AN ANALYSIS OF THE USAGE OF ANTIBIOTICS IN
THE PRIVATE HEALTH CARE SECTOR:
A MANAGED HEALTH CARE APPROACH
RENIER COETZEE
B.Pharm.
Dissertation submitted in partial fulfillment of the requirements for the
degree Magister Pharmaciae in Pharmacy Practice at the
North-West University.
Supervisor: Prof. M.S. Lubbe
Co-supervisors: Prof. J.H.P. Serfontein
Mr. W.D. Basson
2004
Potchefstroom
"Ons oog is nie op die sigbare dinge
gerig nie, maar op die onsigbare dinge;
want die sigbare dinge is tydelik,
maar die onsigbare ewig."
2 Kor. 4:18
I gratefully and humbly extend by sincere gratitude to the Almighty God for giving me
the strength, perseverance and courage to finish this study. I wish to express my
sincere gratitude to the many people who have contributed to this dissertation. The
following persons, however, deserve special mention and are acknowledged for their
assistance:
Prof. MS. Lubbe, in her capacity as supervisor, my appreciation for her excellent
guidance, advice and encouragement.
Prof. J.H.P. Serfontein and Mr. W.D. Basson, in their capacity as co-supervisors, my
appreciation for their willingness to assist and their expert guidance.
Medschemd for providing the database for this study.
The department of Pharmacy Practice, for financial and technical support.
My fellow M-students, Susan and Janine, for their assistance and encouragement,
My parents and family for their constant love and support.
0 To my loving fiancke, Marina, for all her patience, understanding and for believing in
me.
Abstract
Title: An analysis of the usage of antibiotics in the private health care sector: A managed
health care approach.
Key words: Antibiotics, beta-lactam antibiotics, managed health care, drug utilisation review,
pharmacoeconomics, prescribed minimum benefits, reference medicine price list, prevalence,
medicine treatment cost.
The most frequent intervention performed by physicians is the writing of a prescription. Modern
medicine has been remarkably effective in managing diseases. Medicines play a fundamental
role in the effectiveness, efficiency and responsiveness of health care systems. However,
health care expenditure is a great cause for concern and many nations around the world
struggle to contain rising health care costs.
Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation
review (DUR) and disease management have emerged as control tools to ensure cost effective
selection and use of medicine. These managed care instruments are often used to determine
whether new strategies or interventions, such as the implementation of a managed medicine
reference price list, are appropriate and have "value".
The general objective of this study was to investigate the influences of the implementation of a
managed medicine reference price list on the usage and cost of antibiotic medicine in the
private health care sector of South Africa.
The research design used in this study was retrospective, non-experimental and quantitative.
The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31
April 2003) from the central medicine claims database of Medschem&. Data was analysed
according to prevalence, cost and original (innovator) or generic medicine items. For the
purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and
"others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations,
quinolones, chloramphenicol and aminoglycosides.
The results of the empirical investigation showed the total number of medicine items claimed
during the study period amounted to 49098736 medicine items having a total expenditure of
R7150344897.00. There was a decrease in the prevalence of original (innovator) products
during the two-year period. The prevalence of generic products increased from 25.87% to
32.47%.
A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43
representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the
two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics
constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original
(innovator) products contributed 62.32% and generic products 37.68% to the total cost of all
antibiotics claimed.
It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed
(n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43)
for the two-year period. The average cost of beta-lactam items ranged between R112.88 *
69.95 and R122.18 + 81.42.
The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference
pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of
composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine
expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics
claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of
all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed
R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at
the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved.
Cost analysis indicated that it is possible to reduce health care costs by implementing strategies
with the aim to reduce medicine cost. Further research, however, is necessary and in this
regard recommendations for further research were formulated.
Opsomming
Titel: 'n Analise van die gebruik van antibiotika in die privaat gesondheidsorg sektor: 'n
bestuurde gesondheidsorg benadering.
Sleutelwoorde: Antibiotika, beta-laktam antibiotika, bestuurde gesondheidsorg,
medisyneverbruik hersiening, farmakoekonomie, voorgeskrewe minimum voordele, verwysings
medisyne prys lys, voorkoms, medisyne behandelingskoste.
Die mees algemeenste inte~ensie wat uitgevoer word deur dokters is die skryf van 'n voorskrif.
Moderne medisyne is merkwaardig effektief in die beheer van siektes. Medikasie beklee 'n
fundamentele plek in die mate waartoe enige gesondheidsorgsisteem effektief, toereikend en
met positiewe response funksioneer. Gesondheidsorg uitgawes bly egter 'n saak van erns en
talle volke regoor die w6reld strewe om die verhogende gesondheidsorg kostes te beheer.
Programme om farmasuetiese voordele te kontroleer het ontwikkel, soos farmako-ekonomie,
medisyneverbruik hersiening en siektebestuur, en dien as instrumente om koste-effektiewe
seleksie en verbruik van medisynes te bevorder. Navorsing word van tyd tot tyd in verband met
sodanige beheersisteme gedoen sodat vasgestel kan word of nuwe tegnologie of tussentrede
toepaslik en 'waardevoT sal wees.
Die algemene doel van hierdie studie was om die invloed van 'n bestuurde medisyne
verwysings prys lys op die gebruik en voorkoms van antibiotika in die privaat gesondheidsorg
sektor van Suid Afrika te bepaal.
Die navorsings metode wat gebruik is in hierdie studie was retrospektief, nieeksperimenteel en
kwantitatief. Die inligting vir die studiedoeleindes is van die sentrale databasis van
Medscheme verkry en die navorsing is oor 'n tydperk van twee jaar uitgevoer (1Mei 2001 tot
31 April 2003). Data is ontleed volgens voorkoms, koste en oorspronklik (innoverende) en
generiese medisyne items. Vir die doeleindes van die studie verwys antibiotika na beta-laktam
antibiotika (penisilliene, kefalosporiene en "ander"), eritromisien en ander makroliede,
tetrasiklien, sulfoonamiede en kombinasies, kinolone, kloramfenikol en aminoglikosiede.
Resultate van die empiriese studie het getoon dat 'n totaal van 49098736 medisyne items met
'n total koste van R7150344897.00 geeis is gedurende die twee-jaar studie periode. Daar was
'n verlaging in die voorkoms van oorspronklike (innoverende) produkte gedurende die Wee-jaar
periode. Die voorkoms van generiese produkte het verhoog vanaf 25.87% tot 32.47%
'n Totaal van 4092495 antibiotika medisyne items is geis met 'n totale koste van
R526309279.43 en het 7.36% (n = R7150344897.00) van alle farmaseutiese produkte wat
g&is is gedurende die bee-jaar tydperk verteenwoordig. Oorspronklike antibiotika het 'n
voorkoms van 42.32% gehad, tewyl generiese antibiotika 57.67% van alle antibiotika produkte
wat g&is is (n = 4092495) uit gemaak het. Tog, oorspronklike (innoverende) antibiotika het
62.32% en generiese produkte 37.68% begedra tot die totale koste van alle antibiotika wat
g&is is.
Daar is tot gevolgtrekking gekom dat beta-laktam antibiotika 56.99% van alle antibiotika (n =
4092495) verteenwoordig het en het 52.51% bygedra tot die totale antibiotika koste (n =
R526309279.43) vir die bee-jaar periode. Die gemiddelde koste vir beta-laktam items het
gewissel tussen R112.88 + 69.95 en R122.18 + 81.42.
Die Medschema Prys Lys (MPL) is in Mei 2001 gei'mplementeer. Die doel met hierdie
verwysings prys sisteem was om aan 'n bepaalde groep middles, wat gelyk is in samestelling,
kliniese effektiwiteit, veiligheid en kwaliteit, 'n plafon prys toe te ken met die hoofdoel om
mediysne uitgawes te verlaag. Gedurende die jaar wat die MPL ge'implementeer is, het 62.24%
van die beta-laktam antibiotika items wat g&is is op hierdie lys voorkgekom. Hierdie produkte
het 43.25% bygedra tot die totale koste van alle beta-laktam antibiotika (n = R157142778.38).
Mediese fonds maatskappye het R61649211.86 vir alle penisilliene wat geeis is en wat op die
MPL gelys was uit betaal. lndien alle penisillien produkte geeis is volgens die plafon prys soos
bepaal deur die MPL, kon dit 'n koste besparing van 2.79% teweeg gebring het.
Koste analyse het getoon dat dit moontlik is om gesondheidsorg kostes te verlaag met behulp
van strategic wat ten doel het om medisyne kostes te verlaag. Verdere navorsing is egter
nodig en aanbevelings vir verdere navorsing in hierdie verband word gemaak.
Table of contents
List of tables
List of figures
Chapter 1
lntroduction
Problem statement
Research questions
Research objectives
General objectives
Specific objectives
Research method
Phase one: Literature review
Phase two: Empirical investigation
1.5.2.1 Selection of research design
1.5.2.2 Composition of the research population
1.5.2.3 Selection and application of measuring instrumentdcriteria for data analysis
1.5.2.4 Data application and data analysis
1.5.2.5 Reliability and validity of the research instruments
1.5.2.6 Reports and discussion of the results of the empirical investigation
1.5.2.7 Conclusions, recommendations and limitations of the study
1.6 Division of chapters
1.7 Chapter summary
Chapter 2
2.1 lntroduction
2.2 Health care in South Africa
2.2.1 The publics health care system in South Africa
2.2.2 Public health care expenditure in South Africa
2.2.2.1 Financial resources
2.2.3 The private health care system in South Africa
Table of contents
2.2.3. I Medical schemes
2.2.3.2 Medical scheme coverage
2.2.3.3 Medical scheme legislation
2.2.4 Private health care expenditure in South Africa
2.3 Health care expenditure
2.3.1 Increasing pharmaceutical expenditure
2.3.2 Average cost per prescription
2.3.3 Reasons behind increasing pharmaceutical expenditure
2.4 Rational use of drugs
2.5 Brand name products vs. generic products
2.5.1
Quality assurance of generic products
2.5.2 Overview of the use of generic products
2.5.2.1 Generic substitution in Europe
2.5.2.2
Generic substitution in the United States of America
2.5.2.3 Generic substitution in South Africa
2.5.3 Economics of generic products
2.6 Managed health care
2.6.1 Prescribed minimum benefits
2.7 Pharmaceutical reference-based pricing
2.8 Essential drugs
2.8.1 The concept of essential drugs
2.8.1.1 Definition of an essential drugs list
2.8.1.2 Advantages of an essential drugs list
2.8.2 Guidelines for establishing a national programme for essential drugs
2.8.3 Criteria for the selection of essential drugs
2.8.4 Quality assurance
2.9 Pharmacoeconomics
2.9.1 Pharmacoeconomic evaluations
2.9.1.1 Perspective of phannacoeconomic evaluations
2.9.1.2 Costs
2.9.1.3 Outcomes
2.9.2 Type of pharmacoeconomic evaluations
2.9.2.1 Cost-minimisation analysis (CMA)
2.9.2.2 Cost-effectiveness analysis (CEA)
2.9.2.3 Cost benefits analysis (CBA)
2.9.2.4 Cost-utility analysis (CUA)
Table of contents
2.9.2.5 Cost-of-illness (COI)
2.9.3 The purpose and importance of pharmacoeconomics
2.10 Drug utilisation review
2.10.1 Classification of drug utilisation review
2.10.1.1 Quantitative drug utilisation review
2.10.1.2 Qualitative drug utilisation studies
2.10.1.3
Combination of quantitative and qualitative drug utilisation studies
2.10.2 Types of drug utilisation review studies
2.10.2.1 Retrospective drug utilisation review
2.10.2.2 Concurrent drug utilisation review studies
2.10.2.3 Prospective drug utilisation review studies
2.10.3 Defining the unit of measurement
2.10.3.1 Cost data
2.10.3.2 Prescription volume
2.10.3.3 Defined daily dose
2.10.4 Criteria used in drug utilisation studies
2.10.4. I Classification of criteria
2.10.5 The purpose and importance of drug utilisation studies
2.1 1 Chapter summary
Chapter 3
Introduction
An overview of antibiotics
The prevalence of infectious diseases
Definition of antibiotics
Prescribing habits for antibiotics
Physicians' prescribing habits
Reasons behind prescribing habits
Cost of antibiotics
Antimicrobial resistance
The biochemical basis of resistance
The genetic basis of resistance
Factors contributing to resistance
Treating resistance effectively
Some principals of antimicrobial therapy
Decision making regarding antibiotic therapy
3.5.2 Minimum inhibitory concentration
3.6 Drug classification
3.6.1
The Anatomical Therapeutic Chemical (ATC) classification system
3.6.1.1
Structure of Anatomical Therapeutic Chemical (ATC) classification system
3.6.2 Defined Daily Dose (DDD)
3.6.2.1
Principles for Defined Daily Dose assignment
3.6.3 Other classification systems
3.6.4 Classification of antibiotics
3.7 Pharmacology of antibiotics
3.7.1 Penicillins
3.7. I. 1 Antimicmbial action
3.7.1.2 Pharmacokinetics and administration
3.7.1.3 Clinical uses
3.7.1.4 Adverse effects of penicillin
3.7.1.5 Other beta-lactam antibiotics
3.7.2 Cephalosporins
3.7.2. I Antimicmbial action
3.7.2.2 Pharmacokinetics and administration
3.7.2.3 Clinical uses
3.7.2.4 Adverse effects of cephalosporins
3.7.3 Erythromycin and other macrolides
3.7.3.1 Antimicrobial action
3.7.3.2 Pharmacokinetics and administration
3.7.3.3 Clinical uses
3.7.3.4 Adverse effects of erythromycin
3.7.4 Tetracyclines
3.7.4.1 Antimicmbial action
3.7.4.2 Pharmacokinetics and administration
3.7.4.3 Clinical uses
3.7.4.4 Adverse effects of tetracycline
3.7.5 Chlorarnpheniwl
3.7.5.1 Antimicrobial action
3.7.5.2 Pharmacokinetics and administration
3.7.5.3 Clinical uses
3.7.5.4 Adverse effects of chloramphenicol
3.7.6 Aminoglywsides
3.7.6. I Antimicrobial action
3.7.6.2 Pharmacokinetics and administration
3.7.6.3 Clinical uses
3.7.6.4 Adverse effects of aminoglycosides
3.7.7 Sulphonamides
3.7.7.1 Antimicrobial action
3.7.7.2 Pharmacokinefics and administration
3.7.7.3 Clinical uses
3.7.7.4 Adverse effects of sulphonamides
3.7.8 Quinolones
3.7.8.1 Antimicrobial action
3.7.8.2 Pharmacokinetics and administration
3.7.8.3 Clinical uses
3.7.8.4 Adverse effects of quinolones
3.8 Chapter summary
Chapter 4
4.1 Introduction
4.2 Research objectives
4.2.1 General research objectives
4.2.2 Specific research objectives
4.2.2.1 Specific research objectives of the literature review
4.2.2.2 Specific research objectives of the empirical investigation
4.3 Research methodology
4.3.1 Research design
4.3.2 Selection and composition of the study population
4.3.2.1 The database
4.3.2.2 Selection of criteridmeasuring instruments for the data analysis
4.3.2.3 Classification systems
4.3.3 Statistical analysis of the data
4.3.3.1 Variables analysed
4.3.3.1.1 Prevalence
4.3.3.1.2 Medicine cost
4.3.3.1.3 Prevalence and cost of original and generic drugs
4.3.3.2 Computer and soffware used
4.3.3.3 Statistical methods
4.3.4 Reliability and validity of the data
Table of contents
4.4 Reports and discussion of results 87
4.5 Conclusions, recommendations and limitations
4.6 Chapter summary
Chapter 5
5.1 Introduction
5.2 Discussion of the results
5.2.1 Comments of interest with the interpretation of the results
5.2.2 Presentations of results
5.3 General analysis
5.3.1 Prevalence and cost of medicine
5.3.2 Prevalence and cost of original and generic medicine
5.3.3 Prevalence and cost of the top ten main pharmacological groups
5.4 Specific analysis
5.4.1 Prevalence and cost of antibiotics
5.4.2 Prevalence and cost of original and generic antibiotics
5.4.3 Prevalence and cost of different antibiotic pharmacological groups
5.5 Analysis of beta-lactam antibiotics
5.5.1 Prevalence and cost of beta-lactam antibiotics
5.5.2 Prevalence of top ten individual beta-lactam products
5.5.2.1 Penicillins
5.5.2.2 Cephalosporins
5.6 The Medschema Price List (MPL)
5.6.1 Penicillins
Amoxycillin
Cost and prevalence of original and generic products
Cost and prevalence of individual products
Amoxycillin/clavulanic acid combinations
Cost and prevalence of ofiginal an generic products
Cost and prevalence of individual products
Amoxycilliinmucloxacillin combination
Ampicillin
Ampicillin/cloxacillin combination
Cloxacillin
Flucloxacillin
Table of contents
5.6.1.8 Penicillin VK 128
5.6.2 Cephalosporins 128
5.6.2.1 Cefaclor 128
5.6.2.1.1 Cost and prevalence of original and generic products 128
5.6.2.1.2 Cost and prevalence of individual products 129
5.6.2.2 Cefadroxil 129
5.6.2.3 Cephalexin 129
5.6.3 "Other" beta-lactam antibiotics 129
5.7 Summary of results 130
5.8 Chapter summary 133
Chapter 6
6.1 Introduction 134
6.2 Conclusions 134
6.2.1 Conclusions deduced from the literature review 134
6.2.2 Conclusions deduced from the empirical investigation 135
6.3 Recommendations 139
6.4 Limitations and shortcomings of the research 140
6.5 Chapter summary 140
Glossary
Bibliography
Appendices
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
Appendix G
Appendix H
Appendix I
vii
Table of contents
Appendix J
Appendix K
List of tables
Table 2.1:
Table 2.2:
Table 2.3:
Table 2.4
Table 2.5:
Table 2.6:
Table 2.7:
Table 3.1 :
Table 3.2:
Table 5.1:
Table 5.2:
Table 5.3:
Table 5.4:
Table 5.5:
Table 5.6:
Table 5.7:
Table 5.8:
Table 5.9:
Table 5.10:
Table 5.1 1 :
Table 5.12:
Table 5.13:
Table 5.14:
Public health sector expenditure, 199611997 - 199811999 (R million, I99912000
prices) (Thomas et a/., 2000: 5).
Sources of comprehensive public health sector financing, 1996 - 1999 (R million,
real I99912000 prices) (National Health Accounts, 2000: 27).
Distribution of medical schemes by size (Council for Medical Schemes, 2003:
46).
Distribution of beneficiaries in medical schemes (Council for Medical Schemes,
2003: 44).
Cost saving per unit of prescribed drug per generic substitution across
therapeutic categories (Moti & Kreling, 1997: 11).
Possible forms of managed care interventions (South African Health Review,
1998: 1).
Pharmacoeconomic methodologies (Bootman eta/., 1996: 9).
Possible mechanisms of resistance to antimicrobial agents (Sanders & Sanders,
1995: 15).
Main groups of the Anatomical Therapeutic Chemical classification (Persson &
Stram, 2002: 2).
General analysis of the medicine claims database. May 2001 to April 2003.
Medicine items and cost. May 2001 to April 2003.
Prevalence and cost of original and generic medicine. May 2001 to April 2003.
Cost index of the top ten pharmacological groups.
Prevalence and cost of the top ten pharmacological groups. May 2001 to April
2003.
Analysis of antibiotics on the medicine claims database. May 2001 to April 2003.
Prevalence and cost of antibiotics. May 2001 to April 2003.
Prevalence and cost of original and generic antibiotics. May 2001 to April 2003.
Cost and prevalence of the different antibiotic pharmacological groups.
Prevalence and cost of antibiotic pharmacological groups. May 2001 to April
2003.
Prevalence and cost of beta-lactam antibiotics. May 2001 to April 2003.
Prevalence of the top ten beta-lactam products for each period. May 2001 to
April 2003.
Beta-lactam antibiotic expenditure. May 2001 to April 2003.
Summary of data. May 2001 to April 2003.
List of figures
Figure 2.1 :
Figure 2.2:
Figure 5.1:
Figure 5.2:
Figure 5.3:
Figure 5.4:
Figure 5.5:
Figure 5.6:
Figure 5.7:
Managed health care concepts (Serfontein & Hein, 1999).
Models of managed health care (Council for Medical Schemes, 2003: 4).
Prevalence of original and generic products. May 2001 to April 2003.
Prevalence of the top ten main pharmacological groups. May 2001 to April 2003.
Cost percentages of the top ten main pharmacological groups. May 2001 to April
2003.
Cost-prevalence index values of the antibiotic pharmacological groups. May
2001 to April 2003.
Prevalence and cost percentages of beta-lactam antibiotics. May 2001 to April
2003.
Cost index-values of beta-lactam antibiotics. May 2001 to April 2003.
Prevalence of top ten beta-lactam products. May 2001 to April 2003.
Chapter 1
Introduction
1 .I INTRODUCTION
The focus of this dissertation is on the effects of a managed reference price list on the cost and
usage of antibiotics in the private health care sector in South Africa by using a medicine claims
database.
1.2 PROBLEM STATEMENT
The most frequent intervention performed by doctors is the writing of a prescription (Ronchon,
1997: 1096). This is to be expected, since modern medicine has been remarkably effective in
managing diseases.
The previous Minister of Health, Dr Nkosazana Dlamini Zuma (Department of Health, 1996),
stated:
"Drugs have bestowed enormous health benet%s on people all over the world. They have
transformed the treatment and prevention of many diseases thus effecting the saving of many
lives and greatly improving the quality of life."
However, health care expenditure is a great cause for concern. According to Sardinha (1997:
I), nations around the world struggle to contain rising health care costs. In most cases drug
costs are the primary target of reform.
Health care spending in the United States of America rose to $1.3 trillion dollars and an average
of $4,637 per person during 2000. As a percentage of the Gross Domestic Product, it grew
from 13.1% to 13.2% from 1999 to 2000. Spending on health services in the United States of
America increased in the public and private health care sectors at almost identical rates, 6.9%
and 7.0% respectively (Levit et aL, as quoted by Stanton, 2002:2).
In the United States of America the average annual health insurance premium in the private
sector rose to $2,655 for single coverage and $6,772 for family coverage in the year 2000. This
presents an increase of 33.3% for single coverage and 36.7% for family coverage, since 1996
(Stanton, 2002:l). According to the Council for Medical Schemes (2003a: 46) the South African
private sector the total expenditure has an average annual growth rate of 15.5%.
Chapter 1: Introduction
P
In Western Europe medical costs increased by an average of 4.1% each year between 1970
and 1990. The rate of economic growth during the same period increased by 2.7% annually
(Belien, 1996:95).
South Africa is devoting increasing amounts to health care. During 1998 to 1999 South Africa
spent R70.2 billion on health care. This represented 8.8% of the gross domestic product (GDP)
(Doherty et a/., 2002: 2). According to Goudge eta/. (2001: 71), health expenditure has grown
annually by 16% between 1996 and 1998.
The high inflation rate on medical costs is due to volume and price. Unnecessary medication
usage escalates volume and, not utilizing cost-effective medicine, increases prices (Anon.,
2002). According to Stanton (2002: 3), growth rates are driven by factors such as increased
use of health care services, general price inflation, inflation in the prices of medical services and
an aging population.
Health care in South Africa is divided into the public sector and the private sector. The share of
the gross domestic product controlled by public and private financing intermediaries were
respectively 3.6% and 5.2% during 1998 to 1999 (Doherty et a/., 2002: 6). In this context,
problems are still experienced by large sections of the South African population in accessing
health care services and enjoying quality care.
There are four main sources of finance for health care in South Africa: government, households,
employers and donors or non-governmental organizations. Government is the largest source of
health care finance, contributing 44.2% of the total sources and household funding the second
largest source of health care finance, contributing 39.0% of the total sources (Doherty et a/.,
2002: 3).
The National Drug Policy (Department of Health, 1996: 3), states that the private sector in South
Africa consumed 48.5% of the total health expenditure during 1992 to 1993 and was
responsible for 80% of the total expenditure on drugs in 1990.
According to Rehana et a/. (1991: I), antibiotics are the most frequently prescribed drugs on the
market and as a group account for 15% to 30% of the total health budget worldwide. Mediscor
(2002: 9-10) revealed that in 2002 beta-lactam antibiotics were among the top twenty-five
therapeutic classes, contributing 3.8% to the total expenditure on medicines.
In a study done in the public sector, by Paruk et a/. (1999:1), in the Kwazulu Natal province in
South Africa, a large percentage (54%) of prescriptions contained antibiotics. A great
percentage of prescribed antibiotics in this study were listed on the National Essential Drug List
(96.79%) and were prescribed by their generic name (71%).
It is clear that strategies to reduce the cost of drugs must be implemented. A wide range of
strategies have been introduced and evaluated in countries around the globe. Fairfield et a/.
(1997: 1823) stated that managed health care implements a variety of methods to finance and
organize the delivery of comprehensive health care in which an attempt is made to control cost
by controlling the provision of services. Emphasis should, however, be placed on the fact that
while constraining cost, managed care should also maintain and improve the quality of medical
care.
1.3 RESEARCH QUESTIONS
The following research questions can be formulated based on the forgoing discussion:
What does health care in South Africa, as well as internationally, entail?
Which factors contribute tot the high health care costs in the private health care sector of
South Africa, as well as internationally?
LI What influences does the new legislations have on medicine cost in the private heaith care
sector?
Does generic substitution have an effect on medicine cost?
What does pharmacoeconomics, drug utilisation review and managed health care entail?
LI What are the implications of a managed medicine reference price list in the private sector?
0 What is the basic pharmacology of antibiotics?
0 What are the differences in the utilisation patterns and costs of drugs in general before and
after implementation of the Medscheme Price List?
LI What are the differences in the utilisation patterns and costs of antibiotic drugs before and
after implementation of the Medscheme Price List?
LI What are the difference in prevalence and costs of original products vs. generic products
that has been claimed before and after implementation of the Medschemem Price List for
drugs in general and antibiotic drugs specificallp
0 What are the differences in the utilisation patterns and cost of beta-lactam antibiotics before
and after the implementation of the Medscheme Price List?
LI What are the cost savings that could have been incurred if beta-lactam antibiotics were sold
at MPL prices?
Chapter I: Introduction
1.4 RESEARCH OBJECTIVES
This research embraces general and specific objectives.
1.4.1 General objectives
The general research objective of this study is to investigate the influence of the implementation
of a managed medicine reference price list on the usage and cost of medicine in general in the
private health care sector in South Africa with special reference to antibiotics.
1.4.2 Specific objectives
The specific research objectives include activities as listed below:
Conceptualise from the literature what health care in South Africa entail, as well as
internationally.
Determine from the literature which factors contribute tot the high health care costs in the
private health care sector of South Africa, as well as internationally.
o lnvestigate from the literature the influences of the new legislation on medicine cost in the
private health care sector.
Review the influences of generic substitution on the prevalence and cost of medicine.
Conceptualise from literature the concepts of pharmacoeconomics, drug utilisation review
and managed health care.
0 Determine the implications of a managed medicine reference price list in the private sector.
n Review the basic pharmacology of antibiotics.
o lnvestigate the differences in the utilisation patterns and costs of drugs in general before
and after implementation of the Medschema Price List.
0 lnvestigate the differences in the utilisation patterns and costs of antibiotic drugs before and
after implementation of the Medschema Price List.
o Determine and compare the difference in prevalence and costs of original products vs.
generic products that has been claimed before and after implementation of the Medschemee
Price List for drugs in general and antibiotic drugs specifically.
o lnvestigate the differences in the utilisation patterns and cost of beta-lactam antibiotics
before and after the implementation of the Medschema Price List.
o Determine the cost savings that could have been incurred if beta-lactam antibiotics were
sold at MPL prices.
1.5 RESEARCH METHOD
The research method consists of two phases in conjunction with the specific research
objectives, namely a literature review and an empirical investigation.
1.5.1 Phase one: Literature review
The aim of the literature review is to identify methods that are implemented internationally and
nationally to contain the cost of medicine. A brief discussion on managed health care will be
included. The usage of antibiotics in the private health care sector and different mechanisms
that are implemented to reduce cost will be considered. A discussion of the pharmacology of
antimicrobials and antimicrobial resistance will also form part of the literature review.
1.5.2 Phase two: Empirical investigation
The empirical investigation constitutes several steps, namely: the selection of the research
design, the composition of the research population, the selection and application of the criteria
and measuring instruments for data analysis, data application and data analysis, reliability and
validity, the report and discussion of the results of the empirical investigation, and the
conclusion and recommendations based on the results of the empirical investigation as well as
the limitations of the investigation.
1.5.2.1 Selection of research design:
In order to achieve the aim of the study, namely to review, analyze and interpret patterns of
drug utilization as well as to analyze the costs associated with the usage of antibiotics, a
qualitative, retrospective (refer to paragraph 2.10.2.1), drug utilisation research design (refer to
paragraph 2.1 0. I. I) was selected.
1.5.2.2 Composition of the research population:
The research population consisted of patients whose date were obtained from the central
medicine claims database of Medschemd, during the period May 2001 to April 2003. The total
study population comprised of all the patients that had used one or more antibiotics during the
specific period of the study.
1.5.2.3 Selection and application of measuring instruments/criten'a for data analysis:
The prevalence of antibiotic usage, the costs associated with its usage, as well as the innovator
and generic forms of antibiotics were selected and utilised as measuring instrumentslcriteria for
data analysis in order to achieve the objectives of the empirical investigation.
1.5.2.4 Data application and data analysis:
The application of the data was achieved by viewing the criteria retrospectively, there after the
data were analysed by means of SAS@ 8.2 (SAS. Institute lnc., 1999 - 2002).
1.5.2.5 Reliability and validity of the research instruments:
The data utilized in this study were obtained from a medicine claims database, thus no direct
manipulation of the data was possible. It was assumed that all the data obtained from the
central database were valid and correct.
1.5.2.6 Report and discussion of the results of the empirical investigation:
The report and discussion of the results of the empirical investigation are illustrated graphically
or in tables, in order to ensure clarity and to achieve the set aims of the empirical investigation.
A detailed overview of the reports and discussion will follow in chapter five.
1.5.2.7 Conclusionq recommendations and limitations of the study:
The conclusions of the study, based on the results of the literature review and the empirical
investigation, as well as the recommendations derived from this study on the usage patterns of
antibiotics will be discussed in chapter six. Attention will be brought to the limitations
encountered during the study throughout chapters four and five with a further detailed
discussion of these limitations in chapter six.
1.6 DIVISION OF CHAPTERS
The division of chapters will be as follows:
Chapter 1: Introduction
Chapter 2: Health Care and Health Care Concepts
Chapter 3: Antibiotic Usage
Chapter 4: Empirical Investigation
Chapter 5: Results and Discussion
Chapter 6: Conclusions, Recommendations and Limitations
Chapter 1: Introduction
1.7 CHAPTER SUMMARY
In this chapter the problem statement, research questions and objectives, research method and
division of chapters were discussed.
In the following chapter health care in South Africa as well as health care concepts, such as
drug utilisation review (DUR) and pharmacoeconomics, will be discussed.
Chapter 2
Health care and health care concepts
2.1 INTRODUCTION
In the following chapter health care in South Africa as well as health care concepts will be
discussed. A discussion on pharmacoeconomics and drug utilisation review studies will also
form part of this chapter.
2.2 HEALTH CARE IN SOUTH AFRICA
The South African health care system has been under an ongoing revolution for the past few
years. The aim of these changes was to improve inequities in the accessibility and availability
of health care services and to fund a higher level of health care. The South African health care
system consists of a large public sector and a smaller private sector. The public health care
sector is under great pressure to deliver health care services to about 80% of the population
(Anon., 2004a: 1). The private health sector serves about 20% of the population, yet it has over
60% of all the doctors and more than half of all the nurses. Furthermore, more than 60% of all
health expenditure is consumed by the private health care sector (Schneider, 2000: 1).
2.2.1 The public health care system in South Africa
Poverty and unemployment in South Africa make it difficult for most people to pay for health
services. Widespread poverty and the growing gap between the rich and poor continue to
hamper social development. While absolute poverty had declined, with the percentage of
people living below the national poverty line falling from 51.1% in 1995 to 48.5% in 2002, close
to 22 million South Africans were still considered poor (Integrated Regional Information
Networks, 2004: 1). The actual number of people dependent on the public health care sector
has grown by 6.5 million since 1995 (Ntuli & Day, 2004: 3).
Further, aids, tuberculosis and cholera are some of the diseases that place an enormous strain
on the South African public health care system (Anon.. 2004b: 1).
