E-drug: DDD for comparison of consumption
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In Norway the DDD-system has been applied to some extent within current
parts of the health sector for more than 20 years. It functions through
centrally, as well as locally based initiatives - depending on the
follow-up from either of these levels. In the hospital where I work, the
system has evolved as an indispensable tool for review of drug utilisation,
as well as future drug selection. In addition, assessment of the
procurement and pricing of drugs to a major part of public hospitals in
Norway is totally based on software containing price per DDD-unit for all
drug substances. Why not make a start by utilizing the WHO drug
registration software (ref. Valerio Reggie) ?
In Norway, the Drug Utilisation Statistics at the national level have been
published with data on drug consumption in value of money, - and quantity
(DDD) for more than 2 decades. However, the same figures have hardly been
analysed and reviewed by any representative and extensive
cross-professional setting as a follow-up.
In my opinion, the DDD-system is no more complicated to introduce than
normal price figures for the drugs. However, to experience this fact one
has to try for oneself ! A few key points should be highlighted to
experience a successful start:
1. The concept of DDD must be well known - not only by pharmacists, but
also by prescribers, economists and health administrators in the setting
being involved. The fact that 1 DDD is a mean calculated volume figure, -
not containing any professional dosage recommendation, must be repeatedly
stressed.
2. Globally - most drug substances have a DDD definition. Any setting
planning to make use of the DDD-measure, must distribute written
information to current personnel. The information should include a listing
with the DDD-definitions for all drugs being used in the setting. These
measures must also be introduced in current soft-ware.
3. A plan on the production of statistics on drug consumption (containing
figures of volume - DDD and economic expenditure) should be regularly
elaborated. These figures may also be related to the number of patients
receiving the different drugs, or (in a hospital setting) - the number of
treatment days for the respective drugs.
I would like to add some comments to Richard, Valerio and Stein:
Richard Laing:
The prospects of using price per DDD/generic substance (also named price
per DDD/ATC-5th Level) as an economic measure for fund utilisation, must be
stressed. In this manner you may reveal directly how your tendering
strategy is functioning - and the price differences between patented drugs,
branded generics and generically named products. If the ATC-drug
classification system is included in a drug committee setting, - the
economic evaluation could also include differences between related
substances.
Valerio Reggie:
WHO has been advertising the DDD concept for a long time, without much
practical impact in an increasingly liberalised global market setting. Do
you see any new initiatives from your side that may improve this situation.
?
Arthorn Riewpaiboon:
I think your plans are great. You should go ahead - also using the DDD as a
tool of price comparison in the hospital setting !
Stein:
I agree with you that ATC is a great tool. However - it is also possible to
take one step at the time. Start with DDD, and proceed with ATC. !
Good Luck to you all.
Guttorm Folkedal, Hospital Pharmacy Director
Sjukehusapoteket
5500 HAUGESUND - NORWAY
Tel/fax. - work: +47-52732581 / - - -87.
Tel.-home: ++ -52851109
E-mail/work: saihroga@online.no
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