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Drug and Therapeutics Committee

Session 7B. Identifying Problems with Medicine Use: Aggregate Methods

Objectives Discuss the use of aggregate data including defined daily

dose in analyzing the consumption of medicines

• Perform ABC analysis and explain how it can be used to identify medicine use problems, reduce cost, and improve efficiency in the pharmaceutical supply system

• Discuss how VEN system for setting priorities will assist the DTC in medicine selection, purchasing, and inventory management

Outline—Part B Introduction Aggregate data

DDD VEN

ABC Analysis Activities 3–5 Summary

Methods to Investigate Medicine Use Indicator study methods

Use data collected at the individual level—patient, health facility Data insufficient to make judgments about appropriateness of a medicine

for a specific diagnosis

Aggregate data methods Use routine data (e.g., stock records) not collected at the individual patient

level Gives overview of medicine use and can highlight problem areas

In-depth investigation of medicine use Prescription audit, patient record review Drug use evaluation (DUE) (discussed in session 11) Qualitative methods to understand causes of a medicine use problem

(discussed in session 8)

Aggregate Data (1) Medicine use aggregate data sources

Procurement records

Warehouse medicine records

Pharmacy stock and dispensing records

Adverse drug reaction (ADR) and medication error reports

Patient medical records

Aggregate Data (2) Data that can be retrieved

Medicine consumption

Medicine availability

Medicine cost data

Frequency of use

Per capita use of specific product

Prevalence of ADRs

Prevalence of medication errors

Defined Daily Dose (1) The DDD methodology converts and standardizes readily

available product quantity data, such as packages, tablets, injection vials, bottles, into crude estimates of clinical exposure to medicines, such as the number of daily doses

A methodology that allows comparison of consumption of pharmaceutical products across hospitals, regions, and countries

Combines different medicine strengths and doses to provide one unit of consumption for each medicine for comparison of use

Defined Daily Dose (2) Defined globally by the WHO Collaborating

Center for Drug Statistics Methodology, Oslo, Norway http://www.whocc.no/atcddd/

Typically expressed as follows DDD per 1,000 inhabitant per day for total

medicine consumption DDD per 100 beds per day (100 bed-days),

for hospital use

Defined Daily Dose Example 1: Captopril District hospital and clinics use of captopril with 2,700,000 population

– 22,500,000 tablets yearly of captopril 25 mg– 3,000,000 tablets yearly of captopril 50 mg

Quantity of medicine used in 1 year multiplied by strength of the product = (22,500,000 × 25 mg) + (3,000,000 × 50 mg) = 712,500,000 mg

Divide total quantity by assigned DDD for that medicine (captopril = 50 mg ) = 712,500,000 / 50 mg = 14,250,000 DDDs

Divide total quantity by 2,700,000 population and multiply by 1,000 (this is the population denominator for this method) = (14,250,000 / 2,700,000 ) x 1,000 inhabitants = 5,278 DDD / 1,000 inhabitants / year 5,278 / 365 = 14.5 DDD / 1,000 inhabitants / day

Defined Daily Dose Example 2:Carbamazepine Use in South Africa, 2001 Annual consumption = 100 million x 200 mg tablets

= 20,000,000,000 mg = 20,000,000 g

Assigned DDD for carbamazepine = 1 g

No. DDDs consumed = 20,000,000/1= 20,000,000 per year = 20,000,000/365= 54,795 per day for population of 48,000,000= 54,795 / 48,000,000 = 0.0011 per person per day= 1.1 DDD per 1,000 population per day

VEN Analysis Method to prioritize for medicine purchase and stock

V–Vital Potentially lifesaving Crucial to providing basic health services

E–Essential Effective against less severe but significant

illness, but not vital

N–Nonessential For minor illnesses High cost and low therapeutic advantage

Conducting a VEN Analysis Step 1. Classify all medicine on the list as V, E, or N.

Step 2. Analyze the “N” items. Where possible, reduce quantities to purchase or eliminate them.

Step 3. Identify and limit therapeutic duplications.

Step 4. Reconsider proposed purchase quantities.

Step 5. Find additional funds if needed or possible.