During the last ten years the government of South Africa developed a national health plan for
the country (Ntuli & Day, 2004: 5) with the aim to decentralise the health care system into
district health systems and to assure that a standard primary health care package is available to
all (Connolly, 2002: 1). Primary health care for every citizen and free health care for pregnant
women and for children under six formed the basis for reaching this goal together with the
8
Chapter 2: Health care and health care concepts
creation of a single comprehensive, equitable and integrated national health system (Ntuli &
Day, 2004: 1-2).
The structure for the implementation of a national health care system is based on primary health
care and operated by district health systems. The National Department of Health oversees the
system of nine provincial health departments. The individual provinces have their own ministers
and leaders (Connolly, 2002: I). There are 42 health regions and 162 health districts in South
Africa (Anon., 2004: 1).
According to Connolly (2002: I), a decentralised health care system allows the provincial
governments the ability to customise the health care systems to their unique cultural groups,
while the national Department of Health assures that all health districts conform to the national
health policy. The primary goal of the South African health care system is to ensure that all
citizens have access to proper health care.
A unified health system capable of providing quality health care to all would be achieved
through the implementation of a broad range of policies and strategies including (Forman et ab,
2004: 14):
Decentralising the management of health services with an emphasis on the creation of a
district health system.
P Increasing access to services by making primary health care available to all.
Ensuring the availability of safe, good quality essential drugs in health facilities.
o Rationalising health financing through budget reprioritisation.
According to Ntuli and Day (2004: 2) one of the major challenges in implementing the primary
health care approach has been to strengthen the multi-sectoral vision. The lack of basic
infrastructure has been a major stumbling block in reaching this goal.
2.2.2 Public health care expenditure in South Africa
During 1996 and 1999 the public health care sector expenditure increased by R1.7 billion,
reaching a total expenditure of R70.2 billion during 199811999 (Doherty et a/., 2002: 2). The per
capita expenditure for 199811999 was R29 lower than in 499711998, but R10 higher than in
199611997, In 199811999 public health care financing expenditure amounted to 4.1% of the
gross domestic product (GDP) and 15.1% of the overall budget. These percentages were lower
than I99611997 of 4.3% of the gross domestic product (GDP) and 15.8% of the overall budget
(Thomas et a/., 2000: 6).
Chapter 2: Health care and health care concepts
Though there was a drop in financial resources in 199811999 the public health sector's financial
resources increased during 1992 and 1999 with 9% per annum (National Health Accounts,
2000: 28).
Expenditure in the public health sector according to Thomas et a/. (2000: 5), is displayed in
Table 2.1
Table 2.1: Public health sector expenditure, 199Wl997-1998/1999 (R million, 1999/2000
prices) (Thomas et a/., 2000: 5).
23 438 25 689 30 941
199611997
84% 100%
-
Narmw- Expenditure through the national and provincial Department of Health
# Broad - Narmw together Wh expenditure by lacal authorities and provincial departments of works
4 Comprehensive - Broad together with expenditure by other national depatiments and funds of
of other provincial departments.
According to Ntuli and Day (2004: 3) the per capita spending annually at primary care level
ranges from R389 to R42. However, the basic primary health care package recommended by
the Department of Health (excluding HIV-related services) is estimated to cost around R220.
2.2.2.1 Financial resources
According to Thomas et al. (2000: 6), one of the main reasons for the decrease in public health
expenditure is the sources of funds. Sources of comprehensive public health sector financing in
South Africa are general taxation, local authority revenue, user fees from households, provincial
government and donors. General taxation is the largest funding source in the public health
sector accounting for 94% of the total. In sub-Saharan African countries donors play a crucial
part in funding health care. In South Africa donors accounted for less than 1% of public health
care funding.
Chapter 2: Health care and health care concepts
Table 2.2: Sources of comprehensive public health sector financing, 1996-1999 (R
million, real 1999/2000 prices) (National Health Accounts, 2000: 27)
In 199611997 R29244 million of the total public health care sector financing was contributed
through general taxation, while donors contributed only R18 million. There was an increase in
the total contribution from donors to R68 million during I99811999 (National Health Accounts,
2000: 27).
2.2.3 The private health care system in South Africa
There has been an overall lack of growth in medical scheme coverage since 1996. This is due
to slow employment growth and escalation of medical scheme contributions in South Africa
(Harrison, 2004: 297). Private health care in South Africa is provided by a large for-profit sector
and a small workplace-based health care system. There are also a few private charitable health
care institutions that are partly or mainly funded by the State. The Workers' Compensation
Fund and the Road Accident Fund fall under the control of the Department of Labour and
Transport respectively. The private health care sector in South Africa is mainly situated in
urban areas. Not all financing of private health care emanates from medical scheme
contributions. In the poorer communities a significant proportion of out-of-pocket spending goes
to private health care. In the lowest income categories, less than one fifth of private health care
consultations are covered by insurance (Soderlund et al.. 1998: 2).
2.2.3.1 Medical schemes
During the past few years the Medical Schemes Council and government have implemented a
few control measures to control private sector medical schemes (Ntuli & Day, 2004: 4).
Medical schemes are non-profit organisations that are controlled by a board representing their
members. Registered medical schemes and Bargaining Council schemes are the two main
categories of medical schemes in South Africa. Registered medical schemes are those that fall
fully under the regulatory control of the Medical Scheme Act (131 of 1998), while Bargaining
Council schemes are those schemes that are not able to comply fully with the Medical Scheme
Act (131 of 1998) and are granted exemptions from certain of its provisions. Over the past few
years many exempted schemes have acquired registered scheme status (Doherty & McLeod,
2002: 2-3).
2.2.3.2 Medical scheme coverage
Private health care in South Africa is inaccessible to most of the population. During 1995 only
18% of the population in South Africa had access to medical aid coverage (Sodurlund et al.,
1998: 1). According to Ntuli and Day (2004; 3) the medical scheme population decreased to
15.2% in 2002.
Members of medical schemes were predominantly from high-income groups and consisted
mainly of the white population (Sodurlund eta/., 1998: 1). Due to rapid upward job mobility in
the black population there has been an increase in membership. The proportion of the black
population with medical aid coverage increased from 24% in 1991 to 36% in 1995. Medical
scheme membership in older age groups, however, decreased in all population groups. This
places a great burden on the public health sector, because the elderly generally have high care
requirements (Bradshaw, 1998: 3).
The Council for Medical Schemes (2003a: 46) stated that more than half of the schemes have
less than 6000 members and were considered small. In open schemes, 58.4% were large,
while 68% of restricted schemes were small.
Table2.3: Distribution of medical schemes by size (Council for Medical Schemes, 2003a:
46).
(~6000 members)
Medium
(>6000 members but C30000 beneficiaries)
Large
(30000 w mwe beneficiaries
Total
~1~~~
1~~~~
The percentage of the population that are beneficiaries of a medical scheme has increased
since 1996, though the medical scheme population is decreasing as a percentage of the total
population (Goudge et a/., 2001: 74). In 1998 there was a 0.2% decrease in the total
beneficiaries. According to the Council for Medical Schemes (2003a: 43) in 2002 the number of
beneficiaries declined with 0.89% compared with 2001. Though there was an increase of
0.97% in principal members in 2002, the number of dependants decreased with 1.8%, resulting
in a drop in total beneficiaries. In 2002 the total number of beneficiaries of medical schemes
were 6962914, with a dependant ratio of 1.53 (Harrison, 2004: 294).
In 2001 two thirds of medical schemes were restricted schemes, while the remaining were open
schemes. Restricted schemes accept members belonging to the employer or industry that set
them up. Open schemes are open to the general public. In the 1990s beneficiaries were
roughly evenly distributed between the two types of schemes. In 2001 71% of registered
beneficiaries were located in open schemes. (Doherty 8 McLeod, 2002: 3). For 2001 there has
been an increase in the membership of open schemes (growth rate of 6%) and a decrease of
7% in membership of other schemes (restricted, non-reporting and exempted) (Goudge et al.,
2001: 75). According to the Council for Medical Schemes (2003a: 43) in 2002 the number of
principal members in open schemes increased by 1.2%, while the number of dependants
decreased by 2%. The same trend was noted for restricted schemes. The number of principal
members increased by 0.5%, while the number of dependants decreased by 1.4%.
Table2.4: Distribution of beneficiaries in medical schemes (Council for Medical Schemes,
2003a: 44).
.
'Total membership for 2001 restated due to late or non-submission of statutory returns.
Chapter 2: Health care and health care concepts
2.2.3.3 Medical Scheme legislation
The medical scheme industry was deregulated in 1989 and 1993 through legislation passed by
the previous government. Amendments to the medical scheme legislation aimed to deal with
cost escalation. During 1982 and 1992 medical scheme contributions have risen steadily from
7.1% of the average salary to 15.2% (Doherty & McLeod, 2002: 1). The Medical Schemes Act
(131 of 1998) further sought to promote non-discriminatory access to medical scheme coverage
(Harrison, 2004: 292), which was passed in November 1998 (Pearmain, 2000: 1).
According to the Council for Medical Schemes (2003a: I) a new set of regulations governing
managed health care activities in South Africa took effect on 1 January 2003, by way of
amendment to the general regulations made in terms of the Medical Schemes Act (131 of
1998). These changes also impact on further amendments to the regulations relating to the
content and delivery of the prescribed minimum benefits (PMBs). The objectives of the
prescribed minimum benefits are to avoid incidents where patients lose their medical scheme
coverage in the event of serious illness (Harrison, 2004: 292).
Benefits offered by medical schemes for the elderly and sick were greatly diminished in
consequence of the 1993 de-regulation. Medical schemes only attracted the young and healthy
and as a result of this discouraged membership by high-risk individuals and groups through
contribution loadings on the basis of risk profile. The "new Acr determines that contributions
are made on the basis of income level and/or number of dependants. This has the potential for
cross-subsidisation (Pearmain, 2000: 184).
To ensure non-discriminatory access to medical scheme coverage the 'new Acr requires that
medical schemes have to maintain minimum reserve levels as a percentage of gross annual
contributions, increasing incrementally to 25% (Harrison, 2004: 292).
According to Pearmain (2000: I) the amendments to the Medical Schemes legislation of 1998
aim to improve private health care in the following ways:
a Compulsory minimum benefit packages for all members on chronic medication.
a Prohibiting discrimination on the basis of age, medical history and health status.
a Requiring that contributions be determined only on the basis of income and/or number of
dependants.
0 Enabling schemes and hospitals to have and agreement for the provision of minimum
benefits to its members with payment for hospitals.
a Forbidding schemes from excluding applicants except on certain prescribed conditions.
a Regulating administrators and other contractors to medical schemes.
Chapter 2: Health care and health care concepts
2.2.4 Private health care expenditure in South Africa
More than 50% of the total health care spending in South Africa is consumed by the private
health care sector, though less than 18% of the total population have access to private health
care (Sodurlund etal., 1998: 1). Private health care in South Africa had an expenditure growth
rate of 16% between 1996 and 1998. This was two times higher than the Consumer Price
Index (CPI) with an annual growth rate of 7% (Goudge etal., 2001: 71).
The National Drug Policy (Department of Health, 1996: 3) stated that the private sector in South
Africa consumed 48.5% of the total health expenditure during 1992 to 1993 and was
responsible for 80% of the total expenditure on drugs in 1990.
According to the Council for Medical Schemes (2003a: 46-47) the total expenditure on health
care in the private medical scheme sector increased in 2002, representing an average annual
growth of 15.5%. The ratio of expenditure per capita by medical schemes to public sector
provincial health spending has risen from 4.5 in I99711998 to 7.1 in 200212003 (Harrison. 2004:
4). Medical scheme contributions have increased by 7.1% in 2002 (Blecher & Thomas, 2004:
285).
The Council for Medical Schemes (2003a: 46-47) also stated that the bulk of the expenditure in
2002 went to hospitals, which accounted for 32.4% of the overall expenditure. Medicines
accounted for 23.5%, medical specialists 20.2% and general practitioners 8.5%.
Health expenditure flows from the original sources through financial intermediaries to the
providers. The largest intermediary is medical schemes with 73% of the funds and the second
largest is out-of-pocket expenditure from households with 22.5%. It is considered to be an
underestimate. Out-of-pocket expenditure by medical scheme members is higher (16.1%) than
by non-medical scheme members (6.4%). Out-of-pocket spending by medical scheme
members is increasing due to shrinking benefit packages and increased co-payments (Goudge
eta/., 2001: 71).
Chapter 2: Health care and health care concepts
2.3 HEALTH CARE EXPENDITURE
The Organisation for Economic Co-operation and Development (OECD) consists of thirty
member countries and has relationships with more than seventy other countries, and as a group
share a commitment to democratic government and the market economy. According to the
OECD (2004: I) the increase in health spending has driven the share of health expenditure as a
percentage of the GDP up from an average 7.8% in 1997 to 8.5% in 2002. This is in sharp
contrast to the period 1992 to1997, when the share of GDP spent on health remained almost
unchanged.
According to the Agency for Healthcare Research and Quality (2002: I), the United States of
America spends a large share of its gross domestic product (GDP) on health care and it
continues to be the fastest growing component of the Federal budget. During 1999 to 2000
health care spending has grown to 13.2% of the gross domestic product (GDP) (Stanton,
20023: 2), while in 2002 it reached 14.6% (Organisation for Economic Co-operation and
Development. 2004: 1). The total amount that was spent on health care for 2000 in OECD
countries was an estimated $1.3 trillion dollars (Stanton, 2002: 2). The overall health care
spending per capita of $4900 in 2001 was more than twice the OECD average of $2100
(Organisation for Economic Co-operation and Development, 2003:l).
In Western Europe health care spending is the fastest growing segment of government
spending. During 1970 to 1996 government spending has risen from 36.5% to 51% of the gross
domestic product (GDP). It has been determined that medical costs have risen by 4.1%
annually for the period 1970 to 1990 in ten Western Europe countries (Belien, 1996: 95).
The Japanese people can receive equal quality of medical care for the same kind of benefits.
The insured person must pay 20% of the medical expenses on hislher visit for each illness. In
1997 the percentage of the national health expenditure to the Gross Domestic Product was
7.2%. Population increase, costly revision of reimbursement for professional services, aging of
population, technological innovation and others are the main factors contributing to the increase
in health expenditure in Japan (Akaho eta/., 2001: 201-203).
A high proportion of the gross domestic product (7.9%) was absorbed by the South African
health care sector between 1990 and 1997. This was much higher than the average for middle-
income countries, of 4.4%, and not far from the norm of high-income countries, 9%. South
Africa displayed high expenditure per capita with poor access to basic primary health care
(National Health Accounts, 2000: 3).
Chapter 2: Health care and health care concepts
.
In South Africa in 2002 medical scheme contributions per beneficiary were R 6214 per annum,
while in the public sector the total amount per capita was R5364. The ratio of public sector
health expenditure to medical scheme contributions per beneficiary for the same period was
l:7.1 (Harrison, 2004: 297).
2.3.1 Increasing pharmaceutical expenditure
"Serious illness is a major reason why poor populations remain trapped in poverty. Either they
cannot afford health care or else its cost is so high that they are pushed into debt and
dependency. The knock-on effects are many and long lasting. Parents cannot afford to send
their children to school, working days are lost and economic productivity declines. In countries
hit hardest by diseases such as malaria and HIV/AIDS, development has ceased altogether."
(World Health Organization Medicines Strategy: 2000-2003: I).
Rapid advances in medical technologies, ageing population and rising public expectations were
largely responsible for the health spending growth, which was particularly notable in the area of
pharmaceuticals. Between 1992 and 2002, spending on pharmaceuticals grew, on average, 1.3
times faster per year than total health expenditure, rising to account for between 9% and 37% of
total health spending in OECD countries in 2002 (Organisation of Economic Co-operation and
Development, 2004: I).
Health care costs present major challenges to public expenditure policies. Pharmaceutical
expenditure is rising more rapidly than the general inflation rate in most advanced countries.
According to Stanton (2002:l) health care organisations are implementing strategies to reduce
the current levels of growth in health care expenditure without reducing access to needed health
care services or creating unnecessary burdens for providers. Health care expenditure is a great
cause for concern. According to Sardinha (1997: 1) nations around the world struggle to
contain rising health care costs. In most cases drug costs are the primary target of reform.
The increase in public and private spending on pharmaceuticals has been one of the main
drivers of rising health expenditure in many OECD countries. Pharmaceutical spending rose by
more than 70%, in real terms, and now account for more than 10% of total health spending in
nearly all OECD countries. In countries like France and Italy pharmaceuticals account for more
than 20% of total health spending (Organisation for Economic Co-operation and Development,
2003:2).
Chapter 2: Health care and health care concepts
According to the Department of Health of the United Kingdom (2003: 13-15), the Gross
expenditure on drugs for the period of 1998 to 1999 was £4 356 million. The percentage real
term growth for the period 1990 to 1999 was 69.5%. The cost of drugs per prescription in
199811999 was £8.30. an increase of 0.6% from 199711998 to 199811 999.
In South Africa the private sector accounted for nearly 80% of the total expenditure on
pharmaceuticals, though the public sector consumed more than 50% of the total pharmaceutical
consumption. About 32% of medical scheme expenditure is accounted for by medicines (Folb
et a/., 1995: 1).
2.3.2 Average cost per prescription
According to the Council for Medical Schemes (2003a: 5) the average expenditure per item per
annum during 2002 in South Africa was R153.6, with an average of 13 items per beneficiary.
Campbell (2004: 1) states that the average cost per prescription is influenced by a number of
factors. Three of these factors are average cost per brand prescription, average cost per
generic prescription and utilisation rate of brand-name products versus generic products.
The average cost per prescription in a few countries, states and cities are presented as follows:
Arkansas, United States of America: an increase of $24.57 from 1990 up until 2000 to
$41.87 per prescription (Anon., 2000: 1).
United Kingdom: For a branded product the average cost per prescription is €26.36 and for
generic products the average cost per prescription is €5.25 (Winaver, 2003: 1). According to
the England Department of Health (2004: 2) the average cost per prescription increased with
9.7% between 2002 and 2003.
According to the Generic Pharmaceutical Association (2002: I), in the United States of
America the average cost of a brand name prescription was $72.70 while the average cost
of a generic prescription was $16.85 during 2001.
Kentucky, United States of America: Since 1992 the average cost per prescription for the
elderly increased with 48%. In 2000 the average cost per prescription for the elderly was
$42.30. The projected average cost per prescription for 2010 will be $72.94 (Kentucky State
Senate, 2001: 1).
o lndia: Study done on prescribing practices in an urban area revealed that the average cost
per prescription was Rs.150.6, which is expensive for the average person staying in lndia
(Mhetre eta/., 2003: 316-317).
The age of the patient might also have an influence on the average cost per prescription. During
the 1990s, the price of most prescription drugs commonly used by seniors increased much
more than the increase in the overall cost of living as measured by the Consumer Price Index
(CPI) in the United States of America. The average cost per prescription also increased faster
than the overall price index and the indices for other basic necessities (Fiscal Policy Institute for
USAction, 2000: 1).
2.3.3 Reasons behind increasing pharmaceutical expenditure
The Organisation for Economic Co-operation and Development (2003: 1) states that countries
are spending record amounts on health care, largely due to rising cost of pharmaceuticals and
the diffusion of modern medical technologies.
According to loannides-Demos et a/. (2002: 578) the main factors that increase pharmaceutical
expenditure are:
o Price inflation.
0 Substitution of usually older (less expensive) treatments by generally newer (more
expensive) treatments.
0 Increasing number of available drug interventions and an increasing number of drugs shown
to be cost effective when compared with other interventions.
o An increase in elderly patients requiring multiple drug therapy.
Mediscor (2002: introduction) states that in South Africa the significant underlying causes for the
increase in costs are:
The growing demand for prescription medicines to treat the increasing prevalence of chronic
diseases within an ageing medical scheme.
o Consumer awareness and expectations that all medicines should be accessible and
covered by medical schemes.
o The entry into the market of new members previously not exposed to the concept of
managed care.
lncreased abuse and misuse of medicine benefits by scheme members.
o Inability of some medical schemes to control the appropriate use of medicines by members.
o lncreased therapies to treat opportunistic diseases caused by HIVIAIDS.
Akaho et a/. (2001: 209) states that medical expenditure has been inflated by various factors.
One major factor is overmedication that not only injures health by drug interactions and side
effects, but also wastes medical care resources and insurance funds. Rational prescribing by
health workers is urgently needed for future development of medical care.
Chapter 2: Health care and health care concepts
2.4 RATIONAL USE OF DRUGS
From the beginning of time man was interested in human health and illnesses. Yet as recently
as fifty years ago penicillin, the first antibiotic, and choloquine, the first modem antimalarial,
were discovered. Oral contraceptives have generally been available for only thirty years (Quick,
et a/.. 1997:5). The most frequent intervention performed by doctors is the writing of a
prescription (Ronchon, 1997: 1096). This is to be expected, since modern medicine has been
remarkably effective in managing diseases.
Although most industrialized countries have regular access to pharmaceutical care, people in
many parts of the world cannot benefit from simple, safe, effective pharmaceuticals. During the
1970s it was estimated that 60% to 80% of people in developing countries lacked regular
access to most essential drugs (Quick et a/., 1997: 5). Each year millions of people die
because of acute respiratory infections, diarrheal diseases, malaria, pregnancy-related anemia
and other common conditions that can be prevented with essential drugs (Quick, et a/., 1997:
5).
Though, once access to drugs is assured, proper use remains a challenge, since waste by both
prescribers and users is common. Both prescribers and users are prone to overuse of drugs.
The notion that if one drug is good, two will be better dies hard. The quantities of drugs
prescribed for a given illness are often far more than what are reasonably needed (Quick, eta/.,
1997: 21).
This control of health care expenditure takes place against the background of serious problems
with the use, misuse and overuse of medication in our existing health care system (Walters &
Smart, 1994:820). Many issues manifest themselves as various medicine-related problems and
result in serious and often preventable morbidity and mortality. The Director-General of the
World Health Organisation mentioned that up to 75% of antibiotics are prescribed
inappropriately, even in academic hospitals in developing countries. Worldwide an average of
only 50% of patients take their medication correctly (Brundtland, 1999). Statistics from the
United States Food and Drug Administration indicated in 1987 that
12 000 deaths and 15 000 hospital admissions were associated with adverse reactions to
prescription medicines. It was further found that 10% of hospital admissions were due to non-
compliance at a cost of $25 billion. The cost to the USA economy in 1992, due to failure in
taking prescription medication correctly, was an astronomical $100 billion and approximately
55% of prescription medicines were used incorrectly (Van Niekerk, 1994). The cost associated
with inappropriate use of medicines by ambulatory patients has not been fully identified in South
Africa. In 1999, Moodley et a/. (1999) reported that 155 of 281 geriatric patients, attending
Chapter 2: Health care and health care concepts
outpatient's clinics at Addington Hospital, experienced one or more adverse drug reactions with
their medication. In a series of 5674 prescriptions for outpatient psychiatric patients in the North
West Province, Saley et a/. (1999) identified 1123 (19.79%) prescriptions with possible drug-
drug interactions and of these, 13.09% with possible severe, suspected outcomes.
An important aspect in the South African health care system is the high incidence of usage of
traditional practitioners. According to the Department of Health (1998b) 75% of the population in
South Africa consult traditional healers before consulting Western health care services.
According to Quick et a/. (1997: 21), half of the world's drugs are wasted because of irrational
use. Proper use need to be promoted for an effective health policy and well-managed economy.
The emphasis is on the need for the public to understand and use drugs better, particularly in
view of all that is known about nonadherence to treatment. Irrational use often resulted from
lack of proper information and training.
In 1996 the production volume of all drug products in Japan was 1.75 times more and for
prescription drugs it was 1.73 times more than that of 1980. In 1997 antibiotics, metabolic
drugs, central nervous system drugs and cardiovascular drugs represented 52.3% if the total
production volume. Over the counter drugs, used to treat mild disorders, have shown a
decrease in the number of sales. Less money is spent on self-medication than before. The
sales volume of over the counter drugs is lower than that of the United States of America and
major European countries. In Japan it accounts for 15% of the total drug market (Akaho eta/.,
2001: 207-208).
In a study to investigate the rational use of antibiotics in in-patients in district hospitals in
Mashonaland, it has been reported that 16.5% of prescriptions were irrationally prescribed.
Further, 85.86% of these were irrationally indicated and the remainder irrational due to incorrect
dosing (Chikerema & Kasilo, 1994: 1). The Director-General of the World Health Organisation,
Dr Brundtland (1999), mentioned that up to 75% of antibiotics are prescribed inappropriately,
even in academic hospitals in developing countries.
Chapter 2: Health care and health care concepts
2.5 BRAND NAME PRODUCTS VS. GENERIC PRODUCTS
A generic medicine is an equivalent of an originator pharmaceutical product. It contains the
same active ingredient as the originator product. Therefore they are interchangeable (European
Generic medicine Association. 2004a: 1). Pharmaceutical manufacturers are entitled to
produce generic medicines after the patent on an original product has expired. In the United
States, patented products are given a 20-year market monopoly (Moore & Harvey, 2002: 1).
2.5.1 Quality assurance of generic products
A generic product is of the same quality, efticacy and safety as the original product and
undergoes strict analysis before it is registered and given market approval by the authorities
(European generic medicine Association, 2004b: 1). In South Africa the Medicines Control
Council (MCC) is a statutory body that was established in terms of the Medicines and Related
Substances Control Act (10111965) to oversee the regulation of medicines in South Africa. Its
main purpose is to safeguard and protect the public through ensuring that all medicines that are
sold and used in South Africa are safe, therapeutically effective and consistently meet
acceptable standards of quality (Health Systems Trust, 2003: 1).
The European generic medicine association (2004a: 1) encourages pharmaceutical
manufacturers to produce pharmaceutical ingredients and medicinal products of a high
standard. Once a generic product has been approved for human use, the manufacturer and
health authorities monitor it closely.
Generic products undergo strict bioequivalence studies before registration takes place.
Bioequivalence means that the product to be compared produces essentially the same
biological availability of the active substance in the body when given in the same quantity
(European Generic medicine Association, 2004: 1).
2.5.2 Overview of the use of generic products
According to Quick (2002: 1-2) one-third of the world's population lack regular access to
essential drugs. There is, however, a less expensive alternative for combating this problem: the
usage of generic medicine. Though 60% of countries worldwide have generic substitution laws,
true generics are less than one-third of consumption in all but a handful of countries.
Chapter 2: Health care and health care concepts
Quick (2002: 2) further states that to be able to expand generic substitution the following are
required:
P Supportive regulations.
o Reliable quality assurance.
o Professional and public acceptance.
o Financial incentives.
2.5.2. I Generic substitution in Europe
Generic medicines are increasingly prescribed by physicians as effective alternatives to higher-
priced original products in many countries in Europe (European Generic medicines Association,
2004a: 1). Though European governments promote the use of generic medicine, many states
are far from maximising their potential for savings from generic medicines. In many European
countries generics make up as much as 70% of all medicines prescribed in terms of volume,
while in value terms generics represent only 30% of pharmaceutical expenditure (European
Generic medicines Association, 2004d: 1).
At the end of 2005 the new European Union legislation for pharmaceuticals will come into effect.
This will have a major impact on generic medicine since it will (European Generic medicines
Association, 2004d: 1):
o Encourage generic registration before patent expiry.
0 Allow marketing of generics where branded pharmaceuticals have been withdrawn for
commercial reasons.
o Provide a more efficient system for the registration of generic medicines.
o Ensure greater harmony between generic medicines and original products.
0 Provide clear scientific and legal definitions of generic and biosimilar medicines.
2.5.2.2 Generic substitution in the United States of America
During the 1970s in the United States of America pharmacists were prevented from legally
dispensing a generic medicine for a prescribed brand-name multisource product. In 1984 these
laws were repealed and pharmacists were allowed to dispense generic products (Mott &
Kreling: 1997: 4). The passage of the 1984 amendments was a compromise to achieve
balance between the innovator or pioneer drug industry and the generic drug industry. The act
encouraged and awarded innovative new drug development while at the same time made more
drug products eligible for generic competition (Holovac, 2004: 125).
In a study done by Mott and Kreling (19973) to examine whether generic substitution is
determined by the therapeutic drug prescribed and patient insurance type the following results
were found. Of a total of 6120 new prescriptions audited from 10 Midwestern community
Chapter 2: Health care and health care concepts
pharmacies (United States of America), 1686 were eligible for generic substitution. Further, 927
prescriptions were filled with generic substitutes resulting in a substitution rate of 55%.
Considerable variability occurred in substitution rates across therapeutic categories and
between acute and chronic therapeutic groupings (67.4% and 38.2% respectively) (Mott &
Kreling, 1997: 3). Anti-incontinence, analgesics and antibiotics were the top three therapeutic
categories where generic substitution took place. In the antibiotic therapeutic category there
were 285 prescriptions that could be substituted, while only 217 were actually substituted. This
shows a substitution rate of 76.1% for the antibiotic therapeutic category (Mott & Kreling, 1997:
10).
2.5.2.3 Generic substitution in South Africa
The chief executive of Medscheme stated that generic medicine comprised over 50% of all
prescription in the United States of America, Canada and Europe. In South Africa, though, less
than 25% of prescriptions contain generic medicines (Anon., 2002: 1).
According to the
National Association of Pharmaceutical Manufacturers in South Africa, the increased use of
generics can make a major contribution to reducing health care costs in South Africa. Although
the use of generics in South Africa has increased in volume terms, there has only been an
increase of 1% in the use of generics from a value perspective from 1999 to 2003 (Anon.,
2003b: 1).
During 2002 and 2003 amendments were made to the Medicines and Related Substance Act
(10111965). One of the most important elements of the Medicines Act for both pharmacists and
the public that came into operation on the 2 May 2003 is that the pharmacist is required to
inform the patient of the benefits of the substitution for a branded medicine of an
interchangeable multi-source medicine (IMM). Once the patient has been notified of the
benefits of generic substitution (Du Toit, 2003), the generic product1lMM must be dispensed
unless specifically forbidden by the patient. The prescriber may also indicate, with his own
handwriting next to the specific item on the prescription that no substitution is to be done (Gray,
2003: 5).
According to Gray (2003: 5) these interchangeable multi-source medicines must comply with
the following requirements:
o Contain the same active substances, in the same strength.
0 Be presented in the same dosage forms, intended for administration by the same route.
u Meet the standards of therapeutic equivalence.
Chapter 2: Health care and health care concepts
If an interchangeable multi-source medicine is dispensed, the brand name of the product
dispensed or in a case where there is no brand name, the name of the manufacturer of the
product dispensed, must be recorded by the pharmacist (Du Toit, 2003: 4). A pharmacist or
person dispensing the prescription must take reasonable steps to inform the prescriber of the
substitution that has taken place (Du Toit, 2003: 4;Gray, 2003: 5).
A pharmacist or other person dispensing the prescription may not dispense an interchangeable
multi-source medicine in the following situations (Du Toit, 2003: 4):
When the prescriber indicated in his own hand on the prescription, next to the item
prescribed, that no substitution may take place.
u If the retail price of the generic product is higher than the price of the branded product.
0 If a medicine has been declared non-substitutable by the Medicines Control Council.
2.5.3 Economics of generic products
According to the European Generic medicines Association (2004~: 1) increasing access to
generic medicines generates four main public health benefits:
0 Reduces prices.
0 Stimulates competition between drug products.
0 Creates budget headroom for innovation.
0 Encourages the development of new pharmaceutical companies.
Generics are being used more and more due to rising costs of medicines. Generic drugs sell at
approximately 40% of the cost of their brand name counterparts during the first six months on
the market and decline to approximately 80% of the cost of the brand name products by the end
of the year. In the United States of America generic drug sales grew at an 11.3% rate, while
brand name products only grew at a rate of 8% during 200 and 2001 (Generic Pharmaceutical
Association, 2002: 1).
In the United States of America the average cost of a brand name prescription was $72.70 in
2001 while the average cost of a generic prescription was $16.85. This shows a four-fold
difference in price (Generic Pharmaceutical Association, 2002: 1). In the United Kingdom it was
found that generics supply 50% of the products at 20% of the total cost (European Generic
medicines Association, 2004~: 3). It is believed that generic substitution could save South
Africa in the region of around R24-billion per year (Anon., 2003: 1).
In the study previously mentioned by Molt and Kreling (1997: 9) it was found that the cost
savings per unit of prescribed drug per generic substitution was $ 0.51. The antibiotic
therapeutic category had the largest cost savings per unit of prescribed drug per generic
Chapter 2: Health care and health care concepts
substitution. A summary of the top ten cost savings per unit of the prescribed drug per generic
substitution across therapeutic categories is shown in the table below.
Table 2.5: Cost savings per unit of prescribed drug per generic substitution across
therapeutic categories (Mott and Kreling, 1997: 11).
