Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

According to the National Drug Policy one of the health services objectives is to ensure the availability and accessibility of essential drugs to all citizens. An economic objective of the same policy is to promote the cost-effective and rational use of drugs (Department of Health, 1996). Currently, there is no system to scientifically determine the usage of medicines in the public sector and whether the current usage is satisfactory enough (John, 2004:2). The World Health Organization states that "good drug supply management is an essential component of effective and affordable health care services globally (World Health Organization, 1998:1). In the South African context, even though the Essential Drug List helps health care professionals to treat diseases in the public sector, it does not prescribe the minimum guidelines for medicine supply systems (Department of Health, 2006a). The general objective of this study was to develop a therapeutic medicine budget model in a district hospital in the public sector of the North-West Province to control medicine usage. This can be done after analysing the medicine usage patterns and then developing a framework for therapeutic budgeting by evaluating appropriate systems, i.e. the International Code for Disease (ICD-10) classification system, with the therapeutic budget model framework. Retrospective drug utilisation of six months (January 2007 until June 2007) was documented. A random sample population of 25% was selected (n = 1 494). After the data collection period of 9 weeks, the actual study population was only 18.67% (only 1 166 of the 1 494 patients files had a medicine history). All the medicine items prescribed were classified in the therapeutic budget model. Patient confidentially was assured by using a unique pin number on the survey form, so that no names of patients or other biographical details were collected from the patient files onto the survey form, which is in line with the requirements of the Ethics Committee approval conditions for the North-West University. The total number of medicine items dispensed during the study period was 11 768. The average cost per medicine item was R19.36 ± 86.79 for inpatients. The total number of consultations was 3 220. The average number of medicine items per consultation was 3.66 ± 1.98. The total cost of medicine items during the study period was R244 677.11. The average medicine cost per consultation for inpatients was R70.80 ± 177.72. The top three budget groups according to frequency represented 68.11% of all medicine used according to budget groups. The top three pharmacological groups according to total cost represented 61.68% of the total cost of pharmacological groups. The top three therapeutic codes according to frequency represented 18.75% of all therapeutic codes. The top three ICD-10 codes based on total cost represented 59.35% of all medical conditions diagnosed. The total hospital budget for 2007 was predicted at R3 276 750.00. Of this budget, 75% was for pharmaceuticals (R2 457 562.50). The total pharmaceutical medicine cost (excluding surgicals) from the study was R224 677.11 (this was for 18.67% of the total patient visits for six months) which can be calculated at R2 406 824.96 for all patients visits in a full year. The correlation between the actual budget and the projected budget showed a R50 737.54 surplus in the budget of the hospital. A therapeutic budget model can also help in achieving the following: • Proper preparation and planning of budgetary policies in a phased manner based on scientific evidence; • Evaluation of budgetary compliance, cost-efficiency of therapy and standard treatment guidelines (STG) / Essential Drug List (EDL) / formulary compliance; • Better procurement strategies based on demand, expenditure and inventory control; and • Better delivery and maintenance of quality health care by evaluating operational and clinical policies. The therapeutic budget model is a more appropriate manner to use in the projections of budgets and medicine usage. The scope of a therapeutic budget model to be implemented in the hospitals in the public sector of the North-West Province seems to be promising. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

HIV/AIDS treatment is costly. Lesotho as a resource–limited country depends mostly on donor funding for HIV/AIDS treatment and care. Knowledge of how much was spent on treatment of HIV/AIDS was lacking. This leads to overstocking of some ART medicines resulting in expiry. Sufficient funds need to be secured for the treatment programme. The main objective of the study is to assess the cost of antiretroviral medication treatments, by specifically assessing the cost of antiretroviral regimens, antiretroviral side effects, and the cost of medicines used for prophylaxis and treatment of opportunistic infections as well as the cost of monitoring laboratory tests and dietary supplements. The study engaged both public and private ART clinics in the Maseru District in Lesotho. The study population consisted of 1 424 patients and study period was between 12 and 56 months from January 2004 to August 2008. Retrospective observational method was used. The cost for HIV/AIDS treatment comprised the cost of antiretroviral medicines and those used for their side effects, opportunistic infections (OI) prophylaxis and treatment, dietary supplements as well as monitoring laboratory tests. Prescribed daily dose (PDD) was used to calculate the cost of all the medicines used. To determine significant differences in average costs for various regimens d– values were used, while a cost/prevalence index was used to determine whether the cost was worth spending on the population or not. Cost–effectiveness ratio was also utilized in order to assess whether the cost born was worth the benefit. The main findings revealed that regimens 1a (stavudine/lamivudine/nevirapine) and 1c (zidovudine/lamivudine/nevirapine) were the least expensive (cost/prevalence index of 0.6 and 0.7 respectively). Regimens containing efavirenz were found to be more expensive than those containing nevirapine (cost/prevalence index of 1.2 and 1.7 respectively). When using d–values, there was a significant difference between the cost of regimens 1a and 1b, 1a and 1d, 1c and 1d and the information could be used for regimen switching decisions. Increase in CD4 cell count was more in stavudine–based regimens than in zidovudine–based regimens, which cost less per treatment. Cost effectiveness ratio was lower in 1a with R9.42/1cell/mm3 of CD4 cell count increase, and the highest was 1d with R31.77/1cell/mm3 of CD4 cell count increase. Therefore it was concluded that stavudine–based regimens are less costly as they have the lowest cost– effectiveness ratio in the Lesotho clinic environment. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