VEN Applications for DTC

Identifies high-priority medicines for procurement

Identifies low-priority medicines that the DTC should analyze carefully for deletion from the formulary

Description VEN1 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S2 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG3 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES4 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S5 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML6 CLOXACILLIN SODIUM FOR INJECTION500MG7 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S8 DIAZEPAM TABLETS 5MG ;1000'S9 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S

10 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML11 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML12 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML13 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S14 LITHIUM CARBONATE TABLETS 250MG; 1000'S15 LOPERAMIDE 2MG TABLETS;6'S16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML18 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S19 PARACETAMOL TABLETS 500MG;500'S20 PERINDOPRIL TABLET 4MG;28'S21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML24 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE25 VITAMIN B6 TABLETS 25MG;500'S26 WATER FOR INJECTION PLASTIC;10ML

VEN Analysis, Activity, and Discussion

ABC Analysis Method for determining and comparing

pharmaceutical costs within the formulary system

“Separating the vital few from the trivial many”— Pareto principle

Tool for identifying many medicine use problems

Utilizes computer and appropriate software to run analysis

ABC Analysis: A, B, and C Medicines (1)

CategoryPercentage of

BudgetPercentage of

Medicines Ordered

A medicines 70–80% 10–20%

B medicines 15–20% 10–20%

C medicines 5–10% 60–80%

ABC Analysis: A, B, and C Medicines (2) A medicines—High percentage of funds spent on large-

volume or high-cost items Greatest potential for savings Greatest potential for identifying expensive medicines that

are overused

B medicines—Moderate cost and moderate number of items; important items

C medicines—Small amount of funds spent on the majority of the inventory

Applications of ABC Analysis for a DTC Measures the degree to which actual consumption reflects public health

needs and morbidity

Reduces inventory levels and costs by arranging for more frequent purchase or delivery of smaller quantities of class A items

Seeks major cost reductions by finding lower prices on class A items

Reduces inventory of items that have limited use in the system, but costs the system large amounts of money

Provides information for choosing the most cost-effective alternatives and finding opportunities for therapeutic substitution

Gathers information for pharmacoeconomic analysis

Steps in Performing ABC Analysis Step 1. List all items purchased and enter the unit cost.

Step 2. Enter consumption quantities for each item.

Step 3. Calculate the value of consumption for each item.

Step 4. Sort the list in descending order by total value.

Step 5. Calculate the percentage of total value represented by each item.

Step 6. Calculate the cumulative percentage of total value for each item.

Step 7. Choose cutoff points for A, B, and C.

ABC Step 1. List items and unit costs. TOTAL = 666,643 NO.ITEMS = 26

Pack Qty % ofDescription Price Issued Value Value

20 PERINDOPRIL TABLET 4MG;28'S R 20.08 3000 60,22613 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S R 61.65 800 49,32018 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S R 2.38 20000 47,5202 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG R 115.27 400 46,109

25 VITAMIN B6 TABLETS 25MG;500'S R 11.30 4000 45,2003 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES R 36.31 1200 43,572

23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML R 10.18 4000 40,70515 LOPERAMIDE 2MG TABLETS;6'S R 1.22 30000 36,46210 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML R 1.97 18000 35,38112 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML R 33.74 1000 33,7396 CLOXACILLIN SODIUM FOR INJECTION500MG R 2.81 12000 33,696

22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S R 42.46 700 29,7244 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S R 19.73 1500 29,5965 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML R 10.75 2500 26,865

26 WATER FOR INJECTION PLASTIC;10ML R 0.53 50000 26,72914 LITHIUM CARBONATE TABLETS 250MG; 1000'S R 224.64 65 14,6021 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S R 2.68 5000 13,3889 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S R 83.56 160 13,370

21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S R 7.24 1400 10,13019 PARACETAMOL TABLETS 500MG;500'S R 16.61 600 9,9687 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S R 1.91 3000 5,724

17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML R 5.66 1000 5,65911 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML R 11.18 500 5,58924 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE R 5.31 600 3,1888 DIAZEPAM TABLETS 5MG ;1000'S R 9.90 15 148

16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML R 0.68 50 34

ABC Steps 2 and 3. Calculate consumption quantities and values—sort list by descending values.TOTAL = 666,643 NO.ITEMS = 26

Pack Qty % ofDescription Price Issued Value Value

20 PERINDOPRIL TABLET 4MG;28'S R 20.08 3000 60,22613 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S R 61.65 800 49,32018 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S R 2.38 20000 47,5202 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG R 115.27 400 46,109

25 VITAMIN B6 TABLETS 25MG;500'S R 11.30 4000 45,2003 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES R 36.31 1200 43,572

23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML R 10.18 4000 40,70515 LOPERAMIDE 2MG TABLETS;6'S R 1.22 30000 36,46210 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML R 1.97 18000 35,38112 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML R 33.74 1000 33,7396 CLOXACILLIN SODIUM FOR INJECTION500MG R 2.81 12000 33,696

22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S R 42.46 700 29,7244 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S R 19.73 1500 29,5965 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML R 10.75 2500 26,865

26 WATER FOR INJECTION PLASTIC;10ML R 0.53 50000 26,72914 LITHIUM CARBONATE TABLETS 250MG; 1000'S R 224.64 65 14,6021 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S R 2.68 5000 13,3889 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S R 83.56 160 13,370

21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S R 7.24 1400 10,13019 PARACETAMOL TABLETS 500MG;500'S R 16.61 600 9,9687 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S R 1.91 3000 5,724

17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML R 5.66 1000 5,65911 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML R 11.18 500 5,58924 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE R 5.31 600 3,1888 DIAZEPAM TABLETS 5MG ;1000'S R 9.90 15 148

16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML R 0.68 50 34

ABC Step 4. Calculate the percentage of total value represented by each item.