Muscle relaxants'
Antidepressants
Anti-incontinence
Oral contraceptives
-
Sedativehypnotic
Gastrointestinal'
Anti-inflammatory'
Allergy
Analgesic*
'Acute therapeutic categwies
-
1.05
0.74
0.56
0.78
0.66
0.70
0.94
0.59
0.48
0.38 0.67
0.23
0.11
0.33
-
0.21
0.45
-
0.45
0.26 0.44
0.51 0.43
-
0.18
0.15
2.6 MANAGED HEALTH CARE
Managed care involves the delivery of a predetermined level of health care benefits to a defined
population on a prepaid basis (Stergachis et al., 1996: 244)
Managed health care can be referred to as a constantly changing array of health plans that
incorporate mechanisms designed to review and control the cost, quality and use of health
services by means of formulary lists, pre-admission screening, case management, capitation
and other management instruments to control health resources (Stergachis et a/., 1996: 244
and UCT, 1997:27).
The Council for Medical Schemes (2003b: 3) states that managed health care is indeed
necessary for effective private health care funding in South Africa. The definition of managed
health care, as defined by the Council for Medical Schemes, is as follows:
"Managed health care means clinical and financial risk assessment and management of health
care, with a view to facilitating appropriateness and cost-effectiveness of relevant health
services within the constraints of what is affordable, through the use of rules-based and clinical
management-based programmes. "
The integration of managed health care and related concepts are illustrated in the following
figure (Figure 2.1).
Management Management Management Management
Pharmawepidemiology
-1 t-~]
I I
Figure 2.1: Managed health care concepts (Serfontein 8 Hein, 1999).
Some of the possible forms that managed care interventions might take are listed in Table 2.6
below.
Chapter 2: Health care and health care concepts
Table 2.6: Possible forms of managed care interventions (South African Health Review,
Provider networks and capitation
arrangements
Provider profiling and peer review
Pharmaceutical benefit management
Provider-insurer integration
the funder prior to certain interventions.
Application of protocds, generally by nurses, to dired the care of
hospitalised patients.
EstaMishment of contracts between a funder and groups of providers
stipllating reimbursement levels, care requirements, minimum access
levels, etc. In some cases, this has involved providers assuming risk for
utilisation variations through capitation
The use of a variety of comparative review techniques to identify providers
with particularly wasteful, dangerws w potentially fraudulent practices.
Outcomes of the profiling exercise migM include constructive feedback, in-
service education, financial or other penalties, or exdusion from netwwks.
This may involve discount price agreements with pharmacies,
establishment of limited formularies, ongoing supply of chronic
medications, arrangements for generic substitution, etc.
Merging of health care financing and provision organisations into Health
care Maintenance Organisations.
For medical schemes to ensure that interventions are clinically appropriate and cost-effective
they need to combine financial management with clinical management. The patient will benefit
most if the best health outcome is achieved through evidence-based and affordable
interventions. The Council for Medical Schemes (2003b: 3) recognizes the potential significant
advantage of managed health care to the extent that it can
achieve cost reduction;
align the financial incentives of providers and financiers to reduce perverse incentives for
unnecessary care;
o entrench mechanisms to maintain or improve quality of health care;
o encourage the development of standardized treatment approaches;
o support members in gaining access to the most appropriate treatment interventions; and
o promote an integrated and holistic approach to managing the health care needs of patients.
Since the mid-1990s a number of models of managed health care have emerged in South
Africa, some of which are reflected in the figure below.
ChaDter 2: Health care and health care conceDts
Contract Lt.o
Scheme Rules
Contract for managed
care with or without risk transfer
utilisation review; care
coordination; disease
management etc.
Contact for service
provision
Contact for service
provision, including:
HMOs,IPAs, PPOs, EPOs etc
Figure 2.2: Models of managed health care (Council for Medical Schemes, 2003b: 4).
2.6.1 Prescribed Minimum Benefits
Prescribed medical benefits were introduced in the Medical Schemes Act (131 of 1998) in an
effort to prevent private sector patients who had run out of medical cover from being dumped on
the state without compensation from medical schemes. In the regulations under the medical
Schemes Act (131 of 1998) there is a list of 300 minimum benefits that schemes must provide.
From January 2004, schemes will be required to offer members coverage for twenty-five listed
chronic diseases in addition to existing compulsory minimum benefits (Schickerling, 2003:1).
Prescribed Minimum Benefits are minimum benefits which by law must be provided to all
medical scheme members and include the provision of diagnosis, treatment and care cost for
an emergency medical condition and a range of conditions as specified in Annexure A of the
Regulations to the Medical Scheme Act (131 of 1998), subject to limitations specified in
Annexure A. Included in this list of conditions is the list of twenty-five chronic conditions.
30
Chapter 2: Health care and health care concepts
According to the Medical Schemes Act (131 of 1998) the diagnosis, treatment and care costs of
a prescribed minimum benefit condition will only be paid in full by the medical scheme if those
services are obtained from a designated service provider in respect of that condition. If a
service provider other than the designated service provider is used a co-payment may be
imposed on a member. Members may obtain a service from a provider other than a designated
service provider only if the specific service was not available from the designated service
provider; if immediate medical or surgical treatment for a prescribed minimum benefit condition
is required or when no designated service provider within reasonable proximity is available.
Some of the factors that were taken into account when identifying the twenty-five chronic
diseases that would by covered, were the nature of the disease and how that diseases would
affect the quality of life of the individual; the most prevalent conditions; the affordability of the
treatment and the financial impact to medical schemes (Anon., 2003c: 1). Annexure D of the
Medical Schemes Act (131 of 1998) contains the treatment guidelines for chronic minimum
benefits conditions. These treatment guidelines will be revised every two years.
The twenty-five chronic conditions that have been added to the Prescribed Minimum Benefits
list and which, from 2004, medical schemes are required to cover are as follows (Anon., 2003c:
3; Council for Medical Schemes, 2003c: 1):
Addison's disease
Asthma
o Bipolar mood disorder
o Bronchiectasis
Cardiac failure
Cardiomyopathy
o Chronic obstructive pulmonary disorder
o Chronic renal disease
Coronary artery disease
Crohn's disease
o Diabetes insipidus
o Diabetes mellitus types 1 and 2
o Dysrhythmias
o Epilepsy
Glaucoma
0 Haemophilia
o Hyperlipidaemia
o Hypertension
o Hypothyroidism
Chapter 2: Health care and health care concepts
o Multiple sclerosis
o Parkinson's disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus
Ulcerative colitis
The implementation of the Prescribed Minimum Benefits package had the following in mind
(Pearmain, 2000: 2):
Avoid incidents where individuals lose their medical scheme cover in the event of serious
illness and the consequent risk of unfounded utilisation of public hospitals.
Encourage improved efficiency in the allocation of private and public health care resources.
2.7 PHARMACEUTICAL REFERENCE-BASED PRICING
In an attempt to contain rising pharmaceutical expenditure, benefit managers have implemented
a reference-based pricing system. Many governments have adopted reference-based pricing
either as a replacement or in addition to product specific price controls (Dickson & Redwood,
1998: 471).
A reimbursement level or reference price for a group of drugs that are regarded as generally
interchangeable is determined. Payers in the public or private sector set this reimbursement
levels. The reference price becomes the maximum price paid for by medical schemes. When
drugs above the reference price are prescribed the consumer pays the difference. Medical
schemes fully reimburse drugs priced at or below the reference price (loannides-Demos et a/.,
2002: 580).
Pharmaceutical companies are free to determine their own price for a certain medicine product.
From this it is clear that reference-based pricing is not strictly a price control mechanism. It,
however, raises the likelihood of products above the reference price losing their market share
(Dickson & Redwood, 1998: 472). Reference-based pricing places a strict constraint on
pharmaceutical companies' pricing policies. Because of the grouping of similar drug treatments,
price competition amongst pharmaceutical suppliers is encouraged. New and innovative drugs,
drugs still under patent and drugs used in hospital or inpatient care, may be excluded from
reference-based pricing schemes (loannides-Demos eta/., 2002: 580).
Chapter 2: Health care and health care concepts
Reference-based pricing is restricted to those specific segments of the drug market where
several drugs exist without substantial evidence that any particular agent is superior. Drugs are
grouped in one of three ways under reference-based pricing schemes (loannides-Demos et a/.,
2002: 580):
Groups of different brands of the same drug. It involves the grouping of drugs that have the
identical bioactive ingredient and are therefore therapeutically interchangeable (generic
groups).
Related drug groups. Drugs are grouped with related but different drugs regardless of the
indication.
a Drugs grouped by therapeutic indication. All the drugs used to treat a particular condition
are grouped together.
According to Dickson and Redwood (1998: 472), reference-based pricing has one or more of
the following objectives in common:
o To modify physicians' prescribing habits by influencing them to prescribe cheaper drugs.
o To advise patients to accept cheaper drugs or higher co-payment.
Indirectly decrease price by putting pressure on the pharmaceutical industry to keep market
share.
To restrain expenditure on the payer's drug budget.
2.8 ESSENTIAL DRUGS
The saving of lives and improvement of health depends largely on essential drugs. However,
this depends on their availability, affordability, quality and proper usage. Still, in poor
households, medicine purchases consume 60% to 90% of health expenses. In developing
countries medicines are the second highest public health expenditure (Quick, 2002: 1).
According to Quick (2002: I), the estimated number of people in the private and public sectors
to have regular access to essential drugs during 1977 totalled 2.1 billion in South Africa. This
doubled to nearly 4 billion in 1997. All the same, one-third of the world's population lack regular
access to essential drugs.
Chapter 2: Health care and health care concepts
2.8.1 The concept of essential drugs
The essential drug concept was introduced by die World Health Organization in 1975 with the
following objectives (Anon.. 2003: 1):
The focus needs to be on drugs that satisfy health needs
Drugs should be selected based on evidence to meet health needs
o Access to health care needs to be promoted
o Public health care costs need to be reduced
The total number of drugs in public health care systems needs to be reduced
The essential drug concept is a globally accepted approach for the providing of the best
modern, evidence-based and cost-effective health care. Health systems of various types have
recognized its therapeutic and economic benefits. The essential drug concept focuses on
therapeutic decisions, professional training, public information and financial resources on those
drugs that represent the best balance of quality, safety, efficacy and cost for a given health
setting (World Health Organization, 2003: 1). Each country, though, should evaluate and adopt
a list of essential drugs according to its own health policy (World Health Organization, 1998: 1).
The rationale for the selection of essential drugs is that it leads to an improved supply of drugs,
more rational prescribing habits and lower costs (Quick etal., 1997: 122).
2.8.1.1 Definition of an essential drugs list
According to the Department of Health (1998a: iv) essential drugs are defined as follows:
"Essential drugs are those that satisfy the needs of the majority of the population. They should
therefore be available at all times, in adequate amounts, and in the appropriate dosage forms."
When taking the above definition into account it is clear that the availability of medicines at
health care facilities can draw patients to those facilities. At these facilities patients will have
access to other preventive and curative services in addition to medicines (Anon., 2003: 1-2).
2.8.1.2 Advantages of an essential drugs list
There are a few advantages of an essential drugs list according to Quick et al. (1997: 124). It
will ensure the supply of the following:
o Easier procurement, storage and distribution.
o Lower stock volume.
o Better quality assurance.
Easier dispensing.
Chapter 2: Health care and health care concepts
An essential drugs list also influences prescribing habits in the following ways:
o Training more focused and therefore easier.
More experience with fewer drugs.
No irrational treatment alternatives available.
o Focussed drug information.
Better recognition of adverse drug reactions.
The effect on medicine costs is also of great value:
o Lower prices.
More competition.
Essential drugs improve patient use in the following ways:
0 Focused education efforts.
o Reduced confusion and increased adherence to treatment,
Improved drug availability.
2.8.2 Guidelines for establishing a national programme for essential drugs.
The main objective of the National Health Department is to try and achieve optimal availability
and use of drugs for patients and consumers. For this reason a well-designed drug policy
needs to be developed and implemented.
According to Quick et a/. (1997: 56), a National Drug Policy can be defined as follows:
"A National Drug Policy is a guide for action. It is a document specifying the goals set by the
government for the pharmaceutical sector, their relative importance, and the main strategies for
attaining them. It provides a framework to coordinate activities of the pharmaceutical sector the
public and private sectors, NGOs, donors and other interested parties. "
The most common objectives of the National Drug Policy of South Africa are (Quick et al.. 1997:
57)
o to make essential drugs available and affordable;
o to ensure the safety, efficacy and quality of drugs;
0 to improve prescribing and dispensing habits and to promote the correct use of medicines
by health workers and the public; and
0 to improve overall health economy.
Chapter 2: Health care and health care concepts
Before the implementation of an essential drugs programme the following need to be in place
(WHO, 1998: 2-4):
o A national drug regulatory authority should be established. The authority should interact
with organizations responsible for drug procurement in the public and private sectors.
A national drug and therapeutic committee consisting of individuals in the fields of medicine,
clinical pharmacology, pharmacy and clinical microbiology need to be appointed. This
committee's main function will be to give technical advice to the national programme.
P It is advised that the nonproprietary (generic) names for drugs be used. Prescribers should
be provided with cross-index of nonproprietary and proprietary names.
0 A prescriber's formulary containing concise, accurate and comprehensive drug information
should be prepared to accompany the list of essential drugs.
The assurance of quality of each product on the essential drugs list needs to be done. Each
product needs to undergo a product registration process to assure the quality, stability and
bioavailability.
0 It is essential to establish the requirements for prescribing an individual drug or groups of
drugs in a therapeutic category. In some cases personnel with advanced training are
necessary to prescribe initial therapy, while others with less training could be responsible for
maintenance of therapy.
Supply, storage and distribution are factors that will determine the success of the essential
drugs programme.
o Drug utilisation studies will contribute to efficient management of stocks. Procurement
policies should be implemented to eliminate waste and to ensure continuity of supplies.
Clinical as well as pharmaceutical research is required to settle the choice of a particular
drug product under local conditions.
2.8.3 Criteria for the selection of essential drugs.
The selection of essential drugs must always be evidence-based. Drugs to be included on the
essential drugs list should be done after clinical studies regarding efficacy and safety have been
done. The dosage form of the drugs should guarantee adequate quality, stability and
bioavailability (WHO, 1998: 4-5).
In cost comparisons between drugs, the cost of the total treatment and not only the unit cost of
the drug must be considered. The costlbenefit ratio is a major factor that will determine the
choice of drug included on the list (WHO, 1998: 4-5).
Chapter 2: Health care and health care concepts
According to Department of Health of South Africa (1998a: iii), the following criteria are crucial
for the selection of essential drugs:
Drugs included on the list must meet the needs of the majority of the population.
o Scientific data regarding effectiveness must be available.
Drugs included should have a substantial safety and risklbenefit ratio.
Acceptable quality must be guaranteed.
The main focus is to include products that contain single pharmacologically active
ingredients.
More than one pharmacologically active ingredient is accepted when patient compliance
becomes important or the two ingredients act synergistically.
Non-propriety (generic) names are accepted.
o The inclusion of a new product on the list must be evaluated according to scientific data and
appropriate references on its advantages and benefits over an existing product.
o Drugs that are clinically equally effective must be compared on the following factors such as
cost advantages;.
scientific data;
pharmacokinetic properties;
patient compliance; and
local manufacturers.
According to the WHO (1998: 4), the choice of essential drugs depends on many factors, such
as the pattern of prevalent diseases; the treatment facilities; the training and experience of the
available staff; the financial resources; and genetic, demographic and environmental factors.
2.8.4 Quality assurance.
Priority should be given to ensuring that the available drugs have been made according to good
manufacturing practices. The purpose is to ensure that each drug reaching a patient is safe,
effective and of a standard quality. A drug is a dynamic product whose colour, consistency,
weight and even chemical identity can change between manufacturing and consumption (Quick
et a/., 1997: 272).
According to Quick et a/. (1997: 272) a comprehensive quality assurance programme must
ensure that
drugs are selected on the basis of safety and efficacy, in a dosage form with the longest
possible shelf life;
o suppliers with acceptable quality standards are selected;
o drugs received from commercial suppliers and donors meet specified quality standards at
the time of delivery;
Chapter 2: Health care and health care concepts
o packaging meets contract requirements and can withstand handling and storage conditions;
repackaging activities and dispensing practices maintain quality;
o storage and transportation conditions are adequate;
product quality concerns reported by prescribers, dispensers and consumers are addressed
and resolved; and
o drug recall procedures are implemented to remove defective products.
2.9 PHARMACOECONOMICS
As previously mentioned, nations around the world struggle to contain rising health care costs
and aggressive steps are taken to control the growth rates of health care (Sardinha, 1997: 1).
According to Goudge et a/. (2001: 71), private health care expenditure in South Africa has
grown annually by 16%. This is twice as much as the CPI with a growth rate of 7% annually.
The emphasis on cost containment in the health care system has created needs to explicitly
quantify and justify the costs and benefits associated with specific medical programmes and
procedures to make rational therapeutic decisions. This need has increased the application of
economic evaluation techniques comparing health care services, including drug therapies and
clinical pharmacy services (Lee & Sanchez, 1991: 2623).
Pharmacoeconomics is a measure of drug impact on the cost of improving health care and goes
beyond comparison of drug acquisition cost, to evaluate a drug's impact on total institutional
expenditure for patient care. Such pharmacoeconomic analysis allows for the evaluation of all
costs associated with drug therapy (Lipsy, 1992: 267).
Pharmacoeconomics can be defined as an evolving discipline that is dedicated to the study of
how different approaches to patient care and treatment influence the resources consumed in
health care (Truter, 1997: 19). With pharmacoeconomics it is possible to determine the value of
an existing service or the potential worth of a new one. It involves identifying, measuring and
comparing the costs, risks and benefits of programmes, services or therapies and determining
which alternative produces the best health outcome for the resources invested (Jolicoeur eta/.,
1992: 1741).
2.9.1 Pharmacoeconomic evaluations
The are three fundamental dimensions of pharmacoeconomic studies, namely (Malek, 1996a:
760)
o the perspective of the study;
o the types of cost and outcomes used; and
the type of analysis performed.
2.9.1.1 Perspective of pharmacoeconomic evaluation
The point of view determines the scope of the analysis. Economic evaluation on any health
care programme consists of a comparison between the costs and outcomes of all legitimate
alternatives available. The categories of costs and outcomes are not absolute values and are
not context free. It is therefore very important to make the point of view of the study clear from
the beginning (Malek, 1996b: 3).
There are various perspectives from which the study can be conducted. It includes the patient,
the provider, the hospital or health organisation, third party payers, government and society
(McCloskey, 2001: 147). Manufacturers, insurers, providers, guideline development
committees, governmental agencies and policy makers may all benefit from pharmacoeconomic
evaluations.
Patients are generally concerned about the way the treatments will affect their quality of life,
while the providers, hospitals or health organisations are primarily concerned about the benefits
to their organisations (Bootman et al., 1989: 695). There is a difference of perspective through
the cost to patients, providers or third party payers for the medical service. The cost to the
provider is the true cost of the service, while the cost to the payer is the cost allowed by that
payer. The cost to the patients is the amount they pay for the service, which is not covered by
the medical aid or third party payer, together with the other costs incurred due to the illness
(Eisenberg, 1989: 2881).
2.9.1.2 Costs
Health care cost inputs or economic outcomes can be grouped into several categories
(Sanchez, 1997: 3):
o Direct medical costs are the costs associated directly with the delivery of medical care and
purchasing of drugs out of the pocket. It refers the costs incurred for medical products and
services used to prevent, detect and/or treat a disease (Malek, 1996a: 760).
0 Direct non-medical costs are the costs incurred as a result of the illness but do not involve
purchasing of medical services. It includes costs like transportation to hospital, social
services, etc. (Sacristan et al., 1993: 1 128).
Incremental costs refer the difference between the cost of a treatment programme and the
cost of the comparison treatment programme (Anon, 1995: 2).
lndirect medical costs are the costs of medical treatment gained through an earlier
intervention (Anon, 1995: 2).
Indirect non-medical costs are costs that result from changes in production capacity.
Indirect costs are associated with the loss of earnings and the shorfall of finance and
production resulting from illness, as well as loss of earnings due to morbidity and mortality
(Sacristan et a/., 1993: 1128).
Intangible costs are the costs associated with the patient's pain and suffering due to the
illness, which are difficult to express in a monetary value (Sacristhn et a/., 1993: 1129). It
can, however, be taken into account through cost-utility analysis.
o Opportunity costs represent the economic benefit forgone when using one therapy instead
of the next best alternative therapy (Sanchez, 1997: 3).
2.9.1.3 Outcomes
The outcome of a pharmacoeconomic study can either be clinical or humanistic. Clinical
outcomes are the medical events or changes in a medical parameter that occur as a result of
disease or treatment (Jones & Sanchez, 1997: 3). Where the most common type of
pharmacoeconomic method for evaluating humanistic outcomes is the quality of life
measurement (Sanchez, 1997: 4).
Quality-of-life (QoL) is a multidimensional concept, referring to a person's total well-being,
including his or her psychological, social and physical health status (Coons, 1997: 16).
Health-related-quality-of-life (HRQoL) is used to refer to those elements of well-being that are
attributable to health, as a patient's well-being may be influenced by a number of non-health-
related factors (MacKeigan & Pathak, 1992: 2238).
2.9.2 Type of pharmacoeconomic evaluations
There are several pharmacoeconomic evaluation methods namely cost utility, cost minimisation,
cost benefit and cost-effectiveness. The methodologies and their units of measurement are
depicted in the following table.
ChaDter 2: Health care and health care conceDts
Table 2.7: Pharmacoeconomic methodologies (Bootman et al., 1996:9).
M${hodology
I " ~ '> , "
I Cost benefit
Cost-effectiveness
1-' Cost meas~renteiitu'rllr '
II Monetary (rand value)
Monetary (rand value)
Cost-minimisation
Monetary (rand value)
]
]1 Monetary (rand value)
Natural units (life-years gained,
mmollL blood glucose, mm Hg
blood pressure)
Assumed to be equivalent in
comparative groups
Quality-adjusted life-years or other
utilities
Cost-utility Monetary (rand value)
2.9.2.1Cost-minimisation analysis (CMA)
When two or more interventions are examined and demonstrated or assumed to be equivalent
in terms of a given outcome or consequence, costs associated with each intervention may be
examined and compared (Bootman et al., 1996: 10). It is important to have equal clinical
efficacy before the analysis is carried out (Malek, 1996b: 5). According to Eisenberg (1989:
2880) the goal of this analysis is to determine the least expensive way of achieving the
outcome.
Because of strict requirements of therapeutic equality, cost-minimisation analysis is not
commonly used to assess drug therapies, programmes or services (Jolicoeur et al., 1992:
1742). An example of this type of analysis may be the evaluation of two generically equivalent
drugs, which have equal outcomes, but may have different acquisition and administration costs
(Lamprecht, 2002: 115).
2.9.2.2 Cost-effectiveness analysis (CEA)
Cost-effectiveness is designed to identify a preferred choice among possible alternatives
(Bootman et al., 1996: 11). With cost-effectiveness analysis the consequences of each
intervention, whether pharmacological or non-pharmacological, are measured in the most
appropriate natural or physical unit ("years-of-life gained") and the costs are measured in
monetary terms (Lamprecht, 2002: 115).
Cost-effectiveness is defined as a series of analytical and mathematical procedures that aid in
the selection of a course of action from various alternative approaches (Bootman et al., 1996:
11). Mullins et al. (1997: 426) state that a cost-effectiveness analysis should include positive
outcomes, measured by efficacy and patient well-being, and negative outcomes, such as
adverse events and other factors that negatively influence patient quality of life.
41
According to Jolicoeur et a/. (1992: 1741) cost effective alternatives are not by definition the
least expensive therapies. A treatment can be considered to be cost-effective if it is
less expensive and at least as effective as other alternatives;
o more expensive than alternatives with additional benefit worth the additional cost; and
less expensive and less effective in instances where extra benefit is not worth the extra cost.
2.9.2.3 Cost benefit analysis (CBA)
In a cost benefit analysis all costs and benefits of alternatives are measured in monetary terms
(Jolicoeur et a/., 1992: 1741). According to Bootman et al. (1996: 10) cost benefit analysis is a
type of analysis that measures costs and benefits in fiscal units and computes a net monetary
gainlloss or a cost benefit ratio that can be used to improve decision-making processes in the
allocation of funds to health care programmes.
With cost benefit analysis it is difficult to determine a monetary value on clinical outcomes.
Single programmes or multiple programmes can be evaluated through cost benefit analysis,
though effectiveness analysis is more commonly used (Jolicoeur et a/., 1992: 1742).
2.9.2.4 Cost-utility analysis (CUA)
Cost-utility analysis measures health-related quality of life by means of a utility approach, the
outcome often being expressed in quality 07 health. This method evaluates outcomes not only
for the associated monetary costs, but also for the added cost of patient discomfort or change in
function or level of satisfaction (Jolicoeur et al., 1992: 1741). This type of analysis has an
added dimension of a particular point of view, which in most instances, is the patient (Bootman
et aL, 1996: 11).
The relative values that members of society attach to various states of health can be
determined through utility measurements. Often, utility values are on a scale of 1.0 (normal
health) to 0 (dead). No standard criteria have been established for measuring utilities (Jolicoeur
et a/., 1992: 1743).
2.9.2.5 Cost- of-illness (COI)
Cost-of-illness evaluation identifies and estimates the overall cost of a particular disease in a
defined population. It involves the following three components: Medical resources used to treat
the illness, non-medical resources associated with it and loss of productivity due to illness or
disability (Bootman et al., 1996: 12).
Cost-of-illness is not used to compare competing treatment alternatives, but to provide an
estimation of the financial burden of the disease.
Chapter 2: Health care and health care concepts
2.9.3 The purpose and importance of pharmacoeconomics
Pharmacoeconomic studies are done to improve public health through rational decision making
entailing the selection of one alternative among several others. The alternative that produces
the best outcome for the resource invested is preferred as therapy (Bootman etal., 1996: 7).
Corresponding to recent awareness by the public of rising health care cost there has been an
increased interest in evaluating drugs' economic as well as clinical benefits. According to
Stanton (2002:l) health care organisations are implementing strategies to reduce the current
levels of growth in health care expenditure. Nations around the world struggle to contain rising
health care costs. In response to this the expenditure on drugs have become the primary target
of reform (Sardinha, 1997: 1). Thus, pharmacoeconornic evaluations will play an important role
in future.
Sanchez (1997: 6) indicates that pharmacoeconomics is important due to the following reasons:
It can assess the value of the products and sewices that are provided.
o It can assist in decision making between more than one treatment alternative.
o It provides data necessary to make better medication use decisions.
o It can assist in balancing cost with quality and patient outcome.
2.10 DRUG UTlLlSATlON REVIEW
Patterns of drug use along with population changes and disease prevalence are of increasing
importance to health professionals and administrators. In every health care organisation today
there exists a huge need for information on outcomes of treatments, real drug intake and
prescribing patterns for different indications (Serradell et a/., 1987: 996). Further, the increase
in drug consumption and irrational drug use have also led to the initiation of drug utilisation
review studies (Inesta, 1992: 353).
Drug utilisation can be defined as the study of the prescribing, dispensing, administering and
ingesting of drugs. The steps and processes in drug usage and the problems that may arise in
each of these steps are taken into account with this definition of drug utilisation (Serradell etal.,
1987: 994).
The World Health Organization (WHO) defines drug utilisation as the marketing, distribution,
prescription and use of drugs in a society, with special emphasis on the resulting medical, social
and economic consequences (Serradell et a/.. 1987: 994). According to SacristAn and Soto
(1994: 300) this broad definition takes into account the process of drug utilisation, that is the
movement of drugs along the drug chain in the society, and how drug utilisation relates to the
effects of drug use.
It is important to know that there is a clear difference between drug utilisation review (DUR) and
drug utilisation evaluation (DUE). Drug utilisation review (DUR) provides qualitative data on
drug usage, focussing on the quantitative aspects and patterns of drug use, while drug
utilisation evaluation (DUE) focusses on outcomes as well as providing quantitative data
(McGlynn, 1995: 26).
There should also be differentiated between a drug utilisation study and a drug utilisation
programme. In a drug utilisation study one looks at the patterns of drug use retrospectively and
only identifies areas of inappropriate drug use without initiating efforts to correct it, whereas a
drug utilisation programme is more prospective and tries to correct problematic areas before
they arouse (Sacrist5n & Soto, 1994: 30; Kreling 8 Mott, 1993: 417).
2.10.1 Classification of drug utilisation review
When a drug utilisation review study is done it is necessary to obtain quantitative data regarding
the extent and variability in usage and costs of drug therapy, from which medical and social
consequences can be extrapolated. Drug utilisation may either be quantitative or qualitative or
a combination of both.
2.10.1.1 Quantitative drug utilisation review
Quantitative drug utilisation studies are concerned with trends and amounts of drugs used
(Inesta, 1992: 353). Kreling and Mott (1993: 413) described quantitative drug utilisation as
episodic or continuing activities performed by pharmacists and pharmacy departments for
medical schemes.
The main focus of quantitative data is the cost of drug therapy and the resulting social and
economic consequences thereof (Serradell et al., 1987: 994). Quantitative utilisation studies
are concerned with the development of strategies to reduce medical expenditure.
According to Sacristestan and Soto (1994: 300) quantitative drug utilisation studies are used to
a determine the quantities of drugs consumed in a specific period of time and in a specific
geographical area;
a investigate the development of drug utilisation over time;
o compare drug consumption in different geographical areas;
o identify areas of misuse of drugs;
a estimate the utilisation of drugs according to certain variables; and
Chapter 2: Health care and health care concepts
estimate the prevalence of particular illnesses based on the consumption of drugs utilised in
their treatment.
2.10.1.2 Qualitative drug utilisation studies
Qualitative drug utilisation studies can be defined as the process that analyses the
appropriateness of drug use. The analyses can only be done correctly if the diagnoses are
known to the analyst (Inesta, 1992: 353). A judgement on the appropriateness of the drug
treatment can thus be made. Qualitative drug utilisation studies require pre-determined qually
criteria for drug use, such as the duration of treatment, the most suitable dosage for each
indication, the choice of efficient drugs, utilisation of fixed combinations of drugs, etc. (Sacristan
8. Soto, 1994: 300).
According to Kreling and Mott (1993: 416), qualitative drug utilisation studies can be used to
determine the appropriateness of the daily dosage;
analyse the period of time of therapy;
determine the indication of the specific drug therapy;
0 identify possible drug interactions;
o determine the most suitable dosage for each indication; and
assess the fixed combination of drugs.
2.10.1.3 combination of quantitative and qualitative drug utilisation studies
Both quantitatiie and qualitative drug utilisation review studies may be combined into a single
study to produce information about patterns and amounts of drug use as well as the quality of
drug use (Kreling & Mott, 1993: 417).
2.10.2 Types of drug utilisation review studies
Drug utilisation studies may either be prospeche, concurrent or retrospective depending on the
role player under review.
2.10.2. I Retrospective drug utilisation review studies
According to Blackburn (1993: 15) retrospective drug utilisation review studies are done after
the prescription, dispensing and use of drugs have occurred. Thus, the evaluation of therapy
and intervention is performed after the patient has completed therapy.
Retrospective drug utilisation studies have little impact on immediate patient care. It serves to
identify trends in prescribing habits that may lead to interventions aimed at enhancing
prescribing behaviour. These studies are usually relatively inexpensive (Truter, 1995: 338). A
medical aid claims database can be used to apply statistical methods to identify areas of patient
care that are not beneficial or too costly to the funder (SacristAn and Soto, 1994: 301).
2.10.2.2 Concurrent drug utilisation review studies
Concurrent reviews are conducted simultaneously with the dispensing process. Before the
prescription is f lled the pharmacist evaluates the appropriateness and correctness of the drugs
prescribed (Blackburn, 1993: 15). An intervention in the therapy can take place before a
problem arises and the desired effect has not been reached. Supportive information can be
provided to the prescriber at the time of prescribing.
According to Truter (1995: 338) concurrent review studies are more expensive and time
consuming. This type of review study is very limited and it is only used for certain
institutionalised patients and patients on chronic medication (Blackburn, 1993: 15). It, however,
has the potential for much greater pay-offs in preventing problems.
2.10.2.3 Prospective drug utilisation review studies
Prospective drug utilisation studies refer to programmes where the evaluation of therapy and
intervention, if necessary, occurs before the patient receives the first dose of a drug (Blackburn,
1993: 15). This implies providing guideline information to the prescriber and is prospective to
the filling of the prescription, so it has to occur before the prescription process occurs (Edgren,
1996: 124).
