To assess the use of some high-cost drug groups at 103 Military Hospital, including: antibiotics, cancer treatment and immunomodulatory drugs, cardiovascular, gastrointestinal drugs.... that affect the direct costs, the quality of medical examination and treatment of the hospital. Subjects and method: List of drugs used at 103 Military Hospital in 2013 - 2016 period for some groups of high-cost drugs. Cross descriptive, retrospective study (2013, 2014), intervention (2015 - 2016). Results: Almost high-cost drugs groups tended to increase year by year both in terms of drug items and drugs values from 2013 to 2016. However, this result came from the increase of the number of patients examined and technical and professional development orientations on medical treatment of the hospital: organ transplantation techniques, cardiology specialties including cardiovascular intervention, cancer... In addition, the absence of hospital treatment guidelines also limited the drugs selection in the list of medication because there was no legal basis for monitoring and evaluation. Conclusion: The group of high-cost drugs was used at 103 Military Hospital in accordance with the disease model of the first-class general hospital, the number of patients with medical examination and treatment and the technical and professional development orientation of hospital.
Journal of military pharmaco-medicine no7-2019 EVALUATING THE USE OF SOME GROUPS OF HIGH-COST DRUGS AT 103 MILITARY HOSPITAL IN 2013 - 2016 PERIOD Dao Thi Khanh1; Tran The Tang2; Phan Thi Hoa1 SUMMARY Objectives: To assess the use of some high-cost drug groups at 103 Military Hospital, including: antibiotics, cancer treatment and immunomodulatory drugs, cardiovascular, gastrointestinal drugs that affect the direct costs, the quality of medical examination and treatment of the hospital Subjects and method: List of drugs used at 103 Military Hospital in 2013 - 2016 period for some groups of high-cost drugs Cross descriptive, retrospective study (2013, 2014), intervention (2015 - 2016) Results: Almost high-cost drugs groups tended to increase year by year both in terms of drug items and drugs values from 2013 to 2016 However, this result came from the increase of the number of patients examined and technical and professional development orientations on medical treatment of the hospital: organ transplantation techniques, cardiology specialties including cardiovascular intervention, cancer In addition, the absence of hospital treatment guidelines also limited the drugs selection in the list of medication because there was no legal basis for monitoring and evaluation Conclusion: The group of high-cost drugs was used at 103 Military Hospital in accordance with the disease model of the first-class general hospital, the number of patients with medical examination and treatment and the technical and professional development orientation of hospital * Keywords: High cost drugs; Use of drug; 2013 - 2016 INTRODUCTION The medication use is influenced by many factors: Environment, information, economy, culture, knowledge and personal habit Suitable and safe use of medicines brings a lot of economic and social benefits This is actually a global concern The Ministry of Health has issued many regulations and guidelines documents to ensure the stricter management in using medication However, the inappropriate use is still common which brings serious consequences in economic, health, treatment quality reduction, drug resistance increasing and undesirable effects to patients [2, 3, 4, 5, 7] Circular No.21/2013/TT-BYT regulating the organization and operation of Medication Council in hospital in order to enhance the management of medication use in hospital [5] The management of using high cost medication groups (antibiotics, cancer treatment and immunomodulatory drugs, cardiovascular, gastrointestinal tract drugs ) in hospital plays a very important role 103 Military Hospital Department of Military Medecine Corresponding author: Dao Thi Khanh (khanhbv103@gmail.com) Date received: 26/06/2019 Date accepted: 26/08/2019 81 Journal of military pharmaco-medicine no7-2019 This is actually a big concern of hospitals as it influences on direct costs and quality of medical examination and treatment [1, 3] It is for these reasons that monitoring of use of drugs with high-cost is becoming more necessary and urgent groups of high-cost drugs such as: cardiovascular, antibiotics, cancer treatment and immunomodulatory drugs, gastrointestinal tract and blood diseases treatment drugs Method SUBJECTS AND METHODS Subjects, place and duration of research List of drugs used at 103 Military Hospital in 2013 - 2016 period for some Cross-descriptive, retrospective study (2013 - 2014), intervention (2015 - 2016) * Data analysis: Data were processed in Excel 2016 RESULTS AND DISCUSSIONS Evaluating some high-cost drugs groups using in treatment for 2013 2014 period * Drugs list using in 2013, 2014: Table 1: Drug items using in hospital in 2013 - 2014 Year 2013 Year 2014 Military patients Health insurance covered patients Military patients Health insurance covered patients Item number % Item number % Item number % Item number % Drugs for blood diseases treatment 39 3.82 46 3.9 41 3.89 49 3.8 Cardiovascular