TOTAL = 666,643 NO.ITEMS = 26Pack Qty % of Value

Description Price Issued Value Value Cum%20 PERINDOPRIL TABLET 4MG;28'S R 20.08 3000 60,226 9.03%13 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S R 61.65 800 49,320 7.40%18 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S R 2.38 20000 47,520 7.13%2 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG R 115.27 400 46,109 6.92%

25 VITAMIN B6 TABLETS 25MG;500'S R 11.30 4000 45,200 6.78%3 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES R 36.31 1200 43,572 6.54%

23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML R 10.18 4000 40,705 6.11%15 LOPERAMIDE 2MG TABLETS;6'S R 1.22 30000 36,462 5.47%10 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML R 1.97 18000 35,381 5.31%12 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML R 33.74 1000 33,739 5.06%6 CLOXACILLIN SODIUM FOR INJECTION500MG R 2.81 12000 33,696 5.05%

22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S R 42.46 700 29,724 4.46%4 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S R 19.73 1500 29,596 4.44%5 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML R 10.75 2500 26,865 4.03%

26 WATER FOR INJECTION PLASTIC;10ML R 0.53 50000 26,729 4.01%14 LITHIUM CARBONATE TABLETS 250MG; 1000'S R 224.64 65 14,602 2.19%1 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S R 2.68 5000 13,388 2.01%9 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S R 83.56 160 13,370 2.01%

21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S R 7.24 1400 10,130 1.52%19 PARACETAMOL TABLETS 500MG;500'S R 16.61 600 9,968 1.50%7 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S R 1.91 3000 5,724 0.86%

17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML R 5.66 1000 5,659 0.85%11 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML R 11.18 500 5,589 0.84%24 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE R 5.31 600 3,188 0.48%8 DIAZEPAM TABLETS 5MG ;1000'S R 9.90 15 148 0.02%

16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML R 0.68 50 34 0.01%

ABC Step 5. Rank items in descending order. TOTAL = 666,643 NO.ITEMS = 26

Pack Qty % of Value No. ItemsDescription Price Issued Value Value Cum% Cum%

20 PERINDOPRIL TABLET 4MG;28'S R 20.08 3000 60,226 9.03% 9.03%13 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S R 61.65 800 49,320 7.40% 16.43%18 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S R 2.38 20000 47,520 7.13% 23.56%2 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG R 115.27 400 46,109 6.92% 30.48%

25 VITAMIN B6 TABLETS 25MG;500'S R 11.30 4000 45,200 6.78% 37.26%3 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES R 36.31 1200 43,572 6.54% 43.79%

23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML R 10.18 4000 40,705 6.11% 49.90%15 LOPERAMIDE 2MG TABLETS;6'S R 1.22 30000 36,462 5.47% 55.37%10 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML R 1.97 18000 35,381 5.31% 60.68%12 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML R 33.74 1000 33,739 5.06% 65.74%6 CLOXACILLIN SODIUM FOR INJECTION500MG R 2.81 12000 33,696 5.05% 70.79%

22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S R 42.46 700 29,724 4.46% 75.25%4 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S R 19.73 1500 29,596 4.44% 79.69%5 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML R 10.75 2500 26,865 4.03% 83.72%

26 WATER FOR INJECTION PLASTIC;10ML R 0.53 50000 26,729 4.01% 87.73%14 LITHIUM CARBONATE TABLETS 250MG; 1000'S R 224.64 65 14,602 2.19% 89.92%1 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S R 2.68 5000 13,388 2.01% 91.93%9 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S R 83.56 160 13,370 2.01% 93.93%

21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S R 7.24 1400 10,130 1.52% 95.45%19 PARACETAMOL TABLETS 500MG;500'S R 16.61 600 9,968 1.50% 96.95%7 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S R 1.91 3000 5,724 0.86% 97.81%

17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML R 5.66 1000 5,659 0.85% 98.66%11 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML R 11.18 500 5,589 0.84% 99.49%24 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE R 5.31 600 3,188 0.48% 99.97%8 DIAZEPAM TABLETS 5MG ;1000'S R 9.90 15 148 0.02% 99.99%

16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML R 0.68 50 34 0.01% 100.00%

ABC Step 6. Calculate the cumulative percentage of total value for each item.