For prospective utilisation to be effective it is essential for a physician or prescriber to have
access to an integrated computer system (Sacristan and Soto, 1994: 301) containing all the
information regarding the patient's drug and medical history (Truter, 1994; 18). This permits the
practitioner to evaluate the patient's preexisting therapy on a retrospective basis, thus
preventing drug therapy problems before they occur.
2.10.3 Defining the unit of measurement
The three units for quantification of drug use are cost data, prescription volume and defined
daily dose.
2.10.3.7 Cost data
In early drug utilisation studies the gross drug sales data were most commonly used as
indicator. A few problems appeared when using data based on drug cost because of differential
pricing that occurs according to distribution channels employed, quantity purchased, import
duties and currency exchange rate differences between certain countries and regulatory policies
that affect pricing (Serradell et a/.. 1987: 995).
Chapter 2: Health care and health care concepts
2.10.3.2 Prescription volume
Some drug utilisation studies rely on the number of prescriptions written or dispensed for a
particular drug product as a measure of drug use. However, because the quantity of the
prescription items varies from prescription to prescription and the supply per prescription can be
for any period of time, no adequate assessment of the amounts of drugs included in the
prescription or dispensed can be provided. Generic substitution may also influence the results
(Serradel et ab, 1987: 995).
2.10.3.3 Detined daily dose
See 3.6.2.
2.10.4 Criteria used in drug utilisation studies
The type of drug or the disease states analysed, plays an important role in developing the right
criteria for the drug utilisation study performed. Knapp (1991: 600) states that criteria are
predetermined elements against which the quality and economy of drug use are judged,
representing the ideal to which actual drug use is compared. Professionals, relying on
professional expertise and literature, develop criteria. Thus, criteria may be developed in a
variety of ways. It is essential that criteria be grounded in the scientific and clinical literature.
Criteria must be scientifically valid, appropriate to the aim of the analysis, acceptable to both the
review and subjects of the review and likely to yield acceptable numbers of cases for
intervention (Knapp, 1991: 600).
Criteria should be developed for each study performed to assure that the aim of the analysis be
reached. Specific criteria must reflect characteristics of specific drug therapy as known to
pharmacists and physicians (Knapp, 1991: 601).
2.10.4.1 Classification of criteria
Criteria may be developed in a variety of ways and the classification of criteria should also be
determined. Criteria can be classified as absolute, relative or pragmatic (Knapp et al., 1974:
649). Criteria can also be classified as subjective (implicit) or objective (explicit). A third way of
classifying criteria involves an approach that focuses on three factors: structure, process and
outcome (Knapp etal., 1974: 649).
0 Absolute criteria are established prior to data collection and function as thresholds or limits.
o Relative or statistical criteria may be established in relation to the distribution of
measurements.
Chapter care concepts
Pragmatic criteria are those established because it is thought that they are practically or
clinically relevant.
o Subjective criteria are unstructured and are not specifically defined in measurable terms.
o Objective criteria are so explicitly or specifically defined that any judge using them can
evaluate a given date set identically.
Structural criteria include the demographic and ecological characteristics of the unit of
observation.
Process criteria refer to the 'what", the "when", the "where" and the 'how" of care.
Outcome criteria are designed to measure whether the end results of patient care were met.
2.10.5 The purpose and importance of drug utilisation studies
The purpose of drug utilisation is to assure appropriate, safe and effective drug use. According
to Truter (1995: 338) drug utilisation studies, depending on the setting and underlying priorities,
may be used for a variety of purposes, e.g. improvement of quality of care, containment of costs
of medical care, identification of fraud and abuse, etc.
There is a great need for drug utilisation studies to be done. Consumption of drugs is usually
irrational (Quick et al., 1997: 21) and there is an increase in the cost of medicine (Blackburn,
1993: 14). In the process of trying to reduce both the cost of medical treatment and drugs a
balance between cost and drug containment should be kept, in order to assure that optimum
treatment is rendered or supplied to the patient (Blackburn, 1993: 14).
Drug utilisation studies are used in clinical research to measure the effect of the drug and to
calculate its benefit to the patient (Serradell et al., 1987: 1000) and to estimate the incidence
and potential severity of drug reactions (Sacristan 8 Soto. 1994: 305). Further. it is also used to
evaluate the overall quality of drug consumption in a specific geographical area. This is of great
importance to the manufacturer (Sacriskin 8 Soto, 1994: 305). Drug utilisation studies are also
important for determining quality (Enright 8 Flagstad, 1991: 1908) and economic implications
before licensing of pharmaceutical product (Dmmmond, 1994: 42).
Chapter 2: Health care and health care concepts
2.11 CHAPTER SUMMARY
This chapter focussed on health care in South Africa and in particular health care in the public
and private sectors. The definition, aim and importance of pharmacoeconomics, as well as
pharmacoeconomics evaluations were also discussed. Drug utilisation was discussed
according to definition, the goal or purpose of drug utilisation, the significance, classification and
types of drug utilisation studies and the criteria and classification of criteria used in drug
utilisation studies.
Hereby the first few research questions and research objectives, namely to conceptualise health
care in South Africa and internationally and the concepts an approaches of health care, from the
literature have been reached.
The following chapter will focus on the utilisation and costs associated with antibiotics and give
an overview of the basic pharmacology of antibiotics.
Chapter 3
Antibiotic usage
3.1 INTRODUCTION
This chapter will attempt to conceptualise antibiotic usage. A discussion on the
pharmacoeconomics of antibiotics and the influence of prescription habits on antibiotic usage
will also be included.
3.2 AN OVERVIEW OF ANTIBIOTICS
More than fifty years ago after the introduction of penicillin into therapeutic use, antibiotics are
still among the most widely used drugs, not only in the treatment of human ailments but also in
veterinary practice, in agriculture and in animal husbandry (Lancini, 1995: preface). According
to Rehana et al. (1998: 1) antibiotics fall in the group of most frequently prescribed drugs on the
market and as this group accounts for 15% to 30% of the total health budget worldwide.
3.2.1 The prevalence of infectious diseases
In the year 1664 the great plague claimed the lives of 15 to 21% of the population of London
(Williams, 1996: 2). Major epidemics have occurred periodically and have caused substantial
reductions in populations worldwide. Both the world wars, famines, economic failure and
political upheaval have been associated with epidemics of infectious diseases. It is clear that
infectious diseases play a huge role in the percentage of deaths that occur each year (Williams,
1996: 2-3).
Radyowijati and Haak (2003: 1) stated that diseases of bacterial origin are a major cause of
morbidity and mortality in low-income countries. With improved personal hygiene, immunization
and environmental sanitation most of these diseases can be prevented. Antibiotics, though, are
still the main therapy of choice. This has led to high levels of consumption and spending for
antibiotics.
According to McPhee and Schroeder (1999: 3) the decline in the incidence and fatality rates of
infectious diseases are due to improved public health measures that include improved
sanitation, better nutrition and great prosperity. McPhee and Schroeder (1999:3) also
emphasized that immunization is a great factor contributing to preventing infectious diseases.
After the implementation of an immunization programme in the United States of America during
the 1900's. there has been a 90% reduction in measles, mumps, rubella, poliomyelitis,
Chapter 3: Antibiotic usage
diphtheria, pertussis and tetanus. Haemophilus influenza type b infections have been reduced
by more than 95% after the introduction of the first conjugate vaccines. However, the total
deaths per year are staggering due to the fact that only a small percentage of people are
vaccinated.
3.2.2 Definition of antibiotics
The Concise Oxford English Dictionary (2002: 203) defines an antibiotic as a medicine that
inhibits the growth of or destroys micro-organisms.
Lancini et a/. (1995: 1) defined antibiotics as low-molecular-weight microbial metabolites that at
low concentrations inhibit the growth of other micro-organisms. The formal definition of an
antibiotic restricts the use of the term to chemicals that are produced by micro-organisms and
that have the capacity to inhibit the growth of, or to kill, bacteria and other micro-organisms
(Pratt et a/. , 1986: 3).
In the above-mentioned definitions the term 'inhibit" means either temporary or permanent
inhibition of the ability of the micro-organism to reproduce and consequently, inhibition of growth
of the bacterial population rather than of an individual cell. With permanent inhibition, antibiotic
activity is termed bactericidal. If inhibition is lost when an antibiotic is removed from its medium,
antibiotic activity is termed bacteriostatic (Lancini eta/., 1995: 2).
The addition of "at low concentration" to the definition is essential and normal cell components
can cause damage at excessive concentrations (Lancini et a/., 1995: 2). The ideal antibiotic
would have no lethal effect on the patient but only to the micro-organism. Penicillin G in the
nonallergic patient comes as close to this goal of selective toxicity as any of the antimicrobial
drugs (Pratt et a/., 1986: 3).
Cha~ter 3: Antibiotic usaae
3.3 PRESCRIBING HABITS FOR ANTIBIOTICS
The most frequent intervention performed by doctors is the writing of a prescription (Ronchon,
1997: 1096). According to Hasan et a/. (1997: 1) drug therapy is the major component of
patient management in health care settings. This is to be expected, since modern medicine has
been remarkably effective in managing diseases.
3.3.1 Physicians' prescribing habits
Chatfield (2000: 1) revealed that oftice-based physicians are prescribing more antibiotics than
previously. The Centre for Disease Control in the United States of America (Chatfield 2000: 1)
revealed that there has been an increase of 48% in antibiotic prescribing for children from 1980
to 1992. It is estimated that 20% to 50% of the 235 million doses of antibiotics taken annually
are unnecessary.
Though there is an awareness of the emergence of antibiotic resistance, physicians are
prescribing more broad-spectrum antibiotics than before. This encourages antibiotic resistance.
Aldridge (2003: 1) reported that in the United States there has been an increase of 24% in
adults and 16% in children that are prescribed a broad-spectrum antibiotic.
It is estimated that one fourth to one third of patients admitted to hospitals receive an
antimicrobial drug (Hess et a/., 1990:585). In Sharjah antibiotics constituted 45% of
prescriptions (Hasan et aL, 1997: I), where in North Goa the antibiotics prescription rate was
14.06% (Hede et a/., 1987: 146). In a survey of drug use practices at a general hospital in
Nigeria it was found that the average number of antibiotics prescribed per encounter for
outpatients was 1.1% and for in-patients 2.4%. The percentage encounter with antibiotics was
50.3% for outpatients and 96.7% for in-patients (Chukwuani et a/., 2002: 189-190). A study
done in the Kwazulu Natal province. South Africa, revealed that 54% of prescriptions contained
antibiotics (Paruk eta/., 1999: I).
Chikerema and Kasilo (19941) found that in ten district hospitals in Mashonaland that
benzylpenicillin was prescribed 43.8% of the time. Co-trimoxazole followed with 28%.
Amoxicillin used by children and adults increased from 50 to 175 per thousand population
during 1980 to 1992 in Arizona, United States of America (Chatfield, 2000: 1).
Chaoter 3: Antibiotic usaae
3.3.2 Reasons behind prescribing habits
According to Holloway (2000: 9) there are a few reasons why antimicrobials are prescribed too
often and unnecessarily:
a Lack of knowledge or information, leading to uncertainty about the diagnosis and the most
appropriate drug(s).
0 Fear of poor patient therapy outcome.
0 Patient demand for antibiotic treatment.
Prescribers and pharmacists earning a living through selling medicines.
Although it is widely accepted that control of antibiotic prescribing is essential for the prevention
of antibiotic resistance, antibiotic misuse is still common. Sacho and Schoub (1998: 1) state
that up to 70% of antibiotic treatment courses are unnecessary or inappropriate. They further
state that antibiotic therapy is often unnecessarily prolonged and prophylaxis is often
inappropriate or given at the wrong time.
3.3.3 Cost of antibiotics
Many prescribers and retail pharmacists earn their living by selling medicines and not by
charging a consultation fee. It has been shown in many countries where there are not strict
regulations on dispensing, that prescribers who earn money from dispensing medicines
consistently prescribe more drugs than those who do not make money from dispensing. Selling
medicine at high costs may earn dispensing prescribers more profit. Due to the high costs of
medicine some patients may buy incomplete courses, which may have a negative therapeutic
effect when looking at antibiotic therapy (Holloway, 2000: 9).
Studies done all over the world have shown that antimicrobial drugs form the group of drugs
that is most frequently prescribed. Hess et a/. (1990: 585-587) found that antimicrobial drugs
represent 20% to 40% of a hospital's drug budget. A study done by Hess et a/. (1990: 585-587)
at Rhode Island Hospital revealed that antimicrobial drugs accounted for between 32% and
34% of the total drug expenditure during the late 1980s.
Bavestrello and Cabello (2000: 13-14) reported about a study done by the Pan American
Infectious Disease Society and the PanAmerican Health Organization in Chile. The study
revealed increases in sales of antibiotics between 1988 and 1997. Noteworthy are the
increases in sales of amoxicillin (+309%) and oral fluoroquinolones (+473%). The government
reacted upon the study and put control measures in place to contain antibiotic prescribing.
Antibiotics are now only available on prescription or from a pharmacy. Expenditure dropped by
US$6483883 between 1998 and 1999 (Bavestrello 8 Cabello, 2000: 13-14).
Chapter 3: Antibiotic usage
In the North West Province of South Africa is was found that antibacterials for systemic use
presented with the highest cost percentage during April 2000 to March 2001, representing
20.68% of all medicine cost (Saley, 2004: 102).
3.4 ANTIMICROBIAL RESISTANCE
Antimicrobial resistance is of great concern to many people all over the world. The introduction
of antibiotics in the 1940s led many to believe that infectious diseases would be conquered
once and for all. Resistance, however, started as soon as the first antimicrobial drugs were
given to patients (Mazel 8 Davies. 1998:l).
According to Levy (1995: I), antimicrobial resistance is not a local or national problem, but an
international problem affecting hospitals and communities worldwide. Countries all over the
world face a major risk that diseases considered vanquished in industrialised countries will once
again become killers stalking society, bringing an ever present threat of sudden death and
disability. Antimicrobial resistance threatens industrialised countries, as well as developing
countries (World Health Organization, 2000: 1).
Major drug manufacturers invested large amounts of money in seeking cures for heart disease
and other chronic conditions. Intensive antibacterial research was put on the background.
Since the 1980s significant breakthroughs have been largely confined to the development of
antiviral agents targeting the ever-widening HIV epidemic (World Health Organization, 2000: 1).
A few years after penicillin entered market scientists began noticing the emergence of a
penicillin-resistant strain of Staphylococcus aureus. Resistant strains of gonorrhoea, dysentery-
causing shigella and salmonella rapidly followed. Muttidrug-resistant tuberculosis is another
major concern not only confined to any one country or those co-infected with HIV, but also to
developed countries such as Eastern Europe (World Health Organization, 2000: 1).
Levy (1995: 1) stated that between 1979 and 1987 nearly 0.02% of pneumococcus strains were
penicillin-resistant. Almost eight years later in 1995, it was determined that 6.6% of
pneumococcus strains were resistant tot penicillin. Resistance towards antibiotics is growing
rapidly each year resulting in an increased mortality rate. Antimicrobial resistance is a serious
public health concern with economic, social and political implications.
Chapter 3: Antibiotic usage
Bacterial resistance may result naturally, that is without previous exposure to the antibacterial
drug, while acquired resistance is caused by prior exposure to the antibacterial drug (Kee &
Hayes, 2003: 393-394). Pathogens develop resistance to antimicrobials through a process
known as natural selection. When a microbial population is exposed to an antibiotic, more
susceptible organisms will submit, leaving behind only those resistant to the antimicrobial attack
(World Health Organization, 2000: 1). These organisms can then either pass on their genetic
instruction to their offspring by replication, or to another bacterial species through conjugation
whereby plasmids carrying the genes are transferred from one organism to another (Kee and
Hayes, 2003: 394).
3.4.1 The biochemical basis of resistance
Biochemical resistance mechanisms can be classified into three categories (Sanders &
Sanders, 1995: 15):
1:1 Prevention of intracellular drug accumulation.
1:1 Modification of the target site of the drug.
1:1 Production of a drug-inactivating enzyme.
Table 3.1: Possible mechanisms of resistance to antimicrobial agents
(Sanders &Sanders, 1995: 15).
ANTIMICROBIALAGENT
GRAM-NEGA TIVES
:t: :t:
J[
II
II
II
II
II
+++
[ 13-Lactam antbiotics
[ Aminoglycosides
[ Fluoroquinolones
[ Rifampin
I Tetracydines
IMP =Prevention of accumulation of drug
TAR =Modification of the target site of the drug
DIE =Production of drug-inactivating enzymes
+
IMP\il
~I + I
~~
."----
+
TAR
-~ .
:t:
ol,...
~ii:i;ii;/;;;iiiiiii('
+ +++
+ +++ +++
+++ +++
+++ :t: +++ :t:
55
Chanter 3: Antibiotic usaae
3.4.2 The genetic basis of resistance
Genetic resistance mechanisms can be classified into two categories (Mann & Crabbe, 1996:
50):
Production of new genes through mutation.
Adoption of genetic material from other species.
Bacteria have the ability to modify the shape of the active site of the enzyme antibiotics work on.
This change is achieved in one or more nucleotide bases of the DNA sequence coding for the
enzyme. The changes in the binding characteristics or shape of the active site are due to the
resultant change in the amino acid sequence of the enzyme (Mann & Crabbe, 1996: 50).
Plasmids and chromosomes are capable of individual existence and replication within the cell.
The gene products of plasmids are most commonly the enzymes that inactivate or destroy
antibiotics. Plasmids are transferred between two bacterial cells either by conjugation or
transduction. A plasmid that contains genes that specify different enzymes required for the
destruction of antibiotics can be transferred to other cells. During infection with susceptible
species it is possible to incorporate resistance genes, from resistant species, that code for
enzymes that will destroy a range of antibiotics (Mann &Crabbe, 1996: 50).
3.4.3 Factors contributing to resistance
Unknowingly a wide range of factors contributes to bacterial resistance. The factors responsible
for increasing antimicrobial resistance and the potential strategies for attacking the problem are
complex and include a broad range of disciplines. In a study done by Watson et a/. (2000: I),
97% of physicians agree that overuse of antibiotics is a major factor contributing to the
development of antibiotic resistance. Holloway (2000: 9) further states that it also wastes
financial resources.
There is a wide variation in the prescribing habits of antibioticsldrugs. In primary health care
30% to 60% of patients receive antibiotics. Misuse is a common mistake and may take the form
of incorrect dosage or inappropriate prescription (Holloway, 2000: 9). According to Smith (1998:
1) the problem of antimicrobial resistance developed because of patients' insistence upon
antibiotic therapy to recover from illness. Furthermore, patients fail to take a full-prescribed
prescription and some physicians prescribe antibiotics to patronize patients. Holloway (2000: 9)
states that prescribers citing patient demand as a cause of irrational prescribing have been
reported in many countries. Even patient demand for specific drugs has been widely observed
by researchers.
Chaoter 3: Antibiotic usaae
Inappropriate use of antimicrobials creates ideal conditions for the emergence of drug-resistant
microbes. Usage of antibiotics for common cold and other conditions for which they are not
indicated contributes to antimicrobial resistance. Insufficient diagnostic testing may contribute
to overuse of antibiotics (National Institute of Allergy and Infectious Diseases, 2000: 1).
Uncertainty of the diagnosis leads to over-prescription. In many developing countries, the
diagnostic process is often inadequate, resulting in an inability to arrive at a diagnosis with any
certainty (Holloway, 2000: 9). Close contact between patients in hospitals provides a fertile
environment for the development of drug resistance as well as excessive use of antibiotics
(National lnstitute of Allergy and lnfectious Diseases. 2000: 1).
Another factor contributing to antimicrobial resistance is the fact that microbes multiply very
rapidly. This enables a single mutant to become dominant. Microbes also spread readily from
person to person. One patient infected with a resistant strain may be an important source of
spread of a resistant infection (Williams, 2000: 7-8).
Knox et a/. (2003: 85) stated that improved clinical outcome, patient safety, cost savings and
reduction in the burden of antimicrobial resistance are outcomes associated with optimising
antimicrobial use. Although strategies have been implemented in hospital settings, the misuse
of antimicrobials remains a huge problem.
3.4.4 Treating resistance effectively
Antimicrobial resistance is a natural biological occurrence and therefore it cannot be halted,
though it is possible to contain it. According to Williams (2000: 8), coordinator of the Anti-
infective Drug Resistance and Containment at the World Health Organization, the main priority
should be to first prevent infections and secondly to aim for containment of the problem. The
focus should be on minimising any unnecessary, inappropriate or irrational use of antimicrobial
drugs.
A large group of people in the health sector play a role in developing and implementing a
resistance containment action plan (Williams, 2000: 8):
rn Patients and the general public.
rn All groups of prescribers and dispensers.
o Hospital managers and health care professionals.
rn Users of antimicrobials in agriculture.
o National governments.
o Pharmaceutical, diagnostic and 'su~eillance" industries.
o International agencies and professional societies.
Chapter 3: Antibiotic usage
Williams (2000: 8) further states that problems with antimicrobial usage occur in both developed
and developing countries. These include:
Drugs are not equitably available.
Used by too many people.
To treat the wrong disease.
Drugs are administered in the wrong dosage.
For the wrong period of time.
Not in the correct formulation or strength.
It is clear that everyone in the health care sector plays an important role in the fight against
antimicrobial resistance.
3.5 SOME PRINCIPLES OF ANTIMICROBIAL THERAPY
Accurate use of antibiotics can result in favourable therapeutic results. However, uncontrolled
use may result in the emergence of resistant organisms. Antibiotics are not only associated
with the emergence of resistance from microorganisms, but also with serious adverse reactions.
Therefore sound diagnoses, based on evidence that a treatable infection is present, are needed
before a drug therapy can be selected.
3.5.1 Decision making regarding antibiotic therapy
Ideal drug usage involves the correct drug, administered by the best route, in the right amount,
at optimum intervals, for the appropriate period, after the physician had made an accurate
diagnosis (Williams, 2000: 8). According to Jacobs eta/. (2001: 1494) the following steps are
required in each patient considered for antibiotic therapy:
Etiologic diagnosis:
The organism causing the infection can usually be predicted based on the organ associated
with the disease.
P "Best guess":
The physician should select an antimicrobial drug based on past experience with empirical
therapy.
P Laboratory control:
Laboratory examinations should be done before initiating therapy.
Chanter 3: Antibiotic usaae
0 Clinical response:
Based on the clinical response of the patient, the physician should evaluate the laboratory
reports and consider the changing of the drug regimen.
Drug susceptibility tests:
Some micro-organisms are relatively uniformly susceptible to certain drugs. If such organisms
are isolated, they need not be tested for drug susceptibility.
o Promptness of response:
Response towards the chosen drug therapy depends on a range of factors, including the host,
the site of infection, the pathogen, and the duration of illness. Symptoms may arise and do not
indicate improper choice of antibiotics but may be due to the natural history of the disease.
Duration of antimicrobial therapy:
The duration of therapy depends on several factors, namely the type of micro-organism, the site
of infection, and the immunocompetence of the patient. It is clear that each patient should be
seen as an individual.
o Adverse reaction and toxicity:
All antimicrobials can cause adverse effects such as hypersensitivity reactions, direct adverse
effect or toxicity, superinfections and drug interactions. The severity of the disease and the
adverse effects associated with the antibiotics should be measured against the overall outcome
of the therapy.
Route of administration:
The route of administration will depend on the severity of the disease. Parenteral therapy is
preferred for acutely ill patients with serious infections when high levels of antibiotics are
required for successful therapy.
o Cost of antibiotics:
Antibiotics are used extensively. For this reason the wst of these agents can be substantial to
institutions and individuals. Cost should not be the only determinant in choosing antibiotics.
Several drugs with equal efficacy and toxicity are available on the market and one should
choose the least expensive drug therapy.
Chapter 3: Antibiotic usage
3.5.2 Minimum inhibitory concentration
The drug concentration at the site or the exposure time for the drug plays an important role in
bacteria eradication. Antibacterial drugs are used to achieve the minimum effective
concentration necessary to inhibit the growth of a microorganism (Kee 8 Hayes, 2003: 392).
According to Greene and Harris (1998: 549) the minimum inhibitory concentration (MIC) is the
minimum concentration of an antimicrobial that is capable of inhibiting the growth of a particular
organism in vitro.
Duration of time for use of the antibacterial varies according to the type of pathogen, site of
infection and immunocompetence of the patient. With some severe infections, a continuous
infusion regimen is more effective than an intermittent dosing because of constant drug
concentration and time exposure (Kee 8 Hayes, 2003: 393).
The minimum bactericidal concentration is more relevant when it is essential that the organisms
be killed to prevent relapse (Greene 8 Harris, 1998: 549).
3.6 DRUG CLASSIFICATION
Various classification schemes have been proposed. Currently, those natural or semi synthetic
drugs that have a common basic chemical structure are grouped into one class and named after
the member first discovered or afIer a principal chemical property. This classification is very
useful in practice, as the components of one class usually share many biological characteristics.
Drugs can also be classified on the basis of their pharmacological action and therapeutic use.
A complete classification of all medicines according to the MIMS@ (Snyman, 2003: 247-263)
follows in Appendix I.
3.6.1 The Anatomical Therapeutic Chemical (ATC) classification system
The World Health Organization (WHO) introduced the Anatomical Therapeutic Chemical (ATC)
classification system in 1969. A technical unit of measurement called Defined Daily Dose
(DDD) to be used in drug utilisation studies have also been introduced. It was agreed in 1996
that an internationally accepted classification system for drug consumption studies was needed
and the ATClDDD system was recommended. Today many organisations involved in drug
monitoring use this classification (Persson & Strem, 2002: 1).
Chapter 3: Antibiotic usage
3.6.1.1 Structure of Anatomical Therapeutic Chemical (ATC) classificationsystem
The Anatomical Therapeutic Chemical (ATC)classification system classifies drugs according to
the organ or system on which they act as well as their chemical, pharmacological and
therapeutic properties. Table 3.6 shows that there are fourteen main groups (1stlevel),withone
pharmacological/therapeutic subgroup (2nd level). The 3rd and 4th levels are
chemical/pharmacological/therapeutic subgroups and the 5thlevel is the chemical substance.
The complete classification of metforminillustrates the structure of the code (WHO,2002: 1). It
was determined according to Table 3.2:
A Alimentarytract and metabolism (anatomical main group)
A10 Drugs used in diabetes (therapeutic sub group)
A1OB Oral blood glucose loweringdrugs (pharmacological sub group)
A10BA Biguanides (chemical sub group)
A10BA02 Metformin(Chemical substance)
Table 3.2: Main groups of the Anatomical Therapeutic Chemical classification
(Persson &Str(l)m,2002: 2).
61
Anatomical. Ther'CipeutiQChemiQlg"Qgps ....1Ivel
A
Alimentarytract and metabolism
B
Bloodand blood formingorgans
C
Cardiovascular system
D
Dermatologicals
G
Genito urinarysystem and sex hormones
H
Systemic hormonal preparations, excluding sex hormones and
insulins
J
Anti-infectivesfor systemic use
L
Antineoplastic and immunomodulatingagents
M
Musculo-skeletal system
N
Nervous system
p
Antiparasiticproducts, insecticides and repellents
R
Respiratory system
S
Sensoryorgans
V Various
Chapter 3: Antibiotic usage
3.6.2 Defined Daily Dose (DDD)
According to Persson and Str~rm (2002: 2), the World Health Organisation defines the Defined
Daily Dose (DDD) as follows: "The DDD is the assumed average maintenance dose per day for
a drug used for its main indication in adults."
The Defined Daily Dose (DDD) is a unit of measurement and does not reflect the recommended
or prescribed daily dose. Doses for individual patients and patient groups need to be based on
individual characteristics and pharmacokinetic considerations. Data presented in DDDs only
give a rough estimate of consumption and not an exact picture of actual use (WHO, 2002: 1).
3.6.2.1 Principles for Defined Daily Dose assignment
The assigned Defined Daily Dose (DDD) is based on the following principles (WHO, 2002: 1):
o The dosage used by adults for the main indication, as reflected by the ATC code, is used.
When the dosage needs to be calculated using body weight, an adult is considered to be a
person of 70 kg.
0 The maintenance dose is usually preferred when establishing the DDD.
0 The treatment dose is generally used and if prophylaxis is the main indication, this dose is
used.
o A DDD is usually established according to the declared strength of the product.
3.6.3 Other classification systems
The Anatomical Classification (AC-system) developed by the European Pharmaceutical Market
Research Association classifies drugs in groups at three or four different levels. The
Anatomical Therapeutic Chemical (ATC) system has been derived from the Anatomical
Classification (AC-system) (WHO, 2002: 1).
Other classification systems available are the following: Prescribing Analysis And Cost (PACT),
National Approved Product Pricing lndex (NAPPI) and Monthly lndex of Medical Specialities
(MIMSB) used in South Africa. The above-mentioned systems classify drugs according to
therapeutic and pharmacological action.
Chapter 3: Antibiotic usage
3.6.4 Classification of antibiotics
In South Africa antibiotics are classified according to the Monthly Index of Medical Specialities
(MIMSO) (Snyman, 2003: 13a) as follows:
Beta-lactams
Penicillins
Cephalosporins
* Others
o Erythromycin and other Macrolides
o Aminoglycosides
o Tetracyclines
o Chloramphenicols
o Sulphonamides and combinations
o Quinolones
Other antibiotics
A complete classification of the beta-lactam antibiotics according to the MIMSB (Snyman, 2003:
247-263) is given in Appendix J.
3.7 PHARMACOLOGY OF ANTIBIOTICS
This section provides a short overview of some aspects regarding the pharmacology of
antibiotics relevant to this study.
3.7.1 Penicillins
Penicillins form the largest group of antimicrobial drugs. According to Lancini et a/. (1995: 8),
penicillin is the first choice for treatment of a number of infections. Penicillin is a natural
antibacterial agent obtained from the mold genus Penicillium (Kee & Hayes, 2003: 395).
Penicillins all share a common chemical nucleus (6-aminopenicillanic acid) that contains a P-
lactam ring essential to their biologic activity (Chambers, 2004: 734). The addition of different
side chains to the parent nucleus has broadened the choice of penicillins (Greene & Harris,
1998: 551).
Chaoter 3: Antibiotic usaae
According to Chambers (2004: 734) penicillins are divided into the following categories:
o Broad-spectrum penicillins (Aminopenicillins).
Penicillinase-resistant penicillins (Antistaphylococcal penicillins).
o Extended-spectrum penicillins (Antipseudomonal penicillins).
Kee and Hayes (2003: 395-397) also state that there is a fourth category:
Beta-lactamase inhibitors (combination with clavulanic acid).
3.7.1.1 Antimicrobial action
The mechanism of action of p-lactam antibiotics is to inhibit formation of microbial cell walls
(Jacobs et al., 2001: 1502) and is therefore bactericidal (Lancini et al., 1995: 9). The bacterial
cell wall is a rigid outer layer that is not found in animal cells (Chambers, 2004: 734).
Inhibition of the peptidoglycan biosynthesis by plactams has been the most successful
antibacterial discovered by humans. The peptidoglycan layer is an effective target for action
because it accounts for about 5% of the cell wall in gram-negative bacteria and 30% to 40% of
gram-positive bacteria (Mann & Crabbe, 1996: 34-35).
3.7.1.2 Pharmacokinetics and administration
Oral penicillins, except for amoxicillin, should not be given at mealtimes to minimize binding to
food proteins and acid inactivation (Chambers, 2004: 738). Blood levels of penicillin can be
raised when aspirin or probenecid is taken with it (Kee & Hayes, 2003: 398).
Absorption of orally administered drugs differs greatly for different penicillins, depending in part
on their acid stability and protein binding (Chambers, 2004: 736). Penicillin V, ampicillin,
amoxicillin, cloxacillin, dicloxacillin and oxacillin are acid-stable compounds and can be given
orally to patients. Penicillin G is acid-labile and can be given via intravenous route to patients in
hospital (Lesse, 1995: 365).
The acidic nature of penicillin restricts its distribution to a basic environment such as the
prostatic fluid. Penicillins cannot cross cell membranes or be distributed into the spinal fluid
because of the blood-brain barrier. Though, during meningeal inflammation almost 40% of
serum levels can be achieved. Because of the large therapeutic index of penicillin it is possible
to increase the concentration in the cerebrospinal fluid to kill bacteria (Lesse, 1995: 365).
3.7.1.3 Clinical uses
The basic penicillins (penicillin G procaine, penicillin G benzathine, penicillin V potassium) are
used to treat moderately serious infections (Kee & Hayes, 2003: 396) caused by streptococci,
64
Chanter 3: Antibiotic usaae
meningococci, enterococci, Treponema pallidum and non-plactamase-producing gram-negative
anaerobic organisms (Chambers, 2004: 738-739).
