E-drug: Drugs use indicators (5) (DDD for comparison of consumption)
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I should like to add two schematic comments to those sent by Richard
Laing and Arthor Riewpaiboon on the issue of the use of DDDs to analyse
drug consumption.
1) I think that the main reason why DDDs are not very widely used is the
amount of work that is required in order to make proper use of them. For
this reason, we have added a facility to the WHO drug registration software
package that permits to record the number of DDDs for each presentation of
drug products while issuing marketing authorizations. Only one national
regulatory authority has been using this tool. In this country, putting
together the necessary data for all the registered drugs has taken over two
years (including assigning DDDs for drugs that do not have one assigned by
the Oslo centre, entering data into the computer system, relating
registration data with importation data). Now information is readily
available to compare cost of a DDD of different brands of the same drug and
different drugs of the same therapeutic group and this helps with public
sector procurement strategies and treatment guidelines.
2) I tend to disagree with Richard Laing's statement that 'DDD data is
probably more useful for analyzing stock consumption data rather than for
record review'.
I think that comparison of consumption patterns and price is a 'natural'
component of any drug utilization study, and that DDD is a suitable
methodology for this comparison. The fact that hospitals - or whatever data
collection unit - use different price lists, just adds more flavour to
record review studies. It may permit to highlight price differences between
different brands or within the same brand of the same drug. Such finding,
in turn, would guide to identify problems - and perhaps solutions - in the
supply system, and - why not? - help identify areas where initiatives that
influence prescription/consumption could be focussed. In the end, what
other purpose for drug utilization studies?
Valerio Reggi
WHO, Geneva
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