TOTAL = 666,643 NO.ITEMS = 26Pack Qty % of Value No. Items

Description Price Issued Value Value Cum% Cum%20 PERINDOPRIL TABLET 4MG;28'S R 20.08 3000 60,226 9.03% 9.03%13 ISONIAZID AND THIACETAZONE TABLETS 133MG AND 50MG;1000'S R 61.65 800 49,320 7.40% 16.43%18 PARACETAMOL AND CODEINE TABLETS500MG;8MG;20'S R 2.38 20000 47,520 7.13% 23.56%2 AMPHOTERICIN B FOR INJECTIONINTRAVENOUS;50MG R 115.27 400 46,109 6.92% 30.48%

25 VITAMIN B6 TABLETS 25MG;500'S R 11.30 4000 45,200 6.78% 37.26%3 BECLOMETHASONE DIPROPIONATE INHALER;50MCG/DOSE;200 DOSES R 36.31 1200 43,572 6.54% 43.79%

23 THIOPENTONE SODIUM INJECTION 0.5G/20ML;W/OUT DILUENT;MIXER VIAL;20ML R 10.18 4000 40,705 6.11% 49.90%15 LOPERAMIDE 2MG TABLETS;6'S R 1.22 30000 36,462 5.47% 55.37%10 GENTAMICIN SULPHATE INJECTION80MG/2ML;2ML R 1.97 18000 35,381 5.31% 60.68%12 INSULIN INJECTION:HUMAN;SOLUBLE 30%;ISOPHANE 70%;100IU/ML;10ML R 33.74 1000 33,739 5.06% 65.74%6 CLOXACILLIN SODIUM FOR INJECTION500MG R 2.81 12000 33,696 5.05% 70.79%

22 TEST STRIPS AND COLOR CHART,GLUCOSE IN BLOOD ACCUTREND;50'S R 42.46 700 29,724 4.46% 75.25%4 CARBAMAZEPINE 200MG TABLET;PATIENT READY PACK;84'S R 19.73 1500 29,596 4.44% 79.69%5 CHLORHEXIDINE GLUCONATE DETERGENT SOLUTION4%;SURGICAL SCRUB;500ML R 10.75 2500 26,865 4.03% 83.72%

26 WATER FOR INJECTION PLASTIC;10ML R 0.53 50000 26,729 4.01% 87.73%14 LITHIUM CARBONATE TABLETS 250MG; 1000'S R 224.64 65 14,602 2.19% 89.92%1 AMOXYCILLIN CAPSULES PATIENT READY PACK;250MG;15'S R 2.68 5000 13,388 2.01% 91.93%9 ETHAMBUTOL,RIFAMPICIN,ISONIAZID AND PYRAZINAMIDE TABLETS:225/120/60/300MG;100'S R 83.56 160 13,370 2.01% 93.93%

21 RESERPINE TABLETS PATIENT READY PACKS;0,25MG;14'S R 7.24 1400 10,130 1.52% 95.45%19 PARACETAMOL TABLETS 500MG;500'S R 16.61 600 9,968 1.50% 96.95%7 CO-TRIMOXAZOLE 480mg TABLETS PATIENT READY PACK;20'S R 1.91 3000 5,724 0.86% 97.81%

17 NUR-ISTERATE:NORETHISTERONE ENANTATE INJECTION LONG-ACTING;200MG/ML;1ML R 5.66 1000 5,659 0.85% 98.66%11 IBUPROFEN SUSPENSION:PAEDIATRIC;100MG/5ML;100ML R 11.18 500 5,589 0.84% 99.49%24 VACCINE POLIOMYELITIS;ORAL TRIVALENT;10 DOSE R 5.31 600 3,188 0.48% 99.97%8 DIAZEPAM TABLETS 5MG ;1000'S R 9.90 15 148 0.02% 99.99%

16 MERCUROCHROME SOLUTION; 1%; DROPPER BOTTLE; 20ML R 0.68 50 34 0.01% 100.00%

ABC Step 7. Choose cut-off points for ABC analysis chart.

0%10%20%30%40%50%60%70%80%90%

100%

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15%

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Cumulative No. of Items (%)

Cum

ulat

ive

Item

s Va

lue

(%)

Activities 3, 4, and 5 Activity 3. VEN Analysis—Performing a VEN

analysis Activity 4. Performing an ABC analysis—Identifying

high-cost medicines using an ABC analysis

Activity 5. Performing an ABC/VEN analysis using participants’ data

Summary A major function of a DTC is to identify medicine use

problems and to implement corrective measures

Aggregate methods are a useful way to gain an overview of medicine use problems using routine data not collected at the individual patient level.

Examples of a aggregate data methods include— DDD VEN analysis ABC analysis