drugs 127 12.45 172 14.59 147 13.93 192 14.88 Gastrointestinal tract drugs 98 9.61 101 8.57 110 10.43 109 8.45 Anti-parasitic and antiinfection drugs 180 17.65 216 18.32 191 18.1 241 18.68 Cancer treatment and immunomodulatory drugs 55 5.39 87 7.38 70 6.64 104 8.06 Total of 05 drugs groups 499 48.92 622 52.76 559 52.99 695 53.87 Total 1,020 100 1,179 100 1,055 100 1,290 100 Pharmacological group The results presented the increase of some drugs groups in hospital’s drug list using for both military patients and health insurance covered patients in 2014 in comparison with 2013 For example: Cancer treatment and immunomodulatory drugs (70 and 104 in comparison with 55 and 87); anti-parasitic and anti-infection drugs (191 and 241 in 82 Journal of military pharmaco-medicine no7-2019 comparison with 180 and 216); cardiovascular drugs (147 and 192 in comparison with 127 and 172); gastrointestinal tract drugs (110 and 109 in comparison with 98 and 101) However, according to the percentage calculation the difference was not significant (p > 0.005) These results were similar to the study by Dang Bich Viet et al [6] when studying the evaluation of drugs with high health insurance costs in 2016 * Using value of some high-cost drugs: Table 2: Using value of some high-cost drugs in 2013 - 2014 period Year 2013 Pharmacological group Military patients Year 2014 Health insurance covered patients Military patients Health insurance covered patients Cost (VND) % Cost (VND) % Cost (VND) % Cost (VND) % Drugs for blood diseases treatment 1,985,962,641 7.83 5,395,334,137 4.21 2,439,714,181 8.66 8,105,449,464 5.27 Cardiovascular drugs 1,815,248,764 7.15 12,744,583,111 9.95 2,051,339,787 7.28 18,039,618,808 11.72 Gastrointestinal tract drugs 1,751,442,690 6.9 7,866,278,624 6.14 1,625,287,605 5.77 8,200,693,466 Anti-parasitic and anti-infection drugs 4,990,243,529 19.67 36,579,613,828 28.55 5,701,935,786 20.24 40,288,734,094 26.17 Cancer treatment and immunomodulatory drugs 8,129,715,140 32.04 31,466,546,830 24.56 9,137,610,282 32.44 39,501,255,924 25.66 Total of 05 drugs groups 18,672,612,764 73.59 94,052,356,530 73.41 20,955,887,641 74.39 114,135,751,756 74.15 Total 25,370,874,330 100 128,126,385,719 In terms of value: There was only one drug group used for military patients reduced in 2014 in comparison with 2013: Gastrointestinal tract drugs (about 126 million Vietnam dong), while there was an increase in value of all pharmacological groups using in patients covered by health insurance in 2014 For the major drug groups of high cost: cardiovascular, 100 28,166,355,506 100 153,923,078,993 5.33 100 anti-parasitic and anti-infection, gastrointestinal tract drugs, there was a difference in % of drug use between military patients and patients covered by health insurance The reasons were: The medical budget of military officers was allocated per year by National Defense budget according to hospital’s scale while medical cost of patients covered by health 83 Journal of military pharmaco-medicine no7-2019 insurance will be paid by health insurance law Therefore, the patients covered by social insurance can access further to the new drugs, expensive drugs, types of drugs more diversified On the other hand, the rate of treatment patients covered by health insurance was higher than that of military patients Evaluate the results of using high-cost drugs after intervention (2015 - 2016) * The change in the number of drug items used in 2015 and 2016: Table 3: Number of items of high-cost drug groups in 2015 - 2016 Year 2015 Year 2016 Military patients Health insurance -covered patients Military patients Health insurance covered patients Item number % Item number % Item number % Item number % Drugs for blood diseases treatment 49 3.91 63 3.86 53 4.42 70 4.31 Cardiovascular drugs 157 12.52 262 16.05 147 12.27 260 15.99 Gastrointestinal tract drugs 141 11.24 143 8.76 137 11.44 144 8.86 Anti-parasitic and anti-infection drugs 223 17.78 292 17.89 235 19.62 298 18.33 Cancer treatment and immunomodulatory drugs 91 7.26 143 8.76 91 7.59 139 8.55 Total of 05 drugs groups 661 52.71 903 55.33 663 55.35 911 56.04 1,254 100 1,632 100 1,198 100 1,626 100 Pharmacological group Total The above table presents in both military patients and patients covered by social insurance, main groups of drugs used in general hospital increased in both terms of quantity and percentage for 2013 - 2014 period However, the significant difference was only found in cancer treatment and immunomodulatory drugs and drugs for 84 blood diseases treatment This was entirely consistent with the functions, tasks and key techniques of 103 Military Hospital For the anti-parasitic and anti-infection drugs group, the percentage of the drug item decreased in 2015 but increased more than in 2016 This finding showed an increase in the number of drugs used in the hospital Journal of military pharmaco-medicine no7-2019 * Analyzing drug group treament according value of drug items: Table 4: Analysing drug group treatment of high-cost drugs in 2015 - 2016 period Year 2015 Pharmacological group Year 2016 Health insurance -covered patients Military patients Health insurance -covered patients Military patients Cost (VND) % Cost (VND) % Cost (VND) % Cost (VND) % Drugs for blood