Management Sciences for Health (MSH) andWorld Health Organization (WHO) guidelines. ABC Analysis provided a comprehensive and clear picture ofconsumption of chemotherapy medicines. The number of brand names procured for individual medicines were alsocollated. Constructive debate amongst PTC members resulted in making the decision to streamline the procurementof only three brand names for each medicine that had numerous brands procured earlier. PTC members of BIO haveconstructively utilized the forum in further improvising the pharmaceutical management as a first step inestablishing PTC as a decision making body for rational use of medicines.Key words: Pharmacy and Therapeutics Committee; ABC analysis; Rational use of medicinesdeveloped countries. Unfortunately, there has been littlecritical evaluation of the clinical or economic impact ofthis approach in developing countries.PTCs have been mandated standards in hospital settingsin the USA even before 1960s (Bagozzi, 2005) for safeand cost effective use of medicines in hospitals. In thiscontext there is a need to highlight an important conceptthat maximum expenditure is not necessarily the onlymethod to achieve optimal health benefits. Developedcountries use the concept of balancing therapeuticefficacy with cost and not just striving for costeffectiveness. Formularies are updated by using differentapproaches to evolve decision-making methods(Bagozzi, 2005). These include inventory managementapproach, cost accounting approach and criteria basedapproach, to develop and manage an effective formulary.The WHO in promoting the rational selection ofmedicines has used the same concept by highlightingfour paramount features to be considered, which are:efficacy, safety, quality and cost of medicines (WHO,2001) . The rich countries have used the same conceptsdespite lack of financial constraints in order to balancethe expenditure without subrogating the quality of careprovided to patients. Hence the policies in developedcountries have supported PTCs for many years, by usingPTCs as mandated standards in health care organisations(Hochla and Tuason, 1992). Australia considers PTCs46
pivotal to the rational use of medicines (Weekes and This article describes initiatives in rationalBrooks, 1996) and it has been shown that effective PTCs pharmaceutical management as a part of the newlyplay a very active part in educational, communication initiated PTC's activities of Bangalore Institute ofand advisory roles when clinicians, pharmacists and Oncology (BIO). BIO was founded in 1989 as thenursing representatives work together with flagship unit of Banashankari Medical and Oncologyadministrative personnel on PTCs. Based on this proven Research Center Ltd (BMORC). BMORC, initiallyevidence from developed countries, some developing incorporated as a Private limited Company on 13countries such as Brazil (Cruz and Paola, 2006) and Laos November 1986, became a public limited company in(Vang, 2006) have actively adopted the concept of PTCs 1992. It was the first private Comprehensive Cancerin their hospitals to advocate rational therapeutics that Hospital in Bangalore and Karnataka. The idea for such apromote evidence-based medicine along with clinical hospital was initiated and is managed, by like-mindedeffectiveness and not just cost effectiveness.and dedicated cancer specialists who realized that thePharmaceutical management as proposed by theexisting facilities in the government hospitals were notManagement Sciences for Health (MSH) (Quick et al,sufficient to meet the demands and the private sector1997) and the World Health Organization (WHO)needed to step in. BMORC manages and operates BIO, ainvolves four functions: Selection, Procurement,comprehensive cancer center which started its services inDistribution and Use. This cycle requires support of legal1989 with 5 consultants and 30 beds. It is now a 145-bedand policy framework as well as management supporthospital with over 60 consultant physicians and a staffthat comprise financing, information management,strength of 546 people. BIO treats nearly 3000 newhuman resources and organization. Analytical techniquescancer patients every year, and around 110 patientsare designed in developed countries and cost-consciousreceive radiotherapy every day. Besides, the dailycountries to identify and control excess costs inoutpatient attendance exceeds 300. Nearly 1800 majorpharmaceutical management. Even by the 1980s,operations are performed every year. These numbers aredeveloped countries spent about 100 times as much onever increasing.health and 20 times as much on pharmaceuticals, on a perBIO's PTC was initiated in October 2007, with thecapita basis, when compared to developing countriesobjective of promoting rational use of medicines. The(Patel, 1983) and this trend continues to be predominant.PTC is a standing hospital committee responsible,Hence, industrialized countries have adopted techniquesthrough its chairman, to the Hospital executive board. Itto contain costs. This resulted in techniques such as ABCis a policy recommending body to the medical staff andanalysis and Therapeutic Category analysis to quantifyadministration of the hospital on matters related to thecosts and identify areas where costs could be reducedtherapeutic use of drugs. Improved health and economic(Quick et al, 1997; Quick 1982). Cost reducing strategiesoutcome of the hospital care, particularly those related toare aimed at increasing the effectiveness and efficiencythe medication remains the core objective of the PTC.of pharmaceutical supply.MethodologyABC analysis is also known as Pareto analysis. It is aPharmacy and Therapeutics Committee of BIO decidedwell-known method in inventory management, and is ato use the concept of ABC Analysis for rationalizing theuseful tool in analyzing consumption patterns and thedecisions of pharmaceutical procurement ofvalue of total consumption. A Canadian study highlightsAntineoplastic medicines to start with.the extent to which cost effectiveness evaluation is aABC analysis ranks a set of pharmaceuticals byuseful input in decision-making moving beyondcalculating the expenditure on each medicine as aexamining budgets and towards broader balancedpercentage of the total expenditure on all medicines in thebenefits of therapeutic outcomes with economicset. It is a method advocated by WHO and MSH foroutcomes (Dugal et al, 2002). This approach is a directassembling data to determine where money is being spentconsequence of growing concern about rising health care(Quick et al, 1997).costs due to pharmaceuticals as the main component of a. All items purchased are listed according to year andexpenditure (Levy and Gagnon, 2002; Fernandes, 2002). unit cost.Cost-cutting strategies from policy makers, hospital b. Consumption quantities for each are entered.administrators, and health care professionals generally c. Value of consumption is calculated for each bytargeted pharmaceutical expenditures first.multiplying the unit cost by the number of units47
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APTI ijopp - Indian Journal of Pharmacy Practice

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