Aminopenicillins include amoxicillin, ampicillin and combinations with clavulanic acid. They
have greater activity against gram-negative bacteria than penicillin G, due to their enhanced
ability to penetrate the gram-negative outer membrane (Chambers, 2004: 741). This group of
broad-spectrum penicillins is used to treat respiratory tract infections, urinary tract infections,
otitis media and sinusitis. Amoxicillin is the most frequently prescribed penicillin for adults and
children (Kee & Hayes, 2003: 397).
The penicilinase-resistant penicillins are used to treat penicillinase-producing Staphylococcus
aureus. A few of the penicillins, which have been developed in this group, include methicillin,
cloxacillin and flucloxacillin (Greene & Harris, 1998: 552). They are primarily used for systemic
infections caused by resistant staphylococci (Kee & Hayes, 2003: 396).
Carbenicillin, mezlocillin, piperacillin and ticarcillin fall in the category of extended-spectrum
penicillins. This group of drugs is effective against Pseudononas aeruginosa, a gram-negative
bacillus (Chambers, 2004: 741). These drugs are also useful against gram-negative organisms
such as Proteus spp., Setratia spp., Klebsiella pneumoniae, Enterbacter spp. and Acinetobacter
spp. The antipseudomonal penicillins are not penicillinase resistant (Kee & Hayes, 2003: 397).
There are three beta-lactamase inhibitors: clavulanic acid, sulbactam and tazobactam
(Chambers, 2004; 741). When these inhibitors are combined with broad-spectrum antibiotics
the resulting antibiotic inhibits the bacterial beta-lactamase thus making the antibiotic effective
and extending its antimicrobial effect (Kee & Hayes, 2003: 397).
3.7.1.4 Adverse effects of penicillin
Major adverse reactions associated with penicillin are hypersensitivity and superinfection. In
severe cases it may result in anaphylaxis and death. Allergic effects occur in 5% to 10% of
patients receiving penicillin compounds (Kee & Hayes, 2003: 399). Allergic reactions include
urticaria, fever, joint swelling, pruritus and angioneurotic edema. Oral lesions, interstitial
nephritis, eosinophilia, haemolytic anemia and other hematologic disturbances, and vasculitis
may also occur (Chambers, 2004: 741).
Other adverse effects to penicillin are generally less severe than anaphylaxis. The older types
of penicillins cause electrolyte disturbances. This is due to the fact that they are administered
as sodium or potassium salts. Leukopenia is associated with high doses of nafcillin.
Thrombocytopenia and a Coombs'-positive haemolytic anemia occasionally occur (Lesse, 1995:
65
Chaoter 3: Antibiotic usaae
365-369). With high dosages of intravenous penicillin seizures may occur in patients with renal
failure (Chambers, 2004: 741).
3.7.1.5 Other beta-lactam antibiotics
The carbapenems and monobactams have further widened the choice of beta-lactams.
lmipenem is a very broad-spectrum carbapenem (Greene & Harris, 1998: 557). Meropenem is
also included in the carapenems. Carbapenems are active against gram-negative organisms,
including Pseudomonas, and a range of gram-positive bacteria. They are used in the treatment
of septicemia, urinary tract infections, lower respiratory infections and skin infections (Kee 8
Hayes, 2003: 401).
Aztreonam is the only monobactam currently available. It is used for the treatment of gram-
negative infections of the lower respiratory tract, urinary tract, skin and vagina (Kee & Hayes,
2003: 401). It has no activity against gram-positive bacteria or anaerobes (Chambers, 2004:
747).
Loracarbef is a synthetic beta-lactam antibiotic from the carbacephem class. It is effective in
the treatment of respiratory, urinary tract and skin infections (Kee & Hayes, 2003: 401).
3.7.2 Cephalosporins
Cephalosporins are classified as p-lactam antibiotics because of their ability to bind to penicillin-
binding proteins, therefore inhibiting bacterial cell wall synthesis (Kee & Hayes, 2003: 400).
Cephalosporins are divided into four generations on account of the spectrum of antimicrobial
activity they exert.
3.7.2.1 Antimicrobial action
The mechanism of action of cehpalosporins is identical to that of the penicillins, though the
spectrum of microbial sensitivity is broad and extends to gram-negative bacteria (Williams,
1996: 33). They are bactericidal by inhibition of cell wall synthesis (Greene & Harris, 1998:
554).
According to Beam (1995: 374), first-generation cephalosporins are short acting and include
cefadroxil, cefazolin, cephalexin, cephalothin and cephardine. They possess excellent activity
against gram-positive cocci, Escehrichia coli, Proteus, Salmonella, Shigella (Kee & Hayes,
2003: 401), limited activity against Enterobacteriaceae and no activity against
Pseudomonaceae (Beam, 1995: 374).
Chapter 3: Antibiotic usage
Second-generation cephalosporin, such as cefaclor, cefamandole, cefoxitin sodium, cefprozil
and cefuroxime (Kee & Hayes, 2003: 403-404), have a longer half-life, less effective against
gram-positive bacteria than against gram-negative bacteria. They exert no activity against
Pseudomonas (Beam, 1995: 374).
Third-generation cephalosporins' half-life is greater than that of second-generation
cephalosporins. They have greater activity against gram-negative bacteria (Greene & Harris,
1998: 554) and some are effective against Pseudomonas infections (Beam, 1995: 374). Third-
generation cephalosporins include cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftriaxone
and ceftibuten (Kee & Hayes, 2003: 404).
Cefepime is a fourth-generation cephalosporin. It is resistant to most beta-lactamase bacteria
and has a broader gram-positive coverage than the third generations. It is effective against
pneumonia, Escehrichia coli, Klebsiella, Protues, streptococci and certain staphylococci (Kee &
Hayes, 2003: 404).
3.7.2.2 Pharmacokinetics and administration
Cephalosporins may be administered either by the oral or parenteral route. The chemical
formulation for each route of delivery differs. Some drugs that are delivered orally do not have a
comparable parenteral formulation and vice versa (Beam, 1995: 375-376).
Extravascular sites are penetrated by cephalosporins. There is no penetration of intracellularly
sites and therefore they cannot be used to treat intracellular pathogens. Cefuroxime (a second-
generation cephalosporin) (Beam, 1995: 375-376) and third-generation cephalosporins (e.g.
cefotaxime, ceftizoxime, ceftriaxone) can be used for infections of the central nervous system
and bacterial meningitis (Kee & Hayes, 2003: 404).
3.7.2.3 Clinical uses
Cephalosporins may be used for the prophylaxis or treatment of a wide variety of infectious
diseases.
First-generation cephalosporins are used to treat infections caused by streptococcal and
staphylococcal bacteria (Greene 8 Harris, 1998: 554). Cefadroxil is used in the treatment of
urinary tract infections and skin infections. Cephalothin, cephradine, cefazolin and cephalexin
are used in respiratory, gastro intestinal, bone and skin infections. Septicemia, endocarditis and
meningitis are also treated with these drugs (Kee & Hayes, 2003: 403). A limited number of
infections caused by gram-negative strains may be treated with cephalosporins (Beam, 1995:
377).
Chaoter 3: Antibiotic usaae
Second-generation cephalosporins are used to treat infections caused by Haemophilus
influenzae or 13. fragilis and meningitis caused by H. influenzae, Streptococcus pneumoniae and
Neisseria meningitides (Beam, 1995: 377). Other uses include the treatment of infections
outside the central nervous system, intra-abdominal and pelvic infections. Cefamandole,
cefuroxime and cefmetazole are used for preoperative prophylaxis for surgery, while cefoxitin is
used to treat severe infections and septicemia (Kee & Hayes, 2003: 403).
Third-generation cephalosporins (e.g. cefixime, cefpodoxime, ceftriaxone) are useful in the
treatment of nosocomial infections caused by gram-negative bacteria (Beam, 1995: 377). Third-
generation cephalosporins are used in various infections ranging from meningitis, pneumonia,
bacteremia, urinary tract infections, intra abdominal infections, otitis media, lower and upper
respiratory infections, septicemia to skin infections (Kee & Hayes, 2003: 404; Green & Harris,
1998: 554).
The fourth-generation cephalosporin (cefepime) is clinically used for the same infections as the
third-generation cephalosporins, though, it has a broader gram-positive action than the third-
generation cephalosporins (Kee & Hayes, 2003: 404).
3.7.2.4 Adverse effects of cephalosporins
Some adverse effects associated with cephalosporin therapy include nausea, vomiting,
diarrhoea, anorexia and pseudomembrane colitis. Cephalosporins are not generally associated
with hepatotoxicity and nephrotoxicity (Kee & Hayes, 2003: 403). Cephalothin has been
reported to cause tubular necrosis (Beam, 1995: 376).
A positive Coombs' reaction may occur with cephalosporin therapy. When used in high doses
for a comprehensive period of time, cephalosporins may cause neutropenia (Beam, 1995: 376).
3.7.3 Erythromycin and other macrolides
Macrolides (azithromycin, clarithromycin, erythromycin, etc.), lincosamides (clindamycin and
lincomycin) and vancomycin are discussed together. According to Kee and Hayes (2003: 408)
they have spectrums of antibiotic effectiveness similar to penicillin, although they differ in
structure. Drugs from these groups, especially erythromycin, are used as penicillin substitutes,
especially in individuals who are allergic to penicillin.
Erythromycin is an orally effective macrolides antibiotic. It consists of a lactone ring to which
one or more deoxy sugars are attached. Erythromycin is obtained in the metabolic products of
a strain of Streptomyces erythreus (Kapusnik-Uner et al., 1996: 1135).
Cha~ter 3: Antibiotic usaae
3.7.3. I. Antimicrobial action
Macrolide and lincosamide antibiotics are bacteriostatic agents that inhibit protein synthesis by
binding to 50s ribosomal subunits of micro-organisms (Jacobs et a/., 2001: 1512) . Although
they are bacteriostatic agents, they are bactericidal for some gram-positive organisms at higher
concentrations. Vancomycin is a bactericidal antibiotic used against drug-resistant
Staphylococcus aureus (Kee 8 Hayes, 2003: 412).
Erythromycin possesses a broad spectrum of activities against bacteria. The main spectrum of
activity includes gram-positive organisms, except Staphylococcus aureus (Kee 8 Hayes, 2003:
409), and gram-negative aerobic and anaerobic bacteria; mycobacteria; mycoplasma species
and chlamydia (Reynard, 1995: 384). Clindamycin is more widely prescribed than lincomycin
because it is active against most gram-positive organisms, including Staphylococcus aureus,
and anaerobic organisms. It is not effective against the gram-negative bacteria (Kee 8 Hayes,
2003: 410).
3.7.3.2 Pharmacokinetics and administration
Erythromycin base is adequately absorbed from the upper part of the small intestine and
diffuses into intracellular fluids except the brain and cerebrospinal fluid. It is incompletely
absorbed because of inactivation by gastric acids (Kapusnik-Uner et al., 1996: 1137).
Therefore various acid-resistant salts are added to erythromycin (Kee 8 Hayes, 2003: 409).
Erythromycin is formulated as enteric-coated tablets or as capsules containing enteric-coated
pellets that dissolve in the duodenum.
Clarithromycin is rapidly absorbed from the gastrointestinal tract after oral administration. Peak
concentrations are achieved approximately 2 hours after administration. Clarithromycin is
subjected to the first-pass effect and its bioavailabiliiy is thus reduced to 50% to 55% (Kapusnik-
Uner et al., 1996: 1137). Therefore it is administered twice daily (Kee 8 Hayes, 2003: 410).
After administration of azithromycin it is rapidly absorbed and distributed throughout the body. It
has a long half-life and is prescribed once a day (Kee 8 Hayes, 2003: 410). Lower
concentrations are achieved in the cerebrospinal fluid. Concomitant administration with food
will decrease azithromycin bioavailability by 43% (Kapusnik-Uner et ab, 1996: 1137).
3.7.3.3 Clinical uses
Erythromycin is clinically useful in a variety of infections. It is the drug of choice for infections
caused by legionella, mycoplasma, ureaplasma, corynebacteruim (diphtheria) and chlamydia.
Erythromycin is effectively used in penicillin-allergic patients for streptococcal and
pneumococcal infections (Jacobs eta/., 2001: 1512-1513). Other infections that may be treated
69
Chapter 3: Antibiotic usage
are nongonococcal urethritis, syphilis in pregnancy, acne vulgaris, prophylaxis for the
prevention of rheumatic fever, and anaerobic bronchopulonary infections (Reynard, 1995: 384)
and to prevent recurrence of rheumatic fever (Kee 8 Hayes, 2003: 409).
Azithromycin is used for the treatment of mild to moderate streptococcal infections, lower
respiratory tract infections, gonorrhea, chancroid, and infections with Streptococcus
pneumoniae, Haemophilus influenzae and Staphylococcus aureus. For the treatment of upper
and lower respiratory infections, skin and soft tissue infections and Helicobacter pylon'
clarithromycin is preferred (Kee & Hayes, 2003: 408).
Clindamycin in its various salt forms is prescribed for the treatment of serious infections (Kee 8
Hayes, 2003: 408) such as skin and soft tissue infections, chronic osteomyelitis and
septicaemia (MIMS, 2003: 281).
Vancomycin is considered for Staphylococcus aureus-resistant infections and cardiac surgical
prophylaxis (Kee & Hayes, 2003: 408).
3.7.3.4 Adverse effects of erythromycin
Gastrointestinal distress, epigastric pain, nausea, vomiting and diarrhoea are commonly
associated with oral administration of erythromycin (Reynard, 1995: 385). Superinfections,
vaginitis, urticaria and stomatitis are common adverse reactions of erythromycin (Kee & Hayes,
2003: 409). Most adverse effects may be limited by taking drugs with food, though absorption
of some drugs is inhibited. An alternative is to switch from one preparation to another.
Cholestatic hepatitis is primarily associated with erythromycin estolate, probably as a
hypersensitivity reaction (Jacobs et a/., 2001: 1513). Jaundice, accompanied by fever,
leukocytosis, eosinophilia and elevated activities of transaminases in plasma, are associated
with cholestatic hepatitis (Kapusnik-Uner eta/., 1996: 1140).
Clindamycin is considered more effective than linwmycin and has fewer toxic effects. Severe
adverse reactions include colitis and anaphylactic shock (Kee 8 Hayes, 2003: 410).
Ototoxicity and nephrotoxicity are associated with the use of vancomycin. This treatment may
result in permanent hearing loss or temporary or permanent loss of balance (Kee & Hayes,
2003: 412).
Chanter 3: Antibiotic usaae
3.7.4 Tetracycline
The tetracyclines are a large group of antibiotics with a broad spectrum of action and effective
therapeutic effects. The tetracyclines are products of different strains of Streptomyces (Lancini
etal., 1995: 9). Continues use of tetracyclines has resulted in bacterial resistance to the drugs.
Tetracycline resistance has increased in the treatment of pneumococci and gonococci infections
(Kee & Hayes, 2003: 413). Micro-organisms resistant to this group of drugs show extensive
cross-resistance to all tetracyclines (Lancini etal., 1995: 9).
3.7.4.1 Antimicrobial action
The tetracyclines act by preventing bacterial protein synthesis. The tetracyclines bind to the
30s bacterial ribosome, preventing access of aminoacyl tRNA to the acceptor site on the
mRNA-ribosome complex (Kapusnik-Uner et a/., 1996: 1125).
The selective toxicity of tetracyclines to bacterial cells is due to their inability to be transported
into mammalian cells (Reynard, 1995: 381). The tetracyclines are classified as bacteriostatic
when given at normal blood concentrations. At much higher concentrations they may exhibit
bactericidal effects (Pratt et a/., 1986: 205).
3.7.4.2 Pharmacokinetics and administration
Most of the tetracyclines are irregularly absorbed from the gastrointestinal tract. Most of the
absorption takes place from the stomach and upper small intestine (Kapusnik-Uner etal., 1996:
1126). Tetracycline absorption is impaired by dairy products, aluminum hydroxide gels and
chelation with divalent cations (e.g., ca2' or ~e~') (Jacobs etal., 2001: 1514).
After absorption of tetracycline it is distributed into tissues and secretions and accumulates in
the reticuloendothelial cells of the liver, spleen and bone marrow and in bone, dentine and the
enamel of teeth. Tetracycline is known to cross the placenta and reach high concentrations in
the fetal circulation. The amount of tetracycline found in breast milk is also relatively high
(Kapusnik-Uner et a/., 1996: 1126).
3.7.4.3 Clinical uses
Tetracyclines are used in a variety of infections as drug therapy. It is used in infections caused
by chlamydiae, mycoplasmas, rickettsiae, ehrlichia and vibrio. Tetracyclines are also effectively
used in sexually transmitted diseases, pelvic inflammatory disease, acne, respiratory infections,
Lyme disease, malaria, brucellosis, tularaemia and cholera (Jacobs et a/., 2001: 1514 and
Kapusnik-Uner etal., 1996: 1128-1 129).
Chapter 3: Antibiotic usage
Tetracycline and oxytetracycline are short-acting tetracyclines used in urinary tract infections.
Intermediate tetracyclines include demeclocycline and methacycline used for gram-positive and
gram-negative bacteria. The long-acting tetracyclines are doxycycline, used for Legionella
syndrome and treatment of anthrax, and minocycline is used effectively in acne treatment (Kee
& Hayes, 2003: 413).
The use of tetracyclines has declined due to increased bacterial resistance. This resulted as an
effect of overuse in the animal feed industry as well as unmerited use in humans (Kapusnik-
Uner et al., 1996: 1129).
3.7.4.4 Adverse effects of tetracycline
Gastrointestinal disturbances such as nausea, vomiting and pain are usually dose-dependent.
When diarrhoea is associated with tetracycline therapy it should be distinguished from
pseudomembranous colitis (Reynard, 1995: 381). Superinfections (candidiasis) in patients are
due to the broad-spectrum of activity of tetracycline (Kee & Hayes, 2003: 412). Hypersensitivity
reactions to the tetracyclines (doxycycline and demeclocycline) have been described including
rash, fever, glossitis, angioedema and anaphylaxis (Reynard, 1995: 381). Cross-sensitivity is a
general occurrence (Williams, 1996: 89).
Adverse effects with the use of tetracyclines are usually observed in pregnant patients and
patients under the age of eight years. Tetracyclines chelate divalent metals and bind strongly to
bone and tooth material. Tetracyclines cause discoloration of teeth and depression of bone
growth. Due to these adverse effects tetracyclines are wntraindicated in children of tooth-
formation age and pregnant women (Williams, 1996: 89).
3.7.5 Chloramphenicol
Chlorampheniwl was the first therapeutic agent active against rickettsiae and related micro-
organisms. Chlorampheniwl is isolated from a strain of Streptomyces venezuelae. The
widespread use of chlorampheniwl has been limited due to the adverse effects associated with
its use (Lancini et a/., 1995: 173).
3.7.5.1 Antimicrobial action
Chlorampheniwl binds to the 50s subunit of ribosomes to inhibit the peptidyl transfer reaction.
The inhibition of peptidyl transfer reactions is directly mediated by ribosomal RNA and
chlorampheniwl bind to this macromolecule (Lancini et al., 1995: 69). The result of this
reaction is an inhibition of protein synthesis. Chloramphenicol is a bacteriostatic drug.
Cha~ter 3: Antibiotic usaae
3.7.5.2 Pharrnacokinetics and administration
Chloramphenicol is distributed in tissues, including the eye and central nervous system.
Cerebrospinal fluid levels are 70% to 80% of peak serum levels. Metabolism of
chloramphenicol is done in the liver. Less than 10% of the drug is excreted unchanged in the
urine (Jacobs et al., 2001: 1515).
3.7.5.3 Clinical uses
Chloramphenicol is bacteriostatic in its activity. It is effective against both gram-negative and
gram-positive organisms. Chloramphenicol is used for the treatment of severe infections or
when other antibacterials are not effective (Kee & Hayes, 2003: 686). In some circumstances it
shows bacteriocidal effects towards S pneurnoniae, H influenza and N rneningitidis (Jacobs et
al., 2001: 1515).
Chloramphenicol is used to treat meningococcal or pneumococcal infections of the central
nervous system in patients that experienced anaphylaxis when using elactam antibiotics.
Chloramphenicol is also used against anaerobic (B. fragilis) or mixed infections of the central
nervous system. Where vancomycin-resistant enterococcal infections are suspected,
chloramphenicol is used as treatment (Jacobs et al., 2001: 1515).
3.7.5.4 Adverse effects of chlorarnphenicol
Excessive use of chloramphenicol results in serious adverse effects concerning the
hematopoietic system. Disturbances in red cell maturation are revealed within 1 to 2 weeks of
excessive use. This is associated with anemia, hyperferremai, reticulocytopenia and the
appearance of vacuolated nucleated red cells in the bone marrow (Reynard, 1995: 383).
Chloramphenicol used in newborns may produce the fatal 'grey baby syndrome". These
patients lack the ability to metabolise chloramphenicol in the liver and this leads to accumulation
of the drug. The mechanism for detoxification of chloramphenicol in the liver is essential to
newborns, as well as to adults (Jacobs eta/., 2001: 1515).
The combination of chloramphenicol with some drugs is not allowed because of
chloramphenicol's ability to inhibit the metabolism of these drugs, such as the concurrent use
with warfarin, hypoglycaemic agents, phenytion, etc. is prohibited (MIMS, 2003: 272). The
resulting effects are a prolonged action and raised blood concentration of the drugs (Jacobs et
a/., 2001: 1515).
Chapter 3: Antibiotic usage
3.7.6 Arninoglycosides
Aminoglycosides are bactericidal inhibitors of protein synthesis. They are primarily useful in the
treatment of infections caused by aerobic gram-negative organisms (Chambers & Sande, 1996:
1103), such as Escherichia coli, Proteus spp. and Pseudomonas spp. (Kee 8 Hayes, 2003:
415).
3.7.6.1 Antimicrobial action
Aminoglycosides inhibit protein synthesis in bacteria by attaching to and inhibiting the function
of the 30s subunit of the bacterial ribosome (Jacobs et al., 2001: 1515). Inhibition of protein
synthesis is not considered to be fatal to bacteria. Destruction of the cell wall of bacteria is
considered to be more fatal. Aminoglycosides are accepted to be bactericidal because of their
irreversible binding to receptors that result in cell death (Reynard, 1995: 378-379).
3.7.6.2 Pharmacokinetics and administration
Adequate absorption is achieved after intramuscular or intravenous injection (Jacobs et aL,
2001: 1516). Gentamicin and netilmicin have a short half-life and the drug dose can be given
three to four times a day (Kee 8 Hayes, 2003: 415). However, after oral administration,
inadequate concentrations are found in cerebrospinal fluid and the normal kidney excretes all
rapidly (Chambers &Sande, 1996: 1103).
3.7.6.3 Clinical uses
The aminoglycosides are used primarily to treat infections caused by aerobic gram-negative
organisms (Chambers 8 Sande, 1996: 1103). According to Jacobs et al. (2001: 1516),
aminoglycosides demonstrate activity against many gram-positive organisms, but should never
be used alone to treat infections caused by these organisms. This is due to the fact that there is
no clinical experience with the treatment of such infections and because less toxic alternatives
are available.
Aminoglycosides are used for the treatment of a few specific conditions. It has been indicated
for the treatment of plague, tularemia, endocarditis, tuberculosis and acute brucellosis (Jacobs
et al., (2001: 1517). Streptomycin, the first aminoglycoside, is used in combination with
antituberculosis drugs in the treatment of tuberculosis. Amikacin, gentamicin, kanamycin and
tobramycin are effective against Pseudomonas aeruginosa infections. Neomycin decreases
bacteria in the bowels and is used as a preoperative bowel antiseptic, while netilmicin and
paromomycin are used in treating hepatic coma and parasitic infections (Kee 8 Hayes, 2003:
417).
Chapter 3: Antibiotic usage
3.7.6.4 Adverse effects of aminoglycosides
Of concern is the possibility of ototoxicity and nephrotoxicity. Ototoxicity can be irreversible and
cumulative. It presents as hearing loss, noted first with high-frequency tones, or as vestibular
damage, manifested by vertigo and ataxia. Nephrotoxicity is usually reversible, but more
frequent than ototoxicity. Rising serum creatinine levels or reduced creatinine clearance is an
indication of nephrotoxicity. Adverse effects may be potentiated if used concomitant with other
drugs that cause adverse effects associated with aminoglycosides (Reynard, 1995: 380).
Patients suffering from renal failure, volume overload or obesity have distorted antibiotic
clearance or volume of distribution. Whenever one or more of these conditions occur in
patients, once daily dosing is not recommended and aminoglycoside levels are recommended
to guide levels (Jacobs et a/, 2001: 1517).
A curare-like neuromuscular blockade resulting in respiratory paralysis and allergic reactions in
the form of fever and rash may occasionally occur with aminoglycoside therapy (Reynard, 1995:
380).
3.7.7 Sulphonamides
Mandell et a/. (1996: 1057) stated that the sulphonamide drugs were the first effective
chemotherapeutic agents to be used systemically for the treatment of bacterial infections in
humans. Because of their low cost and relative efficacy in many infections, sulphonamides are
used widely (Jacobs et a/., 2001: 1521). The combination of sulfamethoxazole and
trimethoprim has resulted in an increased use of sulphonamides for the treatment of bacterial
infections (Mandell etal., 1996: 1057).
3.7.7.1 Antimicrobial action
Sulfonamides are competitive inhibitors of dihydropteroate synthase, the bacterial enzyme
responsible for the incorporation of para-aminobenzioc acid (PABA) into dihydropteroic acid, the
precursor of folic acid (Mandell etal., 1996: 1058). Animal cells and some microorganisms use
exogenous folate and thus are not affected by sulphonamides (Jacobs et a/., 2001: 1521).
Sulfonamides are primarily bacteriostatic agents because they inhibit the bacterial synthesis of
folic acid, which is essential for bacterial growth (Kee 8 Hayes, 2003: 423).
3.7.7.2 Pharmacokinetics and administration
Sulfonamides are rapidly absorbed in the gastrointestinal tract. After oral administration 70% to
100% of the dose is absorbed and can be found within 30 minutes in the urine. Peak plasma
levels are achieved in 2 to 6 hours after administration (Mandell et a/., 1996: 1059). The
Chapter 3: Antibiotic usage
combination of trimethoprim-sufamethoxazole is well absorbed and is moderately protein-
bound. It has a half-life of 8 to 12 hours (Kee & Hayes, 2003: 425).
3.7.7.3 Clinical uses
There are a number of conditions for which sulphonamides can be used. However, the
development and increase in resistance of several bacterial species has reduced the use of
sulphonamides (Kee & Hayes, 2003: 423). The development of the combination of trimethoprim
and sulfamethoxazole has increased the use of sulphonamides, but to a lesser extent (Mandell
et al., 1996: 1062).
Short-acting sulphonamides include sulfadiazine, sulfamethizole and sulfisoxazole. Short-
acting sulphonamides are used for the treatment of systemic infections and urinary tract
infections. While sulfisoxazle are used also in the treatment and prophylaxis of otitis media
(Kee & Hayes, 2003: 425).
Intermediate-acting sulphonamides are used in a variety of infections. Sulfamethoxazole are
used in urinary tract infections, otitis media and meningococcal A strain meningitis prophylaxis.
For the treatment of ulcerative colitis and Crohn's disease sulfasalazine is preferred (Kee &
Hayes, 2003: 425). Trimethoprim-sufamethoxazole is used for urinary tract infections; parasitic
infections; bacterial infections, leprosy (Jacobs et al., 2001: 1522) and rheumatic fever, burns,
bronchitis, pneumonia, Pneumocystis carinii infections and otitis media (Kee & Hayes, 2003:
426).
3.7.7.4 Adverse effects of sulphonamides
Sulphonamides are capable of producing a wide variety of side effects due to hypersensitivity or
direct toxicity. Some of the effects that may be encountered are disturbances of the urinary
tract; hypersensitivity (skin reactions); acute haemolytic anemia; agranulocytosis, aplastic
anaemia (Lesse, 1995: 390), and gastro-intestinal disturbances (Kee & Hayes, 2003: 424). The
early sulphonamides were insoluble in acid urine; thus crystalluria and hematuria were common
problems (Kee & Hayes, 2003: 424)
The adverse effect of great concem is photosensitivity (Kee & Hayes, 2003: 424). It manifests
as a dermatological skin reaction, ranging from a minor rash to life-threatening exfoliative
dermatitis, toxic epidermal necrolysis and Stevens-Johnson syndrome. Discontinuation of
therapy is advised after the appearance of a rash (Lesse, 1995: 390).
According to Mandell et a/. (1996: 1064), there is no evidence that the combination of
trimethoprim and sulfamethoxazole will induce a folate deficiency in normal persons. When the
76
Chapter 3: Antibiotic usage
cells of a person are deficient in folate the margin between toxicity for bacteria and that for
human beings may be relatively narrow. This may lead to the occurrence of megaloblastosis,
leucopoenia, or thromocytopenia (Mandell et a/., 1996: 1064). Other life-threatening adverse
reactions include agranulocytosis, Stevens-Johnson syndrome and renal failure (Kee & Hayes,
2003: 426).
3.7.8 Quinolones
Quinolone antibacterials inhibit enzymes necessary for replication of micro-organisms. The
best-known synthetic products are nalidixic acid, pipemidic acid and the group of 4-
fluoroquinolones, such as norfloxacin and ciprofloxacin (Lancini etal., 1995: 61).
3.7.8.7 Antimicrobial action
The enzyme DNA gyrase is responsible for combating a mechanical obstacle known as 'over
winding" during DNA replication or transcriptation (Mandell et a/., 1996: 1065). Quinolones act
by inhibition of bacterial DNA synthesis by blocking the enzyme DNA gyrase (Jacobs et a/.,
2001: 1525). Their antibacterial spectrum includes both gram-positive and gram-negative
organisms. They are bactericidal in their action (Kee & Hayes, 2003: 417). Mammalian DNA
gyrase is unaffected by clinical concentrations of the quinolones (Lesse, 1995: 387).
3.7.8.2 Pharmacokinetics and administration
Quinolones and fluoroquinolones are widely distributed in body fluids and tissues after
administration (Jacobs et al.. 2001: 1526, Mandell et al., 1996: 1067). According to Mandell et
a/. (1996: 1067), fluoroquinolones reach peak serum levels within 1 to 3 hours after oral
administration of 400mg.
Food does not impair oral absorption, but may delay the time to peak serum concentrations
(Mandell et al., 1996: 1067). Optimal oral bioavailability is achieved if quinolones are given
about one hour before or two hours after meals. Some heavy metals, calcium and other
multivitamins may inhibit the absorption of quinolones (Jacobs et al., 2001: 1526).
3.7.8.3 Clinical uses
Quinolones have a broad spectrum of activity and because some organisms have the tendency
to develop resistance, these agents should be reserved for the treatment of very ill patients.
When less expensive antibiotics with narrower spectrums are available they should rather be
used (Jacobs etal., 2001: 1527).
Quinolones are used for various infections. According to Kee and Hayes (2003: 419)
quinolones such as cinoxacin, ciprofloxacin, gatifloxacin, enoxacin and nalidixic acid are used to
77
Chapter 3: Antibiotic usage
treat acute and/or chronic urinary tract infection and meningitis. Levofloxacin, moxifloxacin, and
ciprofloxacin are used for the treatment of upper respiratory infections. Some of the other
infections it is used for include: prostatitis; sexually transmitted diseases; gastrointestinal and
abdominal infections and bone, joint and soft tissue infections (Mandell eta/., 1996: 1068).
3.7.8.4 Adverse effects of quinolones
According to Lesse (1995: 388), quinolones have a low overall incidence of adverse effects (2 -
4%) with nausea and vomiting accounting for most of the adverse effects. Some patients may
experience photosensitivity. Adverse reactions that may be encountered are oral candidiasis,
crystalluria, hematuria and urticaria (Kee & Hayes, 2003: 420). Central nervous system effects
that include insomnia, confusion, headaches, dizziness and anxiety are associated with
quinolones (Williams, 1996: 70).
Quinolones are not given to children due to possible cartilage damage that has been found in
clinical studies done in animals (Lesse, 1995: 388).
3.8 CHAPTER SUMMARY
In this chapter the focus was on the utilisation and costs associated with antibiotics. Trends
regarding the usage in countries around the world were compared with South Africa. An
overview regarding the pharmacology of antibiotics was also presented.
Hereby the seventh research question and the seventh specific research objective, namely to
review the basic pharmacology of antibiotics, has been reached.
In the following chapter the methodology of this study will be reviewed.