According to the National Drug Policy one of the health services objectives is to ensure the availability and accessibility of essential drugs to all citizens. An economic objective of the same policy is to promote the cost-effective and rational use of drugs (Department of Health, 1996). Currently, there is no system to scientifically determine the usage of medicines in the public sector and whether the current usage is satisfactory enough (John, 2004:2). The World Health Organization states that "good drug supply management is an essential component of effective and affordable health care services globally (World Health Organization, 1998:1). In the South African context, even though the Essential Drug List helps health care professionals to treat diseases in the public sector, it does not prescribe the minimum guidelines for medicine supply systems (Department of Health, 2006a). The general objective of this study was to develop a therapeutic medicine budget model in a district hospital in the public sector of the North-West Province to control medicine usage. This can be done after analysing the medicine usage patterns and then developing a framework for therapeutic budgeting by evaluating appropriate systems, i.e. the International Code for Disease (ICD-10) classification system, with the therapeutic budget model framework. Retrospective drug utilisation of six months (January 2007 until June 2007) was documented. A random sample population of 25% was selected (n = 1 494). After the data collection period of 9 weeks, the actual study population was only 18.67% (only 1 166 of the 1 494 patients files had a medicine history). All the medicine items prescribed were classified in the therapeutic budget model. Patient confidentially was assured by using a unique pin number on the survey form, so that no names of patients or other biographical details were collected from the patient files onto the survey form, which is in line with the requirements of the Ethics Committee approval conditions for the North-West University. The total number of medicine items dispensed during the study period was 11 768. The average cost per medicine item was R19.36 ± 86.79 for inpatients. The total number of consultations was 3 220. The average number of medicine items per consultation was 3.66 ± 1.98. The total cost of medicine items during the study period was R244 677.11. The average medicine cost per consultation for inpatients was R70.80 ± 177.72. The top three budget groups according to frequency represented 68.11% of all medicine used according to budget groups. The top three pharmacological groups according to total cost represented 61.68% of the total cost of pharmacological groups. The top three therapeutic codes according to frequency represented 18.75% of all therapeutic codes. The top three ICD-10 codes based on total cost represented 59.35% of all medical conditions diagnosed. The total hospital budget for 2007 was predicted at R3 276 750.00. Of this budget, 75% was for pharmaceuticals (R2 457 562.50). The total pharmaceutical medicine cost (excluding surgicals) from the study was R224 677.11 (this was for 18.67% of the total patient visits for six months) which can be calculated at R2 406 824.96 for all patients visits in a full year. The correlation between the actual budget and the projected budget showed a R50 737.54 surplus in the budget of the hospital. A therapeutic budget model can also help in achieving the following: • Proper preparation and planning of budgetary policies in a phased manner based on scientific evidence; • Evaluation of budgetary compliance, cost-efficiency of therapy and standard treatment guidelines (STG) / Essential Drug List (EDL) / formulary compliance; • Better procurement strategies based on demand, expenditure and inventory control; and • Better delivery and maintenance of quality health care by evaluating operational and clinical policies. The therapeutic budget model is a more appropriate manner to use in the projections of budgets and medicine usage. The scope of a therapeutic budget model to be implemented in the hospitals in the public sector of the North-West Province seems to be promising. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

HIV/AIDS treatment is costly. Lesotho as a resource–limited country depends mostly on donor funding for HIV/AIDS treatment and care. Knowledge of how much was spent on treatment of HIV/AIDS was lacking. This leads to overstocking of some ART medicines resulting in expiry. Sufficient funds need to be secured for the treatment programme. The main objective of the study is to assess the cost of antiretroviral medication treatments, by specifically assessing the cost of antiretroviral regimens, antiretroviral side effects, and the cost of medicines used for prophylaxis and treatment of opportunistic infections as well as the cost of monitoring laboratory tests and dietary supplements. The study engaged both public and private ART clinics in the Maseru District in Lesotho. The study population consisted of 1 424 patients and study period was between 12 and 56 months from January 2004 to August 2008. Retrospective observational method was used. The cost for HIV/AIDS treatment comprised the cost of antiretroviral medicines and those used for their side effects, opportunistic infections (OI) prophylaxis and treatment, dietary supplements as well as monitoring laboratory tests. Prescribed daily dose (PDD) was used to calculate the cost of all the medicines used. To determine significant differences in average costs for various regimens d– values were used, while a cost/prevalence index was used to determine whether the cost was worth spending on the population or not. Cost–effectiveness ratio was also utilized in order to assess whether the cost born was worth the benefit. The main findings revealed that regimens 1a (stavudine/lamivudine/nevirapine) and 1c (zidovudine/lamivudine/nevirapine) were the least expensive (cost/prevalence index of 0.6 and 0.7 respectively). Regimens containing efavirenz were found to be more expensive than those containing nevirapine (cost/prevalence index of 1.2 and 1.7 respectively). When using d–values, there was a significant difference between the cost of regimens 1a and 1b, 1a and 1d, 1c and 1d and the information could be used for regimen switching decisions. Increase in CD4 cell count was more in stavudine–based regimens than in zidovudine–based regimens, which cost less per treatment. Cost effectiveness ratio was lower in 1a with R9.42/1cell/mm3 of CD4 cell count increase, and the highest was 1d with R31.77/1cell/mm3 of CD4 cell count increase. Therefore it was concluded that stavudine–based regimens are less costly as they have the lowest cost– effectiveness ratio in the Lesotho clinic environment. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.