sahr2001 - Health Systems Trust

17 • Health and Related Indicators
Despite these problems, the selection of the top 25 drugs from the ABC analysis
presented does make it possible to identify the predominant cost drivers. The
predominant therapeutic groups represented were for chronic conditions (such
as hypertension, epilepsy, asthma and diabetes – 10 products), infectious
diseases (such as tuberculosis and sexually transmissible infections – 8
products), family planning (4 products), and vaccination (2 products). In
comparison, a similar exercise in Australia showed that of the top 10 drugs
for 2000/1 by cost to government, almost all were for chronic conditions,
many associated with an aging population - three were for high cholesterol,
two for ulcers and one for inflammatory conditions.
(http://www.australianprescriber.com/magazines/vol24no6/top_drugs.htm)
In time, more sophisticated measures of drug consumption will be needed,
such as the number of defined daily doses (DDD) of each drug issued per
100 000 population. However, if sufficient care is taken not to misinterpret
the data, several important lessons may be drawn. One striking example is
how the use of a new and relatively expensive, but nonetheless necessary,
item in only one province can account for a significant expenditure. Resistant
malaria in KZN has necessitated the introduction of the artemesinin product,
which now ranks 15 in national expenditure, costing in excess of R5.6 million
per annum. Expenditure on chronic conditions is also very high, with close
to R36 million spent on just one of the wide range of hypertension drugs
available (perindopril). Other agents for the same condition feature at numbers
10, 11 and 12, costing a further R22.8 million at least (excluding some
provinces).
Private sector data on drug expenditure are also almost impossible to gather
at a population level or per province as yet.
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