Chapter 4
Research methodology
4.1 INTRODUCTION
In this chapter both the general and specific research objectives of the literature and empirical
investigation as well as the research methodology will be discussed. The procedures followed
in acquiring the relevant information and the subsequent analysis of the data will also be
discussed.
4.2 RESEARCH OBJECTIVES
4.2.1 General research objectives
The general research objective of this study was to investigate the influence of the
implementation of a managed reference price list on the usage and cost of antibiotics in the
private health care sector in South Africa by utilising a medicine claims database of
MedschemeO.
4.2.2 Specific research objectives
4.2.2.1 Specific research objectives of the literature review
The specific research objectives of the literature review were focussed on the following:
Conceptualise from the literature what health care entails in South Africa, as well as
internationally.
o Determine from the literature which factors contribute tot the high health care costs in the
private health care sector of South Africa, as well as internationally.
Investigate from the literature the influences of the new legislation on medicine costs in the
private health care sector.
Review the influences of generic substitution on the prevalence and cost of medicine.
o Conceptualise from literature the concepts of pharmacoeconomics, drug utilisation review
and managed health care.
Determine the implications of a managed medicine reference price list in the private sector.
o Review the basic pharmacology of antibiotics.
Chapter 4: Research methodology
4.2.2.2 Specific research objectives of the empirical investigation
The specific research objectives of the empirical investigation included the following:
o lnvestigate the differences in the utilisation patterns and costs of drugs in general before
and after implementation of the Medschem* Price List.
lnvestigate the differences in the utilisation patterns and costs of antibiotic drugs before and
after implementation of the Medschem& Price List.
Determine and compare the difference in prevalence and costs of original products vs.
generic products that have been claimed before and after implementation of the
~edscheme~ Price List for drugs in general and antibiotic drugs specifically.
0 lnvestigate the differences in the utilisation patterns and costs of beta-lactam antibiotics
before and after the implementation of the Medschema Price List.
0 Determine the cost savings that could have been incurred if beta-lactam antibiotics had
been provided at MPL prices.
4.3 RESEARCH METHODOLOGY
The study consisted of two phases namely phase one the literature review and phase two the
empirical investigation (refer to paragraph 1.5).
Phase 1: The literature review
The aim of the literature review was to investigate health care in South Africa as well as health
care concepts. A discussion on pharmacoeconomics and drug utilisation review studies also
formed part of this investigation. The aim of the literature review was furthermore to identify
methods that are implemented internationally and nationally to contain the costs of medicine.
There was also an investigation of the usage of antibiotics in the private health care sector and
different mechanisms that are implemented to reduce costs. The basic pharmacology of
antibiotics was also discussed.
Phase two: The empirical investigation
The empirical investigation consisted of the following components:
0 Selection of the research design.
o Selection and composition of the study population.
0 Statistical analysis of the data.
0 Reliability and validity of the data.
o The report and discussion of the results of the empirical investigation.
0 The conclusions and recommendations based on the results of the empirical investigation
as well as the limitations of the study.
Chapter 4: Research methodology
F
4.3.1 Research design
The research design used in this study was retrospective (refer to paragraph 2.10.2.1), non-
experimental and quantitative (refer to paragraph 2.10.1.1).
With the empirical investigation the researcher looks at the conditions that have already
occurred and then collects data to investigate the relationship of these varying conditions to
subsequent behaviours. Retrospective drug utilisation review studies are done after the
dispensing of the prescription and possible usage of drugs have occurred (Blackburn, 1993:
15). SacrisGn and Soto (1994: 301) believed that a medical aid claims database can be used
to apply statistical methods to identify areas of patient care that are not beneficial or too costly
to the funder. This design involves no direct manipulation of conditions because the presumed
cause has already occurred.
4.3.2 Selection and composition of the study population
The research population consisted of patients whose date could be obtained from the central
medicine claims database of Medschemm, during the period May 2001 to April 2003. The total
study population thus comprised of all the patients that had used one or more antibiotics during
the specific period of the study.
In order to facilitate the analysis of the data of antibiotics the central medicine claims database
was used to compile a secondary database. The secondary database consisted out of all the
patient prescription-records that contained an antibiotic that had been prescribed during the
two-year period. This was achieved by identifying all the antibiotics by using their NAPPl codes
and by extracting all prescription records that contained any drug that fell into any of the three
classifications of antibiotics (refer to paragraphs 4.3.2.3).
The data of the secondary database were used to determine the effect of the Medschemm
Price List (MPL) on the usage and cost of beta-lactam antibiotics. A comparison, regarding the
costs and prevalence of beta-lactam antibiotics, was made between the year before
implementation (May 2001 to April 2002) and after implementation of the MPL (May 2002 to
April 2003).
A total of 4004958 prescriptions containing at least one antibiotic medicine item represented the
study population. These data were analysed and discussed according to different
criteridmeasuring instruments selected for the analyses.
Chapter 4: Research methodoloa
4.3.2.1 The database
The data were extracted from the central medicine claims database of Medschemd for a
period of two years, stretching from 1 May 2001 to 30 April 2003.
The medicine claims database consisted of prescription records (claims data) for patients of
various medical schemes. The database included the following information:
0 The prescription date, prescription number, prescriber practice number and pharmacy
number.
o The National Approved Product Pricing Index (NAPPI) code of the dispensed product.
o A description of the NAPPl code, thus the trade name.
o The quantity of the drug supplied to the patient.
o The amount paid by the medical scheme.
0 Medical scheme information such as name, member number and dependant number.
4.3.2.2 Selection of criteridmeasuring instruments for the data analysis
The criteria for inclusion of prescriptions into the study population were:
o A valid patient record indicating the use of one or more drugs, thus all prescriptions claimed
between the period 1 May 2002 and 30 April 2003 (general analysis).
0 Non-medicinal products (such as bandages, syringes, etc.) and mixtures were excluded.
0 The use of antibiotic drugs within the period between 1 May 2001 and 30 April 2003
(specific analysis).
All the cases had to have a cost component.
Since no further demographic or clinical data were available from the medicine claims database,
it was not possible to divide the study population into any other categories e.g. sex, age, illness,
etc. This is a limitation in the medicine claims database, which can be seen as a limitation of
the study (refer to paragraph 6.3).
4.3.2.3 Classification systems
The following classification systems were used to obtain the necessary data from the medicine
claims database.
0 The NAPPl code
Every agent of the medicine claims database has a NAPPl code, which is the National
Approved Product Pricing Index. The NAPPl code consists out of a series of numbers. This
code is unique to every agent and distinguishes between different dosages and dosage forms of
the same agent. The NAPPl codes of the antibiotics were used to obtain the data from the
Chapter 4: Research methodology
central medicine claims database and to run the necessary queries in SAW 8.2 (SAS. Institute
Inc., 1999 - 2002).
MIMW classification
This classification system classifies medicine according to its pharmacological action. The
MIMS63 (Snyman, 2003: lla) classification was used as criterion to classify antibiotics
according to their pharmacological action. This classification system was also used to run
queries in SAS63 8.2 (SAS Institute lnc., 1999 - 2002). Refer to Appendix I for a complete list of
this classification.
o Active ingredient classification
The MIMS63 classification constitutes seven sub-pharmacological groups; therefore the
antibiotics were also classified according to their active ingredients. Refer to Appendix J for a
complete list of the classification of the active ingredients of the antibiotics.
4.3.3 Statistical analysis of the data
4.3.3.1 Variables analysed
In order to achieve the objectives set for this study, the following were used as measuring
instruments or criteria for data analysis:
Prevalence.
Medicine cost.
Prevalence and cost of original and generic drugs.
4.3.3. I. I Prevalence
The Centre for Disease Control in the United States of America (Chaffield 2000: 1) revealed that
there has been an increase of 48% in antibiotic prescribing for children from 1980 to 1992 (refer
to paragraph 3.3). According to Mediscor (2003: 14) one of the antibiotic pharmacological
groups, beta-lactam antibiotics, was one of the five therapeutic classes with the highest
prevalence of use during 2002. It is for this reason that the prevalence of antibiotics was used
as a measuring instrument during the analysis of the data.
4.3.3.1.2 Medicine cost
Hess et al. (1990: 585-587) found that antimicrobial drugs represent 20% to 40% of a hospital's
drug budget. Pharmaceutical spending rose by more than 70%, in real terms, and now account
for more than 10% of total health spending in nearly all OECD countries (Organisation for
Economic Co-operation and Development, 2003:Z). The beta-lactam antibiotics represented
one of the top twenty-five therapeutic classes in 2002 and contributed 3.8% of the total cost that
was spent on medicine in South Africa (Mediscor, 2003: 8-10).
Chapter 4: Research methodology
In this study the total cost of antibiotics, the average cost per antibiotic item, the average cost
per prescription containing antibiotics as well the cost index of antibiotics were analysed.
For the purpose of this study when the term 'cost" is used it refers to medicine treatment cost
(refer to paragraph 2.9.1.2).
4.3.3.1.3 Prevalence and cost of original and generic drugs
In many European countries generics make up as much as 70% of all medicines prescribed in
terms of volume, while in value terms generics represent only 30% of pharmaceutical
expenditure (European Generic Medicines Association. 2004d: 1). In the United States of
America generic drug sales grew at an 11.3% rate, while brand name products only grew at a
rate of 8% during 2000 and 2001 (Generic Pharmaceutical Association, 2002: 1).
Due to frequent occurrence of original products being prescribed, as well as the significant cost
difference between original drugs and generic drugs, the generic and original drugs were used
as measuring instruments in the data analysis.
4.3.3.2 Computer and software used
The analysis of the data was conducted by making use of the following:
o Microsoft@ Excel 2000 was used for the statistical analysis of the data, while Microsoft@
Word 2000 was used for the basic analysis and word processing.
o Statistical analysis was done making use of the SAW 8.2 (SAS Institute lnc., 1999 - 2002)
computer package for Windows.
4.3.3.3 Statistical methods
The measuring instruments were applied retrospectively to the database by making use of the
following statistical methods:
Range
The simplest measure of variation is the range of the distribution. The range indicates the
variation between the smallest and the largest entries (Brase and Brase, 1999: 102).
Where
r = range.
X,, = the largest entry.
Xnin = the smallest entry.
esearch methodology
o Average value (mean)
The average value is usually represented by the arithmetic mean. This is simply the sum of the
values divided by the number of values (Mendenhall eta/., 1993: 38).
Where:
x = the values of the variables.
= the sum of the values of the variables.
n = the number of observations.
Standard deviation
The standard deviation is a statistic that measures the amount of variability. It is based on the
measurement of deviation or difference of values from the mean value. The standard deviation
indicates how much the values in a distribution differ from the average value (Reid, 1987: 77).
Where
s = standard deviation.
x = the values of the variables.
-
x = the average of the sample.
n = the number of observations.
Cost index
The cost index can be defined as follows (Serfontein, 1989: 180):
Cost - index =
cost(%)
~r evalence(o/o)
In context of the study the cost index can be interpreted as follows:
If cost index < 1 then the medicine therapy utilised is relatively inexpensive in comparison
with other therapies.
If cost index = 1 then there is equilibrium between the costs and prevalence of the medicine
therapy.
If cost index > 1 then the therapy utilised is expensive.
In chapter 5 the discussions will concentrate on cost-index values greater than one (1).
o Effect size
Effect size (d) is defined by Cohen (1988: 9) as 'the degree to which the phenomenon is
present in the population".
The effect size can be calculated by the following formula (Steyn, 1998: 3):
Where:
-
- the average medicine treatment cost of a (for e.g. antibiotic drug a)
X. -
-
- the average medicine treatment cost of b (for e.g. antibiotic b)
Xb -
SW
=the maximum standard deviation between a and b
According to Steyn (1998: 3) the dvalue can be interpreted as follows:
Id1 = 0.2: small effect, with no practical significant difference.
Id1 = 0.5: medium effect, which is observable and may be significant.
Id1 = 0.8: large effect, which is significant and of practical importance.
The d-values greater than or equal to 0.8 will be assumed to have practical significant value and
will be discussed in chapter 5.
The effect size will be used to determine whether there is any practically significant difference
between the average medicine treatment costs for different types of antibiotics (e.g. original and
generic products) in this study.
4.3.4 Reliability and validity of the data
The data for analysis were directly obtained from a medicine claims database, MedschemsB.
Direct manipulation of the data by the researcher was therefore impossible.
Data for the analysis were obtained, from the central medicine claims database, for a two-year
period (1May 2001 to April 2003), thus limiting the external validity, implying that results can
only be generalised to the specific database used, as well as to the specific study population.
The research was conducted assuming that all data were correct and accurate. This is a
limitation of the study (refer to chapter 6).
4.4 REPORTS AND DISCUSSION OF RESULTS
An extensive report, followed by an in-depth discussion of the results acquired through the
empirical investigation will be reviewed in chapter five.
4.5 CONCLUSIONS, RECOMMENDATIONS AND
LlMlTlATlONS
The conclusions and recommendations based on the results of the literature review and the
empirical investigation will be discussed in chapter six. The limitations encountered during the
study will be mentioned throughout chapters four and five, with a detailed discussion of the
limitations in chapter six.
4.6 CHAPTER SUMMARY
The empirical research was discussed in this chapter. The discussion included the objectives of
the empirical investigation, the data source, the structure of the database and the methodology
of the empirical investigation.
The results of the empirical investigation will be reported and discussed in chapter five.
Chapter 5
Results and Discussion
5.1. INTRODUCTION
In this chapter the results of the empirical investigation conducted for the period May 2001 to
April 2003 will be discussed.
5.2 DISCUSSION OF THE RESULTS
5.2.1 Comments of interest with the interpretation of the results
The Medschema Price List (MPL) was implemented on 1 May 2002. The period before the
implementation of the MPL (May 2001 to April 2002) was compared with the period afIer the
implementation of the MPL (May 2002 to April 2003) to perceive the difference in prescribing
and utilisation patterns as well as drug expenditure differences.
For the purpose of the study, the following periods will be denoted in the discussion as
follows: May 2001 to April 2002 = first year and May 2002 to April 2003 = second year.
Each year is further divided into three four-month periods:
Year 1
Year 2
I-
May 2001 to August 2001
September 2001 to December 2001
January 2002 to April 2002
May 2002 to August 2002
September 2002 to December 2002
January 2003 to April 2003
o All further analysis concerning the utilisation and cost of antibiotics will be based on the
antibiotics listed in Appendix E. Note that the antibiotics listed are all agents that were
available on the South African market, which appeared on the central medicine claims
database, that was used for analysis, during the period of investigation
Pharmaceutical product refers to a druglmedicine item that is intended to modify or explore
physiological systems or pathological states for the benefit of the patient. Surgical
equipment, non-medicinal items and mixtures (with unidentifiable active ingredients) were
excluded from all analyses of the relevant data.
0 Dosage form refers to the form of the completed pharmaceutical product, e.g, tablet,
capsule, injection, suspension.
Chapter 5: Results and Discussion
m
o Prevalence refers to the number of times a particular product had appeared on the central
medicine claims database during the specified period.
The results of the general medicine utilisation patterns and cost have been represented
separately from those of antibiotics (refer to Figure 1 and 2).
o In figures and tables the percentages have been rounded off to the nearest second decimal
and may not add up to 100%.
0 Only d 2 0.8 (practically significant difference) was used as this value indicated that the
effect is large and of practical importance (refer to paragraph 4.4.3.3).
o For the calculation of the cost-prevalence index, only values higher than 1.00 were used as
a value higher than this indicated a relatively expensive treatment cost (refer to paragraph
4.4.3.3).
0 For the purpose of this study 'original" and 'innovatof products are synonyms, whilst trade
names may refer to either 'original" or 'generic" products. Also refer to paragraph 5.4.2.
5.2.2 Presentation of results
The discussion of the empirical investigation will focus on drug utilisation as well as some cost
aspects of medicine in general with special focus on antibiotics. The analyses will be presented
as summarised in the following diagram.
Chapter 5: Results and Discussion
TOTAL MEDICINE CLAIMS DATABASE
b GENERAL ANALYSIS
SPECIFIC ANALYSIS
1. ANTIBIOTICS
2. BETA-LACTAM ANTIBIOTICS
ChaDter 5: Results and Discussion
5.3 GENERAL ANALYSIS
The results of the general medicine utilisation patterns, derived from the medicine claims
database, are tabulated in Table 5.1.
Table 5.1: General analysis of the medicine claims database. May 2001 to April 2003.
I ':Database ]
EM~~:~~~1tOAPl'!,,~(J(J~=ff!~E~~:..]l:/'" . "~kLj
I Number of prescriptions II 11060996 I
I NumberofmedicineitemsprescribedII 21820911I
I Total cost (R) II 3097064602.00 I
Mity2(i(J2"!~Aprtl2003(Ye"r2J
I",~, ~
I Numberofprescriptions II
I Number of medicine items prescribed"
I Total cost (R) "
143474421
27277825 ]
4053280295.00 1
5.3.1 Prevalence and cost of medicine
o Medicine items
During the two-year period a total number of 49098736 medicine items and 25408438
prescriptions were claimed. According to Table 5.1 there was an increase in the total number of
items issued over the two-year period. During the first year (May 2001 to April 2002) a total
number of 21820911 medicine items were claimed, while during the second year (May 2002 to
April 2003) a total number of 27277825 medicine items were claimed. This increase in total
number of medicine items claimed could possibly be attributed to an increase in medical
scheme beneficiaries.
Accordingly there were more prescriptions issued during the second year (n = 14347442) than
the first year (n = 11060996). The average number of medicine items per prescription ranged
between 2.04 :t 1.25 for P1 to 1.87 :t 1.13 for P6. (refer to Table 5.2). No practical significant
differences were found between the average numbers of medicine items per prescription for the
differentfour-monthperiods(d S 8)1.
1 Refer to paragraph 4.4.3.3 for calculation of effect size (d-value).
91
Chapter 5: Results and Discussion
In April 2002 a total of 2447323 medicine items were claimed, making it the month with the
highest number of medicine items claimed during the two-year period (refer to Appendix A,
TablelA). Though the highest total number of medicine items claimed per four-month period
was found to be during P4 (May 2002 to August 2002) (refer to Table 5.2).
Although the lowest number of prescriptions (n= 595871) was claimed during June 2001 the
average number of medicine items claimed per prescription for this particular month was the
highest (2.07 * 1.26) during the two-year period (refer to Appendix A, Table IA).
Medicine cost
According to Harrison (2004: 294) in 200212003 the proportion that medical schemes paid for
medicines accounted for 24.28% of all benefits paid to providers. This is to a certain extent a
large proportion that is consumed by medicines.
The total cost of all medicine items claimed for the two-year period amounted to
R7150344897.00. The total cost for the first and second years were 43.31% and 56.69%
respectively. In both the first and second years the highest total cost for all medicine items was
found to be during P3 and P6 (January to April 2002 and 2003) (refer to Table 5.2).
According to the Mediscor (2003: 5) the average cost per medicine items during 2002 in South
Africa was R153.60. The results of this study were found to be almost the same. The average
cost per medicine item during the two-year period varied between R131.82 * 160.41 (PI) and
R152.55 & 224.02 (P5), while the average cost per prescription varied between R269.56 f
306.44 (Pl) and R288.73 + 314.51 (P3) (refer to Table 5.2). The d-value analysis reveals that
there were no practical significant differences found between the average costs per medicine
item for the different four-month periods (d S 0.8). The same results were found between the
average medicine costs per prescriptions between the different four-month periods (d 5 0.8).
As previously mentioned the total cost for both the first and second years was found to be the
highest during January to April (refer to Table 5.2). This could be attributed to the fact that most
patients' medical schemes funds are not exhausted during the first few months of the year. As
the year passes patients' medical schemes funds get exhausted, and may have an influence on
their medicine expenditure.
ChaDter 5: Results and Discussion
Table 5.2: Medicine items and cost. May 2001 to April 2003.
Month
(8)
Average number of
medicine items
IL,,~,~ (It)
2.0..,.251 269.;'j
306.44
1.95:t:1.21 276.59:t:
309.75
1.94:t:1.20 I 288.73:t:314.51
1.95:t:1.18 I 279.47:t:306.09
1.88:t:1.14 I 287.16:1:406.40
1.87:t: 1.13 I 281.56:t:325.12
795670612.00
C2J
May-Aug.
IE]
131.82:t:
EJ
6036149 2951703
2001 (P1) 160.41
Sep.-Dec.
IE]
141.80:t:
EJ
6427511 3295200
2001 (P2) 164.14
Jan. -April
IE]
148.54:t:
EJ
9357251 4814093
2002 (P3) 167.09
May-Aug.
IEJ
143.53:t:
EJ
9776243 5020895
2002 (P4) 166.40
Sep. -Dec.
IE]
152.55:t:
EJ
8113959 4310511
2002 (P5) 224.02
Jan.-April
IE]
150.44:t:
EJ
9387623 5016036
2003 (P6) 180.52
* Total number of medicine items claimed during the specific period.
# Total number of prescriptions claimed during the specific period.
911431143.00
1389962847.00
1403168759.00
1237803191.00
1412308345.00
5.3.2 Prevalence and cost of original and generic medicine
I:J Medicine items
Mediscor (2003: 6) revealed that the majority of products used during 2002 were original
products (72.30%). For every generic equivalent dispensed in 2002, 2.6 original products were
dispensed.
It can be derived from Table 5.3 that 70.94% of the 490987362 items claimed during the two-
year period were original products and 29.06% were generic products. Though there was an
increase in the volume of original products claimed, expressed in percentage value there was a
decreasing trend in the utilisation of original products. The percentage of generic products
utilised during the two-year period increased with more than 6%.
During the first year a total of 16030994 original products were claimed. For the first year there
was a decrease of 1.47% in the prevalence of original products from P1 to P3. In the second
year a total of 18799816 original products were issued and there was a decrease of 2.52% in
the prevalence of original products from P4 to P6 (refer to Table 5.3).
2 Due to some products not listed as either original products or generic products on the database, calculation of the
total number of medicine items over the two-year period in Table 5.2 will not correlate with the sum of the total
number of original products and generic products in Table 5.3.
93
ChaDter 5: Results and Discussion
Though the prevalence of generic products is still smaller than that of original products, there
was an overall increase in the prevalence of generic products from P1 to P6. The prevalence of
generic products increased from 25.87% (P1) to 32.47% (P6) (refer to Figure 5.1).
The prevalence of original and generic products for the two-year period is represented by the
following numerical values in Figure 5.1:
1. P1(May2001 to August 2001).
2. P2 (September 2001 to December 2001).
3. P3 (January 2002 to April 2002).
4. P4 (May 2002 to August 2002).
5. P5 (September 2002 to December 2002).
6. P6 (January 2003 to April 2003.)
80
70
60
50
Prevalence 40
(%) 30
20
10
o
o Original products
. Generic products
1 2 3 4 5 6
Study period
Figure 5.1: Prevalence of original and generic products. May 2001 to April 2003.
Q Medicine cost
One of the major reasons behind the overall increase in medicine expenditure is the new
branded medicines entering the market. This increased utilisation of new more expensive
medicines can be curbed by the introduction of generally less expensive generic medicines
(Mediscor, 2003: 6). According to the Generic Pharmaceutical Association (2002: 1) the
generic drug market in the United States grew at a rate of 11.3% during 2000 and 2001.
94
Chapter 5: Results and Discussion
r
According to Table 5.3 the total cost for original products claimed during the two-year period
was R6096817531.00 and for generic products the total cost was R1053499969.00. Thus.
original products consumed 85.27% of the total cost, while generic products constituted 14.73%
of the total cost of medicine items (n = ~7150344897.00)~ claimed during the two-year period.
Original products constituted 86.74% of the total cost of all medicine items claimed (n =
R3097064602.00) during the first year. This percentage decreased in the second year to
84.14% (n = R4053280295.00) (refer to Table 5.3). Calculation of the cost indices revealed that
original products are relatively expensive. The cost indices of the original products for the first
and second years were 1 .I8 and 1.22 respective~y.~
The average cost for original products ranged between R154.87 f 176.89 (PI) and R176.40 *
183.45 (P3) for the first year and between R173.87 + 185.55 (P4) and R186.10 + 258.06 (P5)
for the second year (refer to Table 5.3). Calculation of the d-value revealed that there was no
practical significant difference between the average costs of original products for the different
four-month periods (d 5 0.8).
However, according to Mediscor (2003: 6) the average cost per original product was found to be
R190.00. In comparison the results revealed that there were no practical significant differences
between the average costs per original product (d < 0.8).
The expenditure on generic products increased over the two-year period. During the first year
generic products constituted 13.26% of the total cost of all medicine items (n =
R3097064602.00), while in the second year the generic products constituted 15.86% of the total
medicine cost (n = R642760360). The cost-prevalence indices revealed that generic products
are relatively inexpensive (cost index < 1). The cost-prevalence indices of generic products for
the first and second years were 0.50 and 0.51 respecti~ely.~
The average cost for generic products gradually increased over the two-year period. During the
first year the average cost ranged between R65.78 f 62.64 (PI) and R74.53 + 71.69 (P3), while
in the second year it ranged between R72.55 f 68.78 (P4) and R77.74 f 74.58 (P6) (refer to
Table 5.3). In the Medicines Review done by Mediscor (2003: 6) the average cost of generic
products was R76.00.
Due to some products not listed as either original products or generic pmduds on the database, calculation of the
total cost over the weyear period in Table 5.2 will not melate with the sum of the total cost of original produds and
generic products in Table 5.3.
The wst-prevalence index for original produds was calculated by dividing the wst % by the prevalence %for each
year (e.g. CPI = 86.74Oh 173.47% = 1 .la).
The wst-prevalence index for generic pmduds was calculated by dividing the mst % by the prevalence % for each
year (e.g. CPl = 13.26% 126.53Oh = 0.50).
ChaDter 5: Results and Discussion
With reference to the d-value, there were no practical significant differences between the
average cost of original products and generic products for the different four-month periods (d S
0.8).
Table 5.3: Prevalence and cost of original and generic medicine. May 2001 to April 2003.
%* II cost ,il
l
" '
1
.1?(~f~.:Ir;l
~... 1R) -_~L.JLJI 1R)
EJB
154.87:t
8BG
5.78:t
4474402 74.13 692946182.00 1561747 25.87 I 102724429.00
176.89 62.64
Sep.-
ElB
B8G
166.90:!: 70.27 :!:
Dec. 4757927 74.02 794110336.00 1669584 25.98 I 117320807.00
180.05 66.55
2001 (P2)
Jan.-
88
EJ8
176.40:!: 74.53:!:
April 6798665 72.66 1199268474.00 2558586 27.34
I
II 190694373.00
183.45 71.69
2002 (P3)
May-
B8
88
173.87:!: 72.55:!:
Aug. 6848238 70.05 1190729185.00 2928005 29.95
I
II212439574.00
185.55 68.78
2002 (P4)
Sep.-
BE]
BE]
186.10:!: 77.29:!:
Dec. 5612312 69.17 1044451856.00 2501647 30.83
I
II 193351335.00
258.06 72.02
2002 (P5)
Jan.-
88
EJEj
185.40:!: 77.74 :!:
April 6339266 67.53 1175311498.00 3048357 32.47
I
II236969451.00
204.48 II 74.58
2003 (P6) II
* The prevalencepercentageof originalproductsis the totalnumberof originalproductsdividedbythe totalnumber
of medicine items claimed duringthe specific period multipliedby hundred.
# The prevalence percentage of generic products is the total number of generic products dividedby the total number
of medicine items claimed duringthe specificperiod multipliedby hundred.
May-
Aug.
2001 (P1)
5.3.3 Prevalence and cost of the top ten main pharmacological groups
o Medicine items
Respiratory drugs rated as the main pharmacological group most frequently claimed during the
two-year period. In the first year respiratory drugs represented 13.40% of all medicine items
claimed (n = 21820911). The prevalence of respiratory drugs increased in the second year to
13.94% (n = 27277825) (refer to Figure 5.2, Table 5.4). Respiratory drugs were the most
frequently prescribed during P1 and P4, 16.71% (n = 6036149) and 16.49% (n = 9776243)
96
Chapter 5: Results and Discussion
respectively (refer to Table 5.5). It could be attributed to the fact that respiratory drugs are
seasonal drugs and more often prescribed during winter months.
Cardiovascular drugs represented 13.45% of all medicine items (n = 49098736) claimed during
the two-year period (refer to Table 5.4). This percentage correlates with what was determined
by Mediscor. According to them 14.4% of the total of items claimed in 2002 consisted of
cardiovascular drugs (Mediscor, 2003; 9).
The prevalence percentage for cardiovascular drugs was 13.34% (n= 21820911) for the first
year and 13.54% (n = 27277825) for the second year (refer to Table 5.4). Most cardiovascular
drugs are used on a chronic basis and are not restricted to seasonal changes, thus the
prevalence percentages did not vary much during the months under review. However, most
cardiovascular drugs were issued during P2, 14.55% (n = 6427511), and P5, 14.39% (n
=8113959) (refer to Table 5.5). The Registrar of Medical Schemes stated that hypertension is
by far the most common chronic condition. In 2002 there were 72 cases of hypertension for
every thousand beneficiaries (Council for Medical Schemes, 2003a: 48).
Antimicrobials represented the third highest prevalence, 11.13% (n = 49098736), during the
two-year period. A total of 2356434 (10.80%) antimicrobials were claimed during the first year.
while in the second year it increased to 3107642 (1 1.39%) (refer to Table 5.4 and Figure 5.2).
In the first year most antimicrobials were claimed during PI (1 1.82%) and in the second year
most antimicrobials were claimed during P4 (1 1.67%). This could be attributed to the fact that
antimicrobials are seasonal drugs and are more often prescribed during the winter months
together with respiratory drugs, thus from May to August (refer to Table 5.5). This could be
substantiated by the fact that the five therapeutic classes with the highest prevalence during
2002 were (Mediscor, 2003: 14):
o Agents used for the relief of coughs and colds.
0 Combination analgesics.
0 Beta-lactam antibiotics.
o Non-steroidal anti-inflammatory drugs (NSAID's).
Topical nasal preparations.
During the two-year period there was an increase in the prevalence of analgesics and drugs
used for ear, nose and throat conditions. The prevalence of analgesics during the first year was
8.38% (n = 21820911), and increased to 8.77% (n = 27277825) during the second year. The
prevalence of combination analgesics was 6.4% of all medicine items during 2002 (Mediscor,
2003: 9).
ChaDter 5: Results and Discussion
Ear, nose and throat drugs increased from 4.87% (n = 21820911) during the first year to 4.99%
(n =27277825) during the second year. The prevalence of the other pharmacological drug
groups decreased from the first year to the second year (refer to Table 5.4).
o Prevalence
percentage first year
. Prevalence
percentages second
year
Figure 5.2: Prevalence of the top ten main pharmacological groups. May 2001 to April
2003
o Medicine cost
Respiratory drugs contributed 9.20% of the total cost of all medicine items claimed (n =
R3097064602.00) during the first year. In the second year this contribution increased to 9.70%
(n =R4053280295.00) (refer to Figure 5.3). The cost-prevalence index calculation revealed
that respiratory drugs were relatively inexpensive (cost index < 1) for both years (refer to Table
5.4). Duringthe first period of each year (P1 and P4) the average cost of respiratory drugs was
the lowest and increased with time, while the prevalence was the highest during P1 and P4 and
decreased during the year that followed(refer to Table 5.5).
98
14
12
10
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Chapter 5: Results and Discussion
Cardiovascular drugs had the highest cost percentage for both years. During the first year a
total of R644233349.00 (20.80%) was spent on cardiovascular drugs. In the second year there
was a small decrease to 20.71% (n = R4053280295.00) in the total amount that was spent on
cardiovascular drugs (refer to Figure 5.3). Cardiovascular drugs are relatively expensive when
calculating the cost: prevalence ratio (cost index > 1). The average cost of cardiovascular drugs
did not vary much over the two-year period. During the first year the average cost ranged
between R216.31 + 115.36 (PI) and R226.45 + 116.83 (P3), while during the second year it
ranged between R226.14 + 115.59 (P4) and R229.15 + 117.64 (P6) (refer to Table 5.5).
Antimicrobials contributed 13.56% of the total drug expenditure (n = R3097064602.00) during
the first year. During the second year this percentage increased to 14.93% (n =
R4053280295.00) (refer to Figure 5.3). According to Table 5.4 antimicrobials are relatively
expensive when calculating the cost-prevalence indices. The cost-prevalence indices for the
first and second years were 1.26 and 1.31 respectively. The average cost of antimicrobials
ranged between R168.4 + 235.03 (PI) and R184.22 f 266.05 (P2) for the first year and for the
second year it ranged between R181.10 + 221.83 (P4) and R206.83 + 486.34 (P5) (refer to
Table 5.5).
