Consumption costs of inappropriate medicines estimated from bulk purchase data: The example of NSAids in Guatemala

In contexts where access to medicines is limited or troublesome, it may be important to identify the cases in which there exists access to medicines, but where this access is "inefficient" because it results in non-healing, avoidable toxicity or excessive cost in conditions of similar efficacy. Despite obvious limitations, bulk medicines purchase data of public institutions used to be the only available approximation on what is consumed in some countries. The aim of this study was to describe the results of a qualitative analysis of bulk consumption data, focusing on nonsteroidal anti-inflammatory drugs (NSAIDs) as an example.

The list of all drugs purchased by the Health Ministry of Guatemala in 2004 was quantitatively and qualitatively analyzed both according to the number of units and value. All NSAIDs bought during that period were analyzed in order to find potential intervention areas which could be addressed to improve drug selection.

The studied list included 693 products with a value of 102 million US dollars. Among the top-20 purchased medicines by defined daily doses (DDDs) were several NSAIDs (including aceclofenac, meloxicam and piroxicam). Ranitidine, ciprofibrate and dimethicone were also among these top-20 drugs. In addition, aceclofenac was among the top-20 drugs according to value. The cost of "second-line" NSAIDs was several times higher than the "first-line" diclofenac or ibuprofen. Providing equal efficacy and similar toxicity exists, a theoretical switch from second- to first-line NSAIDs could save up to 2,377 million US dollars/year.

Although it is an old and well-known method, the analysis of bulk consumption data continues to provide information that may help to identify areas of potential improvement in settings without many resources. In the present theoretical example, educative interventions addressed to rational selection of NSAIDs could save more than 2% of the annual drug expenditure of the country. Co-ordinated actions addressed to other drugs could decrease inefficient drug expenditure and improve the quality of health-care.