diseases treatment 2,406,568,574 6.59 9,768,223,556 5.86 1,910,970,144 5.61 10,555,476,355 5.47 Cardiovascular drugs 2,811,260,947 7.69 25,022,645,897 15.02 2,752,405,929 8.08 29,743,543,886 15.42 Gastrointestinal tract drugs 2,688,928,560 7.36 9,083,470,901 5.45 2,378,370,140 6.98 10,177,856,547 5.27 Anti-parasitic and antiinfection drugs 7,368,119,246 20.17 44,830,098,947 26.91 6,323,292,426 18.6 48,786,564,493 25.28 Cancer treatment and immunomodulatory drugs 13,215,622,127 36.17 38,154,570,016 22.90 13,632,302,874 40.0 47,888,363,783 24.82 Total of 05 drugs groups 28,490,499,454 77.98 126,859,009,317 76.14 26,997,341,513 79.23 147,151,805,064 76.26 Total 36,537,159,574 100 166,599,034,022 100 34,073,537,896 100 192,961,833,142 100 In terms of use value after intervention, the absolute values of use increased but by the percentage of the value of use, there were some changes, in particular: - Comparing between years 2015 and 2016, anti-parasitic and anti-infection drugs were used for the military patients had a statistically significant decrease (p < 0.05) Particularly the proportion of cardiovascular drugs group; gastrointestinal tract drugs, cancer treatment and immunomodulatory drugs increased, among of those the cancer treatment and immunomodulatory drugs increased significantly, because the number of cancer patients increased, the number of types of cancer treatment drugs use widely and a larger number of patients using anti-rejection drugs - Comparing 2015, 2016 with 2013 and 2014, the value of use as well as the % rate increased, consistent with the data collected from the hospital's medical examination and treatment - For patients covered by health insurance, drug groups, there was a decrease percentage of using value after intervention: drugs for blood diseases treatment, anti-parasitic and anti-infection drugs, cancer treatment and immunomodulatory drugs However, according to the percentage, there was no difference (p > 0.05) Particularly, the group of cardiovascular drugs, the increased percentage made difference because the types of drugs in the group increased CONCLUSION The groups of high-cost drugs have a tendency to increase gradually in both quantity of drug item and use value of drugs in 2013 to 2016 period However, this increase was due to an increase in 85 Journal of military pharmaco-medicine no7-2019 the number of patients treated and technical development orientation of the hospital: organ transplantation techniques, cardiology specialties including cardiovascular intervention, cancer In additionally, the lack of treatment guidelines of the hospital which limits the selection of drug type in hospital’s dug list because there was no legal basis for monitoring and evaluation activities In order to have effective interventions solutions, 103 Military Hospital needs to quickly develop a treatment guidelines (according to the guidance issued together with Decision No 4068 / QD-BYT dated 29 July 2016) to be able to monitor the high-cost drugs to ensure their use suitably, safely and effectively REFERENCES Department of Pharmaceutical Administration and Economics Pharmaceutical administration in hospital, Pharmaceutical economics curriculum Hanoi University of Pharmacy 2003, pp.290-302 Ministry of Health Circular 40/2014/TTBYT dated 17 November 2014 guiding on the implementation of the list of western medicines under the scope of payment of Health Insurance Fund 2014 86 Ministry of Health Manage and use drugs appropriately at clinical facilities Seminars Phu Yen, 11, May 2013 2013 Ministry of Health Circular 22/2011/TTBYT dated 10 June 10 2011, regulating the organization and operation of the pharmacy department in hospital 2011 Ministry of Health Circular 21/2013/TTBYT dated August 2013, regulating the organization and operation of the pharmacy and treatment council in hospital 2013 Dang Bich Viet, Vo Thuy Kieu, Nguyen Hoang Anh et al Safety signals of drugs with the highest health insurance costs in 2016: Analysis from ADR database report in Vietnam Journal of Research on Pharmacy & Drug Information 2018, (5), pp.17-24 Ministry of Health Decision number 2174/QD-BYT dated 21 June 2013 promulgating the national action plan on drug resistance prevention for the period 2013 - 2020 2013 Christiana Yaba Assessment of supply chain management in hospitals: A case study of greater accra regional hospital - ridge University of Ghana 2014, pp.12-54 A.L Chow A Ang C.Z Chow Implementation hurdles of an interactive, integrated, point-of-care computerised decision support system for hospital antibiotic prescription International Journal of Antimicrobial Agents (Singapore) 2016, pp.1-8 ... anti-infection drugs group, the percentage of the drug item decreased in 2015 but increased more than in 2016 This finding showed an increase in the number of drugs used in the hospital Journal of. .. regulating the organization and operation of the pharmacy department in hospital 2011 Ministry of Health Circular 21/2013/TTBYT dated August 2013, regulating the organization and operation of the. .. Particularly, the group of cardiovascular drugs, the increased percentage made difference because the types of drugs in the group increased CONCLUSION The groups of high-cost drugs have a tendency to increase