The total cost contribution of analgesics and endocrine system drugs increased from the first
year to the second year. During the first year analgesics contributed 3.80% to the total cost
spending (n = R3097064602.00), while in the second year their contribution increased to 3.84%
(n = R4053280295.00). The total cost of the endocrine system drugs stayed almost the same
during the first (10.06%, n = R3097064602.00) and second years (10.09%, n =
R4053280295.00). The cost contribution of the other pharmacological groups decreased from
the first year to the second year (refer to Table 5.4).
ChaDter 5: Results and Discussion
25
20
15
Percentage (%)
10
5
o Cost
percentages
first year
. Cost
percentages
second year
Figure 5.3: Cost percentages of the top ten main pharmacological groups. May 2001 to
April 2003
Table 5.4 gives an indication of the cost-prevalence indices of the top ten main pharmacological
groups for the first and second years. It was found that seven out of the ten pharmacological
groups had a cost-prevalence index higher than one, which gives an indication that these
pharmacological groups are relatively expensive. In both years the cost-prevalence indices of
antimicrobials were higher than one and the central nervous system drugs were the highest,
1.30 and 1.32 respectively (refer to Table 5.4).
100
0
E
1/1
J!I
1/1
E
-
-
1/1
'ii
u
E J!I
u
I'll
'ii
S
c
iii
GI
I!
0
:a GI
-
S
c ... U
1/1
0
m
GI
1/1
GI
-
.c
m
>- ...
I'll
m
>-
m
'ii
-
1/1
U 'ii
1/1
I'll
011
0
... 1/1
C
'0
E
I'll
C GI
1/1
S
:;:: GI
'E
c(
c
-
0
.
1:
:J
1/1 1/1 I'll
- :;::
u 0
GI
S
0
E
I!
c III
U
Gi
c
0
c
...
a.
c(
I'll
'C GI
'T .:
GI
1/1
>, C
c
'II
e
I'll
Q
&
0
w
0
-
w
'E
1/1
- U
I'll
I'll C
III (!)
0 GI :J
0
::E
ChaDter 5: Results and Discussion
Table 5.4: Cost index of the top ten pharmacological groups.
Main pharmacological group
101
Respiratory system
L!j4,jHU.
9.20
LL4!jO
13.40 0.69
Antimicrobials
419943580.00 13.56 2356434 10.80 1.26
Cardia-vascular agents 644233349.00
20.80 2910041 13.34 1.56
Analgesics
117737360.66 3.80 1827632 8.38 0.45
Endocrine system
311707718.54 10.06 2073379 9.50 1.06
Central nervous system
330015227.72 10.66 1791414 8.21 1.30
Muscula-skeletal agents
194754436.75 6.29 1296304 5.94 1.06
Gastra-intestinal tract
188223350.25 6.08 1231941 5.65 1.08
Ear, nose & throat
117222633.92
3.78 I 1063736II
4.87 0.78
Dermatologicals
II 159510266.90 I
5.1511 1062319 II
4.87 1.06
Ma 2002 toApnI2003-"." "]1 I' .<111!:!:illlllllllll!ii'\!!!;!r!r\'.
...
. :11' J
.... .... ....... '......
Respiratory system
393265306.00 9.70 3803523 13.94 0.70
Antimicrobials
605339482.00 14.93 3107642 11.39
1.31
Cardia-vascular agents 839421013.00
20.71 3693474 13.54 1.53
Analgesics
155826487.77 3.84 2391001 8.77
0.44
Endocrine system
408907903.00 10.09 2575906
9.44 1.07
Central nervous system
427561749.00 10.55 2186950 8.02
1.32
Muscula-skeletal agents
233935339.76 5.77 1507085 5.52 1.04
Gastra-intestinal tract
217241117.12 5.36
1401294 5.14 1.04
Ear, nose & throat
151895874.92 II
3.75 1362227 4.99
0.75
Dermatologicals
I 188698695.55II
4.66
1167414II 4.2811
1.09
* The cost percentage of the specific main pharmacologica group is the total cost of the specific main
pharmacological group divided by the total cost of all medicine items claimed for the year period multiplied by
hundred.
# The prevalence percentage of the specific main pharmacological group is the prevalence of the specific main
pharmacological group divided by the total number of medicine items claimed for the year period multiplied by
hundred.
.. The cost-prevalence index of the specific main pharmacological groups is the cost percentage divided by the
prevalence percentage for the specific main pharmacological group for that particular year.
ChaDter 5: Results and Discussion
Table 5.5: Prevalence and cost of the top ten pharmacological groups. May 2001 to April 2003.
* The prevalence percentage for the main pharmacological group is the prevalence of the main pharmacological group divided by the total number of medicine items claimed for the
specific period multiplied by hundred.
102
Main
II,
' My2001:':'Aiig.'2og1(P1)
I,.'" ,w'e!!:?!01:':'=l!(j1(P2J
W"w=J
Jaii;OO2:" pr" (j02 (P$J
" ,
pharmacological
[J[j
A\irge TO'(;Pi$t .
[j
Average
fotalcJ;fi$f
[J
Average
fola1cost' .
group
n .' %* cost
cost
h '%*":
cost
(RJ (RJ
(RJ
(RJ
; .
(R) (RJ
,-' ____.0.___.'.,.,.,.,.,.,.,.,.' '._
"
1'00887911'6.7' I
82.77:i:
181090811'2621
102.18:i:
1"0527216
107.29 :i:
Respiratory system 83483450.10
82860660.86
118587699.00
117.45
118.62 124.16
I 71330711'1.621
168.40 :i:
18291391[3
184.22 :i:
1'0'398811'0.641
181.39:t
Antimicrobials
120118583.00
115901857.00
183923140.00
235.03
266.05
223.44
Cardio-vascular
I 71813011".661
216.31:i:
1935281II'..I
218.44:i:
11258650 11'3'''1
226.45:i:
154904474.00
204301758.00
285027117.00
agents 115.36
113.73
116.83
I Analgeslcs
16[3
59.72:i:
I 497404 IG
60.31 :t
I 805879 IG
70.02:i:
31328209.34
29996373.98
56412777.34
61.56
66.57
81.23
I 527341IG
142.25 :i:
1648199 11'0.081
145.29 :i:
I 897839IG
158.73 :i:
Endocrinesystem 75014613.58
94177389.96
142515715.00
168.77
176.19
197.09
Central nervous
I 4£84781[3
174.07:i:
15027561
185.02:i:
I 8201821[3
187.53:i:
81547907.95
93017903.77
155449416.00
system 180.17
188.95
201.93
Musculo-skeletal
I 352971IG
137.80:i:
1388020IG
148.21:i:
I 5553131G
159.56:i:
48639359.60
57510119.65
88604957.50
agents 121.48
129.45
138.91
B
148.29 :i:
13642571G
144.37 :i:
I 5485251[3
160.99 :i:
Gastro-intestinaltract
47329129.52
52586563.81
88307656.92
156.15
150.41
170.11
I 3095571G
101.53:i:
1307640 1[3
111.29:i:
I 4465391[3
115.45:i:
Ear, nose &throat 31430457.99
34238055.07
51554120.86
78.70
81.72
84.61
12662181[3
154.07:i:
13131281G
148.15:i:
I 4829751G
149.29:i:
Dermatologicals 41014839.03
46391110.99
72104316.88
233.83
224.15
212.72
ChaDter 5: Results and Discussion
Table 5.5 continues
* The prevalence percentage for the main pharmacological group is the prevalence of the main pharmacological group divided by the total number of medicine items claimed for the
specific period multiplied by hundred.
103
Main
II
'],t'ay-Aug.2002{P4) ,
.I=-: ' "':=!!;:eQ'!!f!:5Y
. JL= .'. ?aii. ....1pilr2.((JL I
'N,
. ,
pharmacological
[3J5J
Avei7!ge. Totarc.ost
CJG
.. Average
. t'otalcost
[JrJ
Average
...Tota/cost
,
grOlJp
cost
cost
cost
(R) (R)
(R)
(R) (R)
(R)
1'6'2420 11'....1
93.69i:
1'00409211'2.371
112.65 i:
[ 118701111'2.841
108.75:t
Respiratory system 151071613.00
113108340.00
129085353.00
112.53
131.84
132.60
1"4095611".871
181.10 i:
1 88023911'0.851
206.83 i:
1'08644511".571
199.42i:
Antimicrobials
206624524.00
182059712.00
216655246.00
221.83
486.34
288.80
Cardio-vascular
1'27608611'3'051
226.14:t
1"67991 11'391
226.50 i:
1'24939511'3.31 I
229.15 i:
288571782.00
264549670.00
286299561.00
agents 115.59
113.87
117.64
I Analgesics II 847115IG
62.12i:
I 6712691G
65.37i:
I 872617IG
67.98 i:
52621833.92
43882182.07
59322471.78
75.33
77.32 82.58
I 9075551G
156.71i:
61'0'0'1
156.99i:
1 856150 I
162.57 i:
Endocrine system 142219734.00
127505854.00
139182315.00
194.53
219.41
214.27
Central nervous
1 758235IG
192.44 i:
1 6378731[3
197.45 i:
I 7908421G
196.88 i:
145911342.00
125947858.00
155702549.00
system 204.13
203.19
207.74
Musculo-skeletal
1 5213081[3
156.27:t
I 451753IG
154.80 i:
I 5340241[3
154.56 i:
81463262.99
69931321.34
82540755.43
agents 137.42
133.24
138.17
1 44883616
158.75 i:
I 4183881G
152.95 :t
I 5340701[3
153.52 i:
Gastro-intestinal tract
71254713.35
63993614.43
81992789.34
172.71
177.35
166.53
I 494832IG
105.07i:
I 397346IG
115.98 i:
I 47OO491G
114.50 i:
Ear, nose & throat 51990432.31
46082887.698
53822554.91
79.02
84.02
84.74
I 3970971G
168.33 i:
I 3959871[3
164.62i:
I 374330 16
151.38i:
Dermatologicafs 66843961.13
65188943.87
56665790.55
257.95
242.56
197.28
Chapter 5: Results and Discussion
5.4 SPECIFIC ANALYSIS
The specific analyses were done on the following antimicrobial groups with special emphasis on
the beta-lactam group:
Beta-lactams (penicillins, cephalosporins, other).
Erythromycin and other macrolides.
o Aminoglycosides.
o Tetracyclines.
o Chloramphenicols.
o Sulphonamides and combinations.
o Quinolones.
For clarification during the discussions of this study these antimicrobial groups will be termed as
antibiotics.
5.4.1 Prevalence and cost of antibiotics
All over the world there is an awareness of the emergence of antibiotic resistance. However,
physicians are prescribing more broad-spectrum antibiotics than before. According to Aldridge
(2003: I) there has been an increase in the percentage of adults and children receiving broad-
spectrum antibiotics in the United States. In a study done in Sharjah antibiotics constituted 45%
of prescriptions (Hasan et a/., 1997: I), while in North Goa it accounted for 14.06% of
prescriptions (Hede eta/., 1987: 146).
According to Table 5.5 it can be determined that antimicrobials constituted 11.13% of all
medicine items claimed (n = 49098736) during the two years. The total cost for antimicrobials
constituted 14.34% of the total cost (n = R7150344897.00) of all medicine items claimed during
the two-year study period.
During the first year 2356434 (10.80%) antimicrobial drugs were claimed with a total cost of
R419943580.00, which represented 13.56% of the total cost of all medicine items (n =
R3097064602.00). While during the second year a total of 3107642 (11.39%) antimicrobial
drugs were claimed. The total cost for antimicrobial drugs during the second year amounted to
R605339482.00 (refer to Table 5.4)
The cost-prevalence index of antimicrobial products claimed during both years was higher than
one, giving an indication that antimicrobial therapy is relatively expensive (refer to Table 5.4).
ChaDter 5: Results and Discussion
For further discussions of this study there will only be concentrated on the usage and cost of
antibiotics, which consisted of the groups mentioned above.
Antibiotics (as previously classified under 5.4) represented 74.90% of all antimicrobial items (n =
5464076) claimed and 8.34% of all medication (n = 49098736) claimed during the two-year
period. It was found that antibiotics represented 51.33% of the total cost of antimicrobials (n =
R1025283062.00). Thus, antibiotics have a relatively large influence on the total cost of
antimicrobials. Antibiotics consumed 7.36% of the total cost of all medication (n =
R7150344897.00) on the database.
Table 5.6 summarises the analysis conducted on antibiotics for the study period.
Table 5.6: Analysis of antibiotics on the medicine claims database. May 2001 to April
2003.
[ Number of prescriptions
[ Number of items prescribed
ITotal cost (R)
[=~~=~!~~ij~~~~..
[A#~~001to~~~I~~2.<s!e_rl)
I Number of prescriptions I
I Numberof itemsprescribed I
I Total cost (R) [
Ma.Y2002 to A"ijl~OO3
, ", , "'~""~ .;,~,JII
II
II
II
o Medicineitems
Of the total number of prescriptions (n =11060996) issued during the first year 16.03% of the
prescriptions contained antibiotics (refer to Table 5.6). During the second year there was a
decrease in the percentage of prescriptions that contained antibiotics. Though there were more
antibiotic prescriptions issued during the second year, as a percentage of the total number of
prescriptions (n = 14347442) claimed, there was a decrease of 0.47% in the number of
prescriptions containing antibiotics in comparison with the first year (refer to Table 5.6). This
aspect was not further investigated as itwas outside the scope of this study.
There was no practical significantvariation in the average number of antibiotics per prescription
found between the first year and the second year (d S 0.8). The average number of antibiotic
prescriptions for both the first and second years ranged between 1.02 :t 0.14 (P1) and 1.02:t
0.16 (P6) (refer to Table5.7).
105
Chapter 5: Results and Discussion
The total number of antibiotic items prescribed during the first year was 1812001, while in the
second year 2280494 items were prescribed. When comparing the first year with the second
year, there was a decrease in the number of antibiotic-containing prescriptions issued, however,
there was an increase in the number of antibiotic items issued when comparing the first year
(8.30%) with the second year (8.36%) (refer to Table 5.7).
Figure 5.3 reveals that antibiotics had the highest prevalence during P1 (9.58%) and P4
(9.08%). Both P1 and P4 are winter periods in South Africa and thus more antibiotics are
issued during these months.
o Medicinecost
Rehana et al. (1998: 1) stated that antibiotics classify under the most frequently prescribed
group of drugs on the market and as a group account for 15% to 30% of the total health budget
worldwide. The results here indicated a much lower cost percentage.
The total cost of antibiotics during the first year amounted to R232312831.04, constituting
7.50% of the total cost (n = R3097064602.00) of all medicine items on the database; along with
the average cost per antibiotic item ranging between R124.10 :t 88.06 (P2) and R132.04 :t
98.86 (P3). In the second year the total cost of antibiotics claimed was R293996448.38
(7.25%), while the average cost per antibiotic item ranged between R126.13:t 102.44 (P5) and
R130.33:t 94.61 (P4) (refer to Table 5.7). The d-value indicated that there was no practical
significant difference between the average costs of antibiotics for the different four-month
periods (d S 0.8).
The average cost per antibiotic prescription ranged between R126.71 :t 90.96 (P2) and R135.31
:t 101.95 (P3) during the first year. The average cost per antibiotic prescription varied between
R128.85 :t 106.36 (P5) and R132.89 :t 97.09 (P5) for the second year (refer to Table 5.7).
Calculation of the d-value revealed that there was no practical significant difference between the
different four-month periods relating to the average cost per antibiotic prescription (d S 0.8).
106
ChaDter 5: Results and Discussion
n
Table 5.7: Prevalence and cost of antibiotics. May 2001 to Apri/2003.
PiiiSciiption
.-
,~.. Average
numbet;of
antibiotics
BE]
126.52:1:
8B
578122 9.58 566903 19.21
90.62
Sep.-
EJB EJB
124.10 :I:
De;~~:01 472499 7.35 88.06 462760 14.04
Jan.-
EJB EJB
132.04 :I:
April 2002 761380 8.14 743011 15.43
98.86
(P3)
r::l
EJ
130.33:1: c::lr::l
L:J 9.08 94.61 00
Sep.-
BE] EJB
126.13 :I:
Dec. 2002 624742 7.70 611542 14.19
102.44
(P5)
Jan.-
BE] EJB
129.56:1: 132.65:1:
Apr. 2003 767628 8.18 749714 14.96
1
1.02:1:0.16
11
II 99450872.86
98.01 100.94
(P6)
* The prevalence percentage of antibiotic items is the prevalence of antibiotic items divided by the total number of
medicine items claimed for the specific period multiplied by hundred.
# The prevalence percentage of antibiotic prescriptions is the prevalence of antibiotic prescriptions divided by the
total number of prescriptions claimed for the specific period multiplied by hundred.
May-
Aug. 2001
(P1)
May-
Aug. 2002
(P4)
1.02:1:0.14
129.02 :I:
95.43
73142174.13
1.02 :I:0.15
126.71 :I:
90.96
58637492.53
1.02:1:0.16
135.31 :I:
101.95
100533165.00
1.02:1: 0.14
132.89 :I:
97.09
115747058.00
1.02:1:0.15
128.85 :I:
106.36
78798517.52
5.4.2 Prevalence and cost of original and generic antibiotics
An analysis of the prevalence, cost and cost-prevalence index values of antibiotics based on the
original (innovator) and generic classification of antibiotics will also be discussed in this study. It
is important to note that all antibiotic agents that were available on the database at the time of
the study are classified as an original or generic product (refer to Appendix G) and will be
included in the analysis. The classification of antibiotics, as original products or generic
products, is based on the following criteria:
o The dosage indications for both the original and its generic counterparts must be identical,
thus instances where generic agents with a slightly different amount of active ingredients but
with identical dosage indications as the corresponding original drug may exist.
o Both the original and generic agents must contain the same active ingredient, however
different derivatives of the active ingredients are present in certain generic agents but are
still classified under the original product.
107
ChaDter 5: Results and Discussion
a Medicine items
During the two-year period 42.32% (n = 4092495) original antibiotic products and 57.68% (n =
4092495) generic antibiotic products were claimed (refer to Table 5.8).
According to Table 5.8 there was a decrease in the percentage of original antibiotic products
claimed. During the first year 45.11% (n = 1812001) original antibiotics were claimed, but
decreased with 5% in the second year to 40.11% (n = 2280494). The highest percentage of
original antibiotics that were claimed was 48.44% (n = 578122) (P1).
Consequently the percentage generic antibiotics claimed increased over the two-year period.
During the first year 54.89% (n = 1812001) generic antibiotics were claimed and increased
during the second year to 57.68% (n = 2280494) (refer to Table 5.8).
One of the goals of the MPL was to promote generic substitution and from Table 5.8 it could be
seen that there was an increase in generic prescribing concerning antibiotics. According to
Mediscor (2003: 6) generic substitution and the promotion of the prescribing of generic
equivalents are seen as mechanisms to reduce medicine expenditure.
a Medicine cost
Original products contributed 62.32% of the R526309279.42 that was spent on antibiotics
during the two-year period, while only 37.68% of the total cost was contributed by generic
products. Calculation of the cost to prevalence ratio (1.5) of original products revealed that the
medicine therapy is rather expensive when comparing it with the cost prevalence ratio (0.70) of
generic products.
The average cost of original products ranged between R175.90:t 95.10 (P1) and R207.42 :t
101.61 (P6) (refer to Table 5.8). Calculation of the d-value revealed that there was no practical
significant difference between the average costs of the original products for each of the six
periods (d S 0.8).
The average cost that was spent on generic antibiotic products ranged between R80.13 :t 54.69
(P1) and R88.82 :t 63.06 (P3) (refer to Table 5.8). Compared to the average cost of original
antibiotic products the average cost of generic antibiotic products was much cheaper. Further
analysis revealed that there was a practical significant difference found between the average
costs of original antibiotic products and generic antibiotic products (d > 0.8).
108
ChaDter 5: Results and Discussion
Table 5.8: Prevalence and cost of original and generic antibiotics. May 2001 to April
2003.
Month
(R) (R)
cost
(R)
May-Aug.2001
IBE:]
175.90:t
E:JE:JI
80.13:t
280015 48.44 49253885.41 298107 51.56 II 23888288.72
(P1) 95.10 54.69
Sep.. Dec. 2001
laB
176.50:t
BaEJI
82.43:1:
209325 44.30 36944939.84 263174 49.98 II 21692552.69
(P2) 91.42 57.92
Jan.-APril2002
1E:JEJ
189.16:1:
BEJI 88.8" I
327993 43.08 62041757.70 433387 56.92 I 38491407.18
(P3) 108.17 63.06
MaY-AU9.2002
IEJEJ
190.71:t
E:JEJ18389<1
386097 43.47 73633423.60 502027 56.53 I 42113634.17
(P4) 96.80 60.56
sep.-Dec.2002
IBEJ
192.88:t
BEJI
I 84.17:t
241152 38.60 46513365.16 383590 61.40 II 32285152.09
(P5) 119.58 59.48
Jan..APril2003
1E3EJ
207.42:t
~61
82.96:t
287373 37.44 59606616.78 480255 62.56 II 39844256.08
(P6) II 101.61 58.11
* The prevalence percentage of original products is the prevalence of original products divided by the total number of
antibiotic items claimed for the specific period multiplied by hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of
antibiotic items claimed for the specific period multiplied by hundred.
5.4.3 Prevalence and cost of different antibiotic pharmacological groups
Q Medicine items
Beta-Iactams accounted for 56.99% of all the antibiotic items (n = 4092495) claimed during the
two-year period. The prevalence of beta-Iactams increased from the first year (56.78%) to the
second year (57.16%) (refer to Table 5.9). As previously mentioned, most antibiotics were
claimed during P1 and P4. The same were found to be true of beta-Iactam antibiotics. The
prevalence percentages of beta-Iactams during P1 and P4 were 59.09% and 59.75%
respectively (refer to Table 5.10)
Over the two-year period a total of 507908 (12.41%, n = 4092495) macrolides were claimed.
The prevalence for the first year was 12.94% (n = 1812001), while it decreased in the second
year to 11.99% (n = 2280494). As with the beta-Iactams, most macrolides were issued during
P1 (n = 84555) and P4 (n = 13.17) (refer to Table 5.10).
The antibiotic pharmacological group that had the third highest prevalence was the quinolones.
The quinolones accounted for 12.40% of all antibiotics (n = 4092495) prescribed during the two
years. The prevalence of the quinolones increased from the first year to the second year, being
109
ChaDter 5: Results and Discussion
12.17% (n = 1812001) and 12.59% (n= 2280494) respectively. Though the most antibiotics
were prescribed during P1 and P4, the prevalence of the quinolones was the highest during P3
(n = 106264) and P6 (n = 108730) (refer to Table 5.10).
The prevalence of the aminoglycosides was overall the lowest. During the first year it
accounted for 0.02% of all antibiotics (n =1812001), with the highest prevalence during P3 (n =
173). The prevalence decreased during the second year to 0.01% (n = 321). The highest
prevalence during the second year was found to be during P6 (n = 116) (refer to Table 5.10).
The prevalence of tetracyclines for the first and second years was 9.09% (n = 1812001) and
8.06% (n = 2280494) respectively. There was an increase in the prevalence of chloramphenicol
and sulphonamides during the two-year period. A total of 1667 chloramphenicol products and
122543 sulphonamides was prescribed during the first year, while it increased to 2661 and
180865 in the second year respectively.
Q Medicine cost
A total cost of R276356577.56 (52.51%) was spent on beta-Iactams during the two-year period.
The beta-Iactam group accounted for 51.32% of the total costs of all antibiotics (n =
R232312831.66) claimed on the database during the first year of the study. During the second
year of the study this percentage increased to 53.54% (n = R293996448.38), though the
prevalence only increased with 0.38%. The cost index-value specifies that the prevalence: cost
ratio was relatively low (CPI < 1) during the first year, while in the second year there was a drop
in the cost index-value (CPI < 1) (refer to Table 5.9 and Figure 5.4).
The average cost of beta-Iactam products ranged between R112.88 :t 69.95 (P2) and R200.25
:t 260.65 (P3) during the first year. In the second year there was a decrease in the average cost
of beta-Iactam products, ranging between R118.01 :t 75.67 (P5) and R122.19 :t 81.42 (P6)
(refer to Table 5.10). Calculation of the d-value revealed that there was no practical significant
difference (d < 0.8) between the average cost of beta-Iactam products for the first and second
years.
Table 5.9 revealed that the macrolides contributed 16.08% to the total cost of all antibiotics (n =
R526309280.04). Though the prevalence of the macrolides was higher than that of the
quinolones, the costs of the quinolones were relatively higher than that of the macrolides.
There was an increase in the cost that was spent on the macrolides from the first year to the
second year. During the first year the total cost of macrolides amounted to 15.90% of the total
cost of all antibiotics (n = R232312831.66), while in the second year the cost amounted to
16.22% of the total cost of all antibiotics (n = R232312831.66) on the database.
110
ChaDter 5: Results and Discussion
The average cost of the macrolides was more expensive than that of the beta-Iactams, though
after calculation of the d-value it indicated that there was no practical significant difference
between the average cost of beta-Iactams and macrolides (d < 0.8). The average cost that was
spent on macrolidesduringthe first yearwas betweenR154.27:f: 98.95 (P2) and R159.49:f:
116.96 (P3). In the second year there was an increase in the average cost of macrolides,
ranging between R156.44:f: 110.80 (P4) and R191.70:f: 124.65 (P6) (refer to Table 5.10). In
the first year the cost-prevalence index was 1.23 and in the second year it was 1.35. The cost
index-value gives an indication that the cost of macrolides is relatively expensive (cost index>
1) when taking the prevalence into account (refer to Figure 5.4).
1
o Cost index
first year
. Cost index
second year
3
2.5
2
CostIndex 1.5
0.5
1/1
CD
.5
U
»
u
I!
~
1/1
'0
u
C
CD
.c
CL
E
I!
o
:c
o
1/1
1/1 C
CD0
'tJ;;
- III
E c
11I-
c.a
o E
.c 0
CLu
'5'tJ
U) C
III
1/1
CD
C
o
'0
c
'5
a
Figure 5.4: Cost-prevalence index values of the antibiotic pharmacological groups. May
2001 to April 2003.
The quinolones are relatively expensive when comparing the cost-prevalence indices with other
antibiotic pharmacological groups. The cost-prevalence index for quinolones during the first
year was 1.54, while in the second year it decreased to 1.38 (refer to Table 5.9). Quinolones
contributed 17.97% of the total cost of all antibiotics (n = R526309280.04). The cost of
quinolones on the database decreased from 18.76% during the first year (n = R232312831.66)
to 17.34% during the second year (n = R293996448.38).
111
0
1/11/1
'tJ 1/1
CD
E
c CD
'tJ
1II'tJ
"iii
S
c=
8
u
- 0
u ...III
»u
»
.,.
E III
Q
o E
0
... ...
c
III
.c CD
E
or(
w
ChaDter 5: Results and Discussion
The average cost of quinolones was higher during the first year than during the second year.
The averagecost rangedbetweenR194.34:i:: 120.58(P2) and R205.37:!: 126.38 (P1) for the
first year and between R161.08:!: 113.50 (P6) and R195.68:!: 116.06 (P4) for the second year
(refer to Table 5.10). No practical significant differences were found between the average costs
of the first and second years concerning quinolones (d S 0.8).
Aminoglycosides had a relatively high cost-prevalence index during the first (2.70) and second
(2.61) years. The cost-prevalence index revealed that the prevalence: cost ratio was more than
one, which gives an indication that aminoglycosides are relatively expensive (refer to Figure
5.4).
The cost index-values off the antibiotic pharmacological groups are shown in Table 5.9.
112
ChaDter 5: Results and Discussion
Table 5.9: Cost and prevalence of the different antibiotic pharmacological groups.
I Beta-Iactams
Erythromycin and other
macrolides
I
I Aminoglycosides
ITetracyclines
[ Chloramphenicols
ISulphonamides and combinations
IQuinolones
[Other
Nlay2002 to Ajlflf200
II ,'" <, :~:';:;illJ1 'II' J"','",w, ,-"'-, 10-;,"';' I
I Beta-Iactams 157142778.38 53.4511 130346411 57.1611 0.94 I
Erythromyc;nandolher II I"::lr--:=ll I~macrolides 47688263.30 J~~ 11.99 ~
I Aminoglycosides 107817.61 0.04 321 0.01 2.61 I
I Tetracyclines 22499542.18 7.65 183775 8.06 0.95 I
I Chloramphenicols 78455.11 0.03 2661 0.12 0.23 I
I Sulphonamidesandcombinations 8888907.16 3.02 180865 7.93 0.38 I
I Quinolones 50986840.62 I 17.34 I . 287094 12.59 1.38 I
I Other 6603843.7911 2.25 I 48792 2.14 1.051
* The cost percentage of the pharmacological group is the total cost of the pharmacological group divided by the total
cost of all antibiotic items claimed for the year period multiplied by hundred.
# The prevalence percentage of the pharmacological group is the prevalence of pharmacological group divided by
the total number of antibiotic items claimed for the year period multiplied by hundred.
+ The cost-prevalence index of pharmacological group is the cost percentage divided by the prevalence percentage
of pharmacological group for that particular year.
113
11119213799.18II
51.3211
1028817
36948095.27IGG
130492.03 0.06 377
21700213.82 9.34
164655 9.09
46522.80 0.02
1667 0.09
5741596.57 2.47
122543 6.76
43589837.29 18.76
220482 12.17
ChaDter 5: Results and Discussion
Pharmacological group
n
Seji. -
Table 5.10: Prevalence and cost of antibiotic pharmacological groups.
Chloramphenicols
~"""
""
"""
.
..
.
...
.
.
..
.
...
.
.
.
.
..
...
.
.
...
..
...
..
...
...
.
..
.
...
...
.
.
.
.
...
.
...
.
.
.
.
...
'i> .
, .n
68
113.03:1:
86
112.88:1:
68/
120.15:1:
341598 59.09 38610263.61 270615 57.27 30547004.00 416604 54.72
70.67 69.95 78.20
86
157.83:1:
66
154.27:1:
86
159.49:1:
84555 14.63 13345488.31 56362 11.92 8695193.99 93469 12.28 II 14907412.97
84.52 98.95 116.96
[3[:] 407.10. I IC3G
358.33:1:
~GG
295.9H I I
127 0.01 51701.15 77 0.02 27591.33 173 0.02 51199.55
428.21 562.45 324.24
6G
126.46:1:
B~
133.80:1:
[3[3
134.06:1:
47624 8.24 6022388.84 44389 9.39 5939257.09 72642 9.54 II 9738567.89
83.79 83.11 88.92
~~ 27.2H I I~~ 285H I I~~~I I~
6
503 0
B
O.09 4::~5: 13715.16 L--=:J
a
429 0
B
O." ~:~: 12246.50.~
6
735 0
[3
°.,0 ~ 20561.14
33599 5.81 1532406.95 36184 7.66 1696501.86 52760 6.93 II 2512687.76
59.95 37.18 37.68
68
205.37:1:
66
194.34:1:
881
195.09:!:
Quinolones I 59982 10.38 12318791.77 54236 11.48 10540019.74 106264 13.96 II 20731025.78
126.38 120.58 129.45
6G
123.0eI I 18B
115.57:1:
6GI
134.26:1:
Other II 10134 1.75 1247418.34 10207 2.16 1179678.02 18733 2.46 II 2515178.22
II 156.58 60.15 109.55
* The prevalence percentage of the pharmacological group is the prevalence of the pharmacological group divided by the total number of antibiotic items claimed for the specific period
multiplied by hundred.
(R) (R)
EJ
(R) (R)
(~)
Beta-Iactams
50556531.57
Erythromycin and other
macrolides
Aminoglycosides
Tetracyclines
Sulphonamides and
combinations
114
ChaDter 5: Results and Discussion
Table 5.10 continues.
'* The prevalence percentage of the pharmacological group is the prevalence of the pharmacological group divided by the total number of antibiotic items claimed for the specific period
multiplied by hundred.
115
I
",y;""ug;g()02(R4J
, .JI .
$ep.:gJRl
]I'=
,:!;'"Apf!r2,QJ1(fi6). =-h'_"<'<W.-=',.,<* < . ,,,,,,.., ,
I'lrarmaf;Qloglcal group
[J5J
Average
TotalCQst..-;
[J[J
Average
Totalcost
[JrJ
Average..
ToTali::iiSt
n . %'*. cost n .. %'* . cost.
'n ". %'*
c()St
.. . ,
, ,
" . . ........:', '
£81 () (R)
() (R)
c ._.....,.___._..._........._.._.........._...__..._., 'u
15306321159.751
120.94 :t
1349440 1155.931
118.01 :t
14233921155.'°1
122.19 :t
Beta-Iactams 64173841.29
41236456.35 51732480.74
76.05
75.67 81.42
Erythromycinand other
1"696411'3.111
165.44 :t
I 7060811".331
168.07 :t
I 6573016
191.70:t
19353714.88
11900428.93 16434119.49
macrolides 110.80 114.39 124.65
Aminoglycosides
[3[3 328.1S. I 40363.341[3[3
269.180<I 22072.39IG 391.22> I 45381.8°1
464.25
404.01 264.57
Bc:J
119.95 :t
I 537941[:]
125.42 :t
I 64466IG
122.45:t
Tetracyclines
7858666.36 6746966.96
7893908.86
92.23 93.15
96.94
Chloramphenicols
[3[3 29.45 'I 24499.46 [3
28.780< I 2653677I[3G 30.23<I 27418.881
23.5718.98
32.05
Sulphonamides and
6[3 I 567441[3
51.14:t
6[3
51.23 :t
57923 6.52 2595804.66
2901950.59 3391151.91
combinations
34.01 33.73
34.58
I 9963211".221
195.68 :t
I 787321112.00 I
177.51 :t
1'08730 11''61
161.08 :t
Quinolones 19496417.82
13976025.38 17514397.42
116.06 111.08
113.50
I 164831G
133.70 :t
1'4220I
139.81:t
6
133.34:t
Other 2203749.96
1988080.15 2412013.68
155.15 317.29
114.02
ChaDter 5: Results and Discussion
5.5 ANALYSIS OF BETA-LACTAM ANTIBOITICS
In 2002 beta-Iactam antibiotics ranked as the number seven therapeutic class based on the
percentage contribution (3.80%) to the total medicine expenditure and was one of the top five
therapeutic classes with the highest prevalence of use (Mediscor, 2003: 9-14).
With reference to Table 5.10 it can be determined that beta-Iactams accounted for more than
50% of all antibiotics issued on this database over the two-year period. Also, the beta-Iactams
consumed more than 50% of the total cost of all antibiotics during the same period.
5.5.1 Prevalence and cost of beta-Iactam antibiotics
The beta-Iactam pharmacological group, consisting out of penicillins and cephalosporins, will be
discussed further on in detail regarding costs, prevalence and the influence of the MPL
(Medscheme@ Price List) on the prevalence and cost of the pharmacological group as such.
Refer to Appendix J for a complete classification of the beta-Iactam group.
[J Medicine items
A total of 2317586 beta-Iactam antibiotic prescriptions, containing between 1.01 :t 0.07 and 1.07
:t 0.08 antibiotics per prescription, were issued during the two-year period. A total of 2332281
beta-Iactam products were claimed. Beta-Iactam antibiotics contributed 56.99% to the total
number of antibiotic items (n = 4092495) claimed during the two-year period (refer to Table
5.11).
According to Table 5.11 1028817 (59.09%) beta-Iactam items were issued during the first year.
The prevalence of beta-Iactam antibiotics was the highest during P1 and decreased as time
progressed, reaching a total of 416604 (54.72%) (refer to Figure 5.5). Also, the number of
prescriptions claimed decreased from P1 (59.89%) to P3 (55.74%) (refer to Table 5.11).
At the start of the second year the prevalence of beta-Iactam items increased to 59.75% of the
total number of antibiotics (n = 578122) issued. However, as with the previous year the
prevalence of beta-Iactam items decreased to 55.16% of the total number of antibiotics (n =
767628) issued (refer to Figure 5.5 and Table 5.11). A total of 527273 prescriptions containing
beta-Iactam items were claimed during P4 and decreased to 420547 during P6 (refer to Table
5.11).
116
ChaDter 5: Results and Discussion
10
o Prevalence
percentages
. Cost
percentages
60
50
40
Percentage (%) 30
20
o
P1 P2 P3 P4
P5 P6
Figure 5.5: Prevalence and cost percentages of beta-Iactam antibiotics. May 2001 to
April 2003.
[J Medicine cost
During the two-year period the total amount that was spent on beta-Iactam antibiotics was
R276356577.56. The total cost of beta-Iactam antibiotics constituted 3.86% of the total cost of
all medicine items (n = R7150344897.00), which correlates with the results of Mediscor of
3.80% (Mediscor 2003: 9), and 52.51% of all antibiotics (n = R526609279.92) (refer to Table
5.11).
It was determined that for the two year period, the first year contributed 43.14% of the total
expenditure on beta-Iactam antibiotics (n = R276356577.56) and the second year contributed
56.86% of the total expenditure on beta-Iactamantibiotics (refer to Table 5.11).
The total cost of beta-Iactam antibiotics in the first year was R119213799.18 and contributed
51.32% of the total cost of all antibiotics (n = R232312831.54) claimed. The average cost per
beta-Iactamitem rangedbetweenR113.03:!::70.67 (P1) and R120.15:!::78.21 (P3) (referto
Table 5.11). Calculation of the d-value indicated that there was no practical significant
difference found between the average costs of beta-Iactam antibiotics for the different periods (d
< 0.8).
117
ChaDter 5: Results and Discussion
Beta-Iactam antibiotics accounted for 53.45% of the total cost of all antibiotics (n =
R293996448.38) during the second year. There was, however, an increase in the cost
contribution of the beta-Iactam antibiotics to the total expenditure on antibiotics. The average
cost ranged between R118.01 :I:75.67 (P5) and R122.18:!: 81.42 (P6) (refer to Table 5.11).
According to the Mediscor@survey the average cost of a beta-Iactam product is R115.58, while
the average expenditure per beneficiary is R75.85 and per utilising beneficiary R210.25
(Mediscor, 2003: 9).
In this study conducted the average cost per prescription ranged between R113.72 :I:70.96 (P1)
and R123.01 :!:81.82 (P6), with no practical significant difference (d < 0.8) (refer to Table 5.11).
According to Figure 5.5 there were no big differences between the prevalence percentage and
cost percentage of beta-Iactam antibiotics during the two-year period. Figure 5.6, though,
indicated that there was an increase in the cost-prevalence index over the two-year period. The
cost-prevalence indices increased from 0.89 (P1) to 0.94 (P6). In both years, during the last
two periods (P2 and P3, P5 and P6) the cost-prevalence index remained the same, 0.91 and
0.94 respectively. According to the cost-prevalence index the beta-Iactam therapy was
relatively inexpensive «1.5).
o Cost index values
0.94
0.93
0.92
0.91
Cost index 0.9
0.89
0.88
0.87
0.86
P1 P2 P3 P4 P5 P6
Figure 5.6: Cost index-values of beta-Iactam antibiotics. May 2001 to April 2003.
118
ChaDter 5: Results and Discussion
Table 5.11: Prevalence and cost of beta-Iactam antibiotics. May 2001 to April 2003.
[J~II><II ~
BB
113.03:1:
BB
341598 59.09 339510 59.89
70.67
Sep.-
BB BB
112.88 :I:
Dec. 2001 270615 57.27 269150 58.16
69.95
(P2)
Jan.-
EJB EJB
120.15:1:
Apr. 2002 416604 54.72 414140 55.74
78.21
(P3)
BB
120.94:1:
8B
530632 59.75 527273 60.53
76.05
Sep.-
EJB EJB
118.01 :I:
Dec. 2002 349440 55.93 346966 56.74
75.67
(P5)
Jan.-
EJB EJB
122.18:1: 123.01 :I:
Apr. 2003 423392 55.16 420547 56.09
1
1.01 :1:0.08
11
II51732480.74
81.42 81.82
(P6)
·The prevalence percentage of beta-Iactam items is the prevalence of the beta-Iactam items divided by the total
number of antibiotic items claimed for the specific period multiplied by hundred.
# The prevalence percentage of beta-Iactam prescriptions is the prevalence of beta-Iactam prescriptions divided by
the total number of antibiotic prescriptions claimed for the specific period multiplied by hundred.
antibiotics
May-
Aug. 2001
(P1)
1.01 :I:0.08
113.72 :I:
70.96
38610263.61
1.01 :I:0.07
113.49 :I:
70.18
30547004.00
1.01 :I:0.08
May-
Aug. 2002
(P4)
1.01 :I:0.08
1.07 :I:0.08
5.5.2 Prevalence of top ten individual beta-Iactam products
An in depth discussion on the prevalence and costs of the individualbeta-Iactam products, as
well as the influence of the Medscheme@ Price List(MPL)willfollowin paragraph 5.6.
During the two-year period none of the antibiotics was listed as one of the top ten selling
products according to the general analysis medicine items on the central medicine claims
database (refer to Table 3B and 4B, Appendix B).
5.5.2.1 Penicillins
Figure 5.7 indicates that Augmaxil@375mg tablets represented the largest proportion of the
beta-Iactam pharmacological group utilised during the first year, amounting to 8.68% (n =
119
120.87:1:II50056531.57
I I
121.71 '1164173841.291
76.21
II I
118.85:1:II 41236456.35
75.96
ChaDter 5: Results and Discussion
1028817). During the first (P1), second (P2) and third (P3) period of the first year it had the
highest prevalence of all beta-Iactam products (refer to Table 5.12).
However, during the second year the prevalence of Augmaxil@ 375mg tablets decreased
drastically to 5.18% (n = 1303464). In the second year its prevalence was the fourth highest of
all beta-Iactam products (refer to Figure 5.7). Generic prescribing increased as a result of the
implementation of the MPL. Though Augmaxil@is a generic product, there was an increase in
the usage of other generic products (e.g. RanclaV@and Rolab-AmoclaV@).In effect there where
almost no differences in the prevalence of the amoxicillin/clavulanic acid combination between
the first year and the second year. The prevalence of Augmaxil@, however, was very high
during the first year, contributing the highest percentage to the prevalence of the
amoxicillin/clavulanic acid combination and during the second year it was contributed by other
generic products.
The increase in the usage of RanclaV@375mg tablets and ClavumoX@375mg tablets could be
attributed to a lower average cost per medicine item. Tables 4G, 5G and 6G (Appendix G)
indicated that the average cost of Ranclav@375mg tablets and Clavumox@375mg tablets were
the lowest of all amoxicillin/clavulanic acid antibiotics during P5 and P6. This could be the
reason behind the increase in the prevalence of both these products during the second year
(refer to Table 5.12). This also gives a reason behind the redistribution of the prevalence of
generic products of the amoxicillin/clavulanic acid combination antibiotics.
5.5.2.2 Cephalosporins
According to Mediscor (2003; 19), Zinnat@ 250mg tablets ranked as the twenty-fourth highest
product contributing 0.4% of the total expenditure and 0.3% of the total number of items claimed
during 2002.
The prevalence of Zinnat@250mg tablets increased from the first year (7.03%, n = 1028817) to
the second year (8.03%, n = 1303464) (refer to Figure 5.7). During the first year it was the
second highest selling beta-Iactam product on the database, while in the second year it was the
highest. In both years the prevalence was the highest during the May to August period (P1 and
P4), reaching a prevalence of 7.51% (n = 341598) and 9.17% (n = 530632) respectively (refer
to Table 5.12).
The high prevalence of Zinnat@250mg tablets could be attributed to the fact that no generic
products were available on the market at the time of the investigation. Further reasons for the
high prevalence could be due to the once daily dosage and the existence of antimicrobial
resistance with regard to other antibiotics.
120
ChaDter 5: Results and Discussion
There was also an increase in the prevalence of OreloX@Junior suspension over the two-year
period. During the first year it was the third highest selling beta-Iactam product, with a
prevalence of 6.15% (n =1028817). During the second year though, it ranked as the second
highest selling beta-Iactam product, with a prevalence of 6.58% (n = 1303464) (refer to Table
5.12). As withZinnat@,no direct generic substitution was possible withOreloX@.
From Table 5.12 and Figure 5.7 it was revealed that the prevalence of cephalosporins
increased during the second year, while there was a decrease in the prevalence of penicillins.
The top three selling products of all antibiotics during the second year were cephalosporins
antibiotics.
9
8
7
6
5
Percentage (%)
4
3
2
1
o Prevalence
first year
. Prevalence
second year
Figure 5.7: Prevalence of top ten beta-Iactam products. May 2001 to April 2003.
121
0
Om m °0 °0 m om m 00. m °0 m m
0 m m
c(
0 0 0 0 0
I:J) I:J) I&.
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I:J) I:J)
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0
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m E E
E E
0
E E E E
'c
10
10 10
@
10 10 0 0 10 10
1»
0 0
t-- N
><
t-- t-- 10 0
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t-- t-- 10 0
C') co
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C') C') N .... ., C') C')
E
N 10
III
E
:;::
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10
c
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N
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0 III III
.... III III
III
:s
c(
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Q.
'!
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() ()
c c
E
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I:J)
C c
E
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>-
c 0
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:s
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)(
0 0 III
E
III
I:J)
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:s
:s
III III
:E
a:::
1
c
c(
c( 0 0
N,g
III
'0
a:::
Chaoter 5: Results and Discussion
Table 5.12: Prevalence of the top ten beta-Iactam products for each period. May 2001 to April 2003.
[rf "I![ %*]I"~.~ I %* ,,~~.'-U %*' I' n,IIL ~~ H IITU ' '%.~~]I="~~=-II~
Augmaxil@375mg TAB II 30082 II 8.81 23676 8.75 35561 II 8.54 39660 I 7.47 16252 I 4.65 11637 2.75
Augmaxil@625mg TAB II 7848 I 2.30 1076611 2.58 12850 2.42
Augmaxil@S SUS II 6620 2.45 II
Augmaxil@SFSUS II I 7315 2.70 9186 II 2.20
Augmentin@BDTAB II 16170 4.731 13798 5.10 I 2161011 5.19 24011 4.52 17564 5.03 22654 5.35
Clamentin@375mg TAB I 10233 3.00 7005 2.591 11995 2.881 14051 2.65 10828 3.10 11943 2.82
ClavumoX@375mg TAB 8496 2.49 6445 2.38 9334 2.24 I 12404 2.34 9646 2.76 15101 3.57
Moxypen@250mgCAP I 10987 2.07
OreloX@100mg TAB 16433 4.81 I 11359 4.20 18393 4.41 30186 5.69 15142 4.33 18169 4.29
OreloX@Junior SUS 20730 6.07 17042 6.30 25490 6.12 35970 6.78 22826 6.53 26910 6.36
RanclaV@375mg TAB I 10727 3.07 15435 3.65
Rolab-AmoclaV@375mgTAB II 8711 2.49 10907 2.58
Zinnat@ 125mg/5mlSUS 16908 4.95 14974 5.53 20517 4.92 30661 5.7811 19389 5.55 22882 5.40
Zinnat@250mgTAB 25643 7.51 17297 6.39 29437 I 7.07 48639 9.1711 25771 7.37 30303 7.16
Zinnat@500mg TAB 7919 I 2.3211 II II 1
* The prevalence percentage of individual antibiotic products is the preva ence of the individual antibiotic product divided by the total number of antibiotics claimed for the specific
period multiplied by hundred.
122
ChaDter 5: Results and Discussion
5.6 THE MEDSCHEME@PRICE LIST (MPL)
The Medscheme@Price List (MPL) is a reference pricing system whereby a ceiling price has
been allocated to a group of drugs, which are similar in terms of composition, clinical efficacy,
safety and quality. Medscheme@only reimburses up to the ceiling price for the specific group
of drugs, irrespective of which drug has been prescribed. At least one medicine in each group
will be reimbursed fully, and no co-payment from the patient should be required other than that
which is determined by scheme rules. If the drug in question is more expensive (including VAT)
than the MPL Reference Price for that generic group of drugs, then the patient will be required
to pay the difference directly to the provider of the medicine (Medprax, 2001: 1).
The reference price has been set for a specific pack size (quantity) and it will apply pro rata to
any other number of units supplied. The reference price for all pack sizes other than the MPL
reference pack will be a direct conversion from the MPL reference pack and reference price to
the dispensed pack size (Le. if the reference price for a 30 pack is R100.00, then the reference
price for a 100 pack will be R100/30 x 100 = R 333.34).
In the following section some possible aspects of the effect(s) of the Medscheme@Price List
(MPL) on the prevalence and cost of the beta-Iactam antibiotics will be discussed. As
mentioned before the beta-Iactam antibiotics represented 56.99% of all antibiotics claimed (n =
4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309280.04) for
the two-year period (refer to paragraph 5.5.4).
The beta-Iactam antibiotics are divided into three sub-groups (penicillins, cephalosporins and
other beta-Iactams) with their individual original and generic products. The discussion will be
done according to the active ingredient classification referred to in Appendix J. Only the
products listed on the MPL will be discussed.
The MPL was implemented in May 2001. The lists for each month for the period May 2001 to
April 2003, with the relevant information, were received from Medscheme@ and could be
referred to in Appendix H.
During year two (P4 to P6), the year of implementation of the MPL, 62.24% of all beta-Iactam
antibiotics (n = 1303464) claimed were MPL listed6. These products constituted 43.25% of the
total cost of all beta-Iactam antibiotics (n = R157142778.38(
6 This percentage was calculated by dividing the number of beta-Iactam antibiotic items daimed (listed on the MPL in
Appendix H) by the total number of beta-Iactam antibiotics claimed during year two, multiplied by hundred.
123
ChaDter 5: Results and Discussion
Itshould be noted that in the discussion that followsonly year two (P4 tot P6) would be relevant,
as it is the year the MPLwas implemented. Notificationwillbe given ifthe period discussed is
not year two (P4 to P6).
5.6.1 Penicillins
Of the three sub-pharmacological groups of the beta-Iactam antibiotics, penicillins had the
highest prevalence of medicine items listed on the MPL. A total of 776413 penicillinmedicine
items were claimed that were MPL listed (95.70%). These products had a cost of
R63340370.62 and contributed 93.20% to the total cost of all beta-Iactam antibiotics (n =
R67961959.50) listed on the MPL(refer to Table 5.13).
According to Table 5.13 the MPL reimbursed R61619211.86 for the penicillinsthat were listed
on the MPL. This resulted in a saving of 2.79% for medical schemes. The difference of
R1721158.76 was either paid as a levyby the patient or given as a discount to the patient.
Eight of the thirteen sub-pharmacological groups of penicillinwere MPL listed (refer to Table
5.13). Products containing one of the followingas active ingredient(s) were not listed on the
MPL: benzathine penicillin,benzylpenicillin,benzylpenicillin/procainecombinations, piperacillin
and procainepenicillin(referto AppendixG). Mostof these productsare givenparenterallyto
patientsandwerenotlistedonthe MPL.
5.6. 1. 1 Amoxycillin
With reference to Table 5.13 it was determined that of all the amoxycillin items claimed only
314358 were listed on the MPL. The total cost that was claimed for the amoxycillin items were
R12290046.70, while the MPL only reimbursed R11715893.27. From these results it could be
concluded that R574152.83 was either paid by the patient or given as a discount by the
dispenser. Thus it is possible to say that the MPL brought a saving of 4.67%.
Products such as Amoxil@ 250mg vials, Amoxil@ paediatric drops, Ranmoxy@ dispersible
250mg tablets and Ranmoxy@dispersible tablets were not included in the calculations for these
products were not listed on the MPL (refer Appendix G and Appendix H). There was no
differentiation between different dosage forms of the same active ingredient and strength (Vice,
2004: telephonically).
7This percentage was calculated by dividing the cost of beta-Iactam antibiotic items claimed (listed on the
MPL in Appendix H) by the total cost of beta-Iactam antibiotics claimed during year two, multiplied by
hundred.
124
ChaDter 5: Results and Discussion
The total number of products that was claimed, but not listed on the MPL, was 7132. Most of
these products were original products with no generic substitution possible. The prescribing of
these products was possibly due to patient compliance, patients unable to swallow, patients
being unconscious, etc. The amounts that were claimed for these products for each of the three
periods were as follows, R134352.63 (P4), R167588.58 (P5) and R267787.98 (P6) (refer to
Appendix G).
These products that were not listed on the MPL were however reimbursed by the medical aids,
but the amount that was reimbursed was calculated according to ceiling price that was paid for
the specific strength of drug. For example, if the physician prescribed the Ranmoxy@
dispersible 250mg tablets, the medical aid paid the dispenser the amount according to the MPL
that was agreed on for any amoxicillin 250mg tablets. The patient paid the difference between
the Ranmoxy@dispersible 250mg tablets and the calculated cost according to the MPL for
amoxycillin 250mg tablets.
5.6.1.1.1 Cost and prevalence of original and generic products
Table 1K (Appendix K) revealed that 2.01% of all amoxycillin products claimed were original
products, while 97.98% were generic products. A total of R438602.42 was claimed for original
amoxycillin products. Original amoxycillin products had a cost-prevalence index of 1.78. This
indicated that it was a relatively expensive medicine therapy. Of the total amount that was
claimed for original amoxycillin products, medical aid companies only paid R231504.82.
Generic amoxycillin products claimed had a cost-prevalence index of 0.98, indicating that is was
a less expensive medicine therapy when comparing it with the original amoxycillin products.
The total cost of these products claimed was R11851444.28 (refer to Appendix K).
5.6.1.1.2 Cost and prevalence of individual products
During the three periods (P4 to P6) more than sixty different amoxycillin items were claimed.
Their average cost ranged between R7.18 :!: 13.28 (C-Mox@250mg capsules) and R361.81
(Amoxil@250mg vial). The amoxycillin product with the highest average cost that was listed on
the MPL was Amoxil@500mg capsules with an average cost of R91.82 :!:48.69 (refer to Table
19, Appendix G).
Amoxil@ 500mg tablets had the highest prevalence of all original amoxycillin products (n =
1000) claimed and a total cost expenditure of R91819.63 during P4. During P5 Amoxil@500mg
tablets had a decrease in the total number of items claimed (n = 631). Consequently the total
cost decreased to R53220.43. In the last period (P6) the total number of Amoxil@ 500mg
tablets claimed was 563, with a total cost of R31947.38 (refer to Appendix G). The average
125
ChaDter 5: Results and Discussion
package size varied between 16.61 :t 5.97 (P5) and 17.01 :t 6.30 (P4). There were no practical
significant differences between the package sizes (d < 0.8).
5.6.1.2Amoxycillin/clavulanic acid combination
Amoxycillin/clavulanic acid combination products had the highest prevalence (n = 398189) of all
beta-Iactam products that were listed on the MPL. It had an expenditure of R44659065.23 and
contributed 65.71% to the total cost of beta-Iactam antibiotics (n = R 67961959.50). However,
after calculation of the cost saving it was determined that if the MPL had been applied
completely it could have resulted in a saving of only 1.02%. More than R450000.00 in
difference was paid by the patient (refer to Table 5.13).
Augmentin@0.6g vials, Augmentin@ 1.2g vials, Augmentin@ 1000mg SD tablets, Augmentin@
Comb pack, Clamentin@0.6g vials and Clamentin@1.2g vials were not listed on the MPL. The
total number of these products that was claimed was 66985 and the total cost was
R14705970.71 (refer to Appendix G). These products were, however, reimbursed, but only up
to the MPL ceiling price.
5.6.1.2.1 Cost and prevalence of original and generic products
During the year of implementation of the MPL 2.69% original amoxycillin/clavulanic acid
combination products were claimed (n = 398189). The cost-prevalence index (1.13) revealed
that these products were a relatively expensive medicine therapy. A total cost of R1359529.00
was claimed, while medical aid companies paid providers only R1194353.30 (refer to Appendix
K).
The total cost that was spent on the 387458 (97.31%) generic amoxycillin/clavulanic acid
combination products was R43299536.23. The cost-prevalence index was 1, indicating that
there was equilibrium between the cost percentage and the prevalence percentage for generic
amoxycillin/clavulanic acid combination products. The prevalence of generic
amoxycillin/clavulanic acid combination products increased from 96.90% (P4) to 98.08% (P6).
5.6.1.2.2 Cost and prevalence of individual products
A wide variety of amoxycillin/clavulanic acid combination products exist on the market. During
the study period thirty-eight different amoxycillin/clavulanic acid combination products were
claimed.
Augmaxil@ 375mg tablets had the highest prevalence of all the amoxycillin/clavulanic acid
combination products. In each of the three periods 39660 (P4), 16252 (P5) and 11637 (P6)
were claimed. In the last period (P6) Clamentin@ 375mg tablets (n = 11943), Clavumox@
126
ChaDter 5: Results and Discussion
375mg tablets (n = 15101) and RanclaV@375mg tablets (n = 15435) had a higher prevalence
than Augmaxil@375mg tablets (n = 11637) (refer to Appendix G). As mentioned in paragraph
5.4.5.1, though Augmaxil@375mg is a generic product, there has been a tendency to prescribe
more of the other generic products.
5.6.1.3Amoxycillin/flucloxacillin combination
The second highest beta-Iactam antibiotic products that were claimed were the
amoxycillin/flucloxacillin combination products. A total of 34587 amoxycillin/tlucloxacillin
combination products with a total expenditure of R3058576.88 were claimed during the year.
5.6. 1.4 Ampicillin
A total of 4639 ampicillin products were claimed during the year the MPL was implemented.
The total expenditure for all the ampicillin products was R1450881.41. The medical aid paid
dispensers more than the amount that was claimed, R164725.44 (refer to Table 5.13).
5.6.1.5 Ampicillin/cloxacillin combination
The ampicillin/cloxacillin combination products had a higher prevalence than products
containing only ampicillin. The 9405 ampicillin/cloxacillin combination products had a total cost
of R892396.89. If the MPL had been applied the amount of R978835.30 would have been paid
to dispensers. However, R86438.30 less was claimed than the MPL was willing to reimburse
(refer to Table 5.13).
5.6.1.6 Cloxacillin
During the year 5640 cloxacillin products were claimed. These products contributed
R531342.84 to the total expenditure on beta-Iactam antibiotics listed on the MPL. The MPL was
willing to reimburse more for cloxacillin products than the amount that was claimed. However,
the difference of R68206.85 was not saved by the medical aid. The MPL paid the ceiling price
to the provider even if the amount claimed by the provider was lower than the MPL price (refer
to Table 5.13).
5.6.1.7 Flucloxacillin
According to Table 5.13 the MPL reimbursement price for tlucloxacillin was much higher than
actual amount that was claimed. Dispensers only claimed R186966.24 for 1409 tlucloxacillin
products. This brought a difference of R469314.61 that was paid to dispensers even though the
price they wanted was much lower (refer to Table 5.13). Medical aid companies could have
saved much more if the ceiling price had been lower.
127
ChaDter 5: Results and Discussion
5.6.1.8 Penicillin VK
During the year after implementation of the MPL a total 8186 Penicillin VK products were
claimed. The total cost that was claimed for Penicillin VK was R271094.43. The amount that
was paid to providers, however, was R40764.86 more than the claimed amount (refer to Table
5.13).
5.6.2Cephalosporins
The cephalosporin products that were claimed and listed on the MPL were 4.29% (n = 811270).
This percentage is low compared to penicillin antibiotics. This is attributed to the fact that most
of the cephalosporin products claimed were original products and thus no generic substitutions
were possible. The MPL were only applied if generic substitution where possible.
Subsequently the cost contribution was also very low, 6.80%.
It was revealed after calculation of the calculated cost that the MPL would reimburse
R4786451.79 for all cephalosporin products listed on the MPL. However, providers claimed
only R4621588.89 for cephalosporin products.
A large number of products containing cephalosporin were not listed on the MPL. Most of these
products were original (innovator) products and no generic substitutes were on the market.
Only three (cefaclor, cefadroxil and cephalexin) of the fifteen sub-pharmacological groups of
cephalosporin were listed on the MPL.
5.6.2.1Cefaclor
Cefaclor products had the highest prevalence of all cephalosporins. It had a prevalence of
1.55% of all beta-Iactam antibiotics (n = 1303464). The ceiling price for cefaclor products,
according to the MPL, was much higher than the price that was actually claimed by dispensers.
The total expenditure for cefaclor products was R3091078.74, while the amount that was paid
by medical aids was R3236818.61 (refer to Table 5.13).
All of the cefaclor products were listed on the MPL except for Adco-Cefaclor@ SD tablets and
Rolab-Cefaclor@ 500mg CD tablets. These cefaclor products not listed on the MPL had a
prevalence of 4882 and a total cost expenditure of R718247.90 (refer to Appendix G).
5.6.2.1.1 Cost and prevalence of original and generic products
Original cefaclor products contributed 5.17% to the total number of cefaclor products (n =
20238) claimed. Providers claimed R170129.81 for all original cefaclor products provided to
patients. More than 18% could have been saved to patients if providers claimed cefaclor
products at the ceiling price set by the MPL (refer to Appendix K). Calculation of the cost-
128
ChaDter 5: Results and Discussion
prevalence index of original cefaclor products revealed that it is not a very expensive medicine
treatment (CPI S1).
The prevalence of generic cefaclor products during year two was 94.81% (n = 20238).
Providers for the dispensing of generic cefaclor products claimed less than the amount paid by
medical aid companies. Further analysis revealed that this is an inexpensive medicine therapy
(CPIS1).
5.6.2.1.2 Cost and prevalence of individual products
More than 40 different cefaclor products that were registered on the market were claimed during
year two. Nine of these products were original products and the rest generic products.
Adco-Cefaclor@ SD 187mg suspension had the highest prevalence during each of the three
periods, 2423 (P4 to P6). This product had an average package size of between 50.95 :!: 7.16
and 51.13 :!: 7.72 and the average cost ranged between R98.74 :!: 15.29 (P6) and R101.46 :!:
14.35 (P5) (refer to Appendix G).
5.6.2.2 Cefadroxil
Cefadroxil products had a prevalence of 2548 products claimed, with a resulting cost of
R367618.67. More than 43% was paid unnecessary by medical aids to dispensers and
providers.
5.6.2.3Cephalexin
Dispensers claimed a total of 12111 cephalexin products. The ceiling price that the MPL
calculated to pay for cephalexin products was much lower than the actual amount claimed.
Dispensers claimed R1162891.48, while only R1020588.38 was paid to the dispensers. More
than R140000.00 was paid out of the pocket by patients or were given as discounts by
providers (refer to Table 5.13).
5.6.3 "Other" beta-Iactam antibiotics
None of the "other" beta-Iactam antibiotic products were listed on the MPL. Products containing
meropenem, loracarbef or imipenem/cilastatin were not listed on the MPL. No generic
substitutes were listed on the market for these products. Also some of these products were for
parenteral use and therefore not listed.
129
ChaDter 5: Results and Discussion
The "other" beta-Iactam products had a prevalence of 25008 medicine items and a total cost
expenditure of R5557259.72. Lorabid@ (Ioracarbef) had the highest prevalence of 24958
(99.80%) of all "other" beta-Iactam products. During both year one and year two the prevalence
remained the same for Lorabid@. No different prescribing pattern was noted.
Table 5.13: Beta-Iactam antibiotic expenditure. May 2002 to April 2003. #
# This table is a summary of Table 1K given in Appendix K.
* Saving percentage is the total generic cost divided by the total cost (sum of original and generic) multiplied by
hundred.
5.7 SUMMARY OF RESULTS
In the following section a concise summary of the results of this study will be given.
The general analysis of the central medicine claims database revealed that a total of 25408438
prescriptions containing one or more medicine items were prescribed during the two-year study
period. The total number of medicine items claimed was 49098736, with a total cost
expenditure of R7150344897.00
After the implementation of the Medscheme<IDPrice List (MPL) there was an increase in the
prevalence of generic medicine items. From the first to the second year the number of generic
medicine items claimed increased from 26.53% to 31.08%. The cost-prevalence ratio of
generic medicine items indicated that it is a relatively inexpensive medicine therapy compared
to original medicine items.
130
II
'alculiredcost
'[herapeutfcclaS$
(R)
Amoxycillin (n=314358)
12290046.70 11715893.27
Amoxycillin/davulanic acid (n=398189)
44659065.23 44202402.14
-456663.09 -1.02
Amoxycillinlflucloxacillin (n=34587)
3058576.88 2989665.88 -51960.63
-1.70
Ampicillin (n=4639)
1450881.41 164725.44 19637.03 1.35
Ampicillin/cloxacillin (n=9405)
892396.89 978835.30 86438.30 9.69
Cefaclor (n=20238)
3091078.74 3236818.61
145739.13 4.71
Cefadroxil (n=2548)
367618.67 529044.80 161426.13
43.91
Cephalexin (n=12111)
1162891.48 1020588.38 142303.10 12.24
Cloxacillin (n=5640)
531342.84 599549.69
68206.85 12.84
Flucloxacillin (n=1409)
186966.24 656280.85 469314.61 251.02
Penicillin VK (n=8186)
271094.43 311859.29 40764.86 15.04
ChaDter 5: Results and Discussion
The specific analysis revealed that during the two-year period a total of 4004958 prescriptions
containing one or more antibiotic medicine items was claimed. The total number of antibiotic
items, 4092495, had a total cost of R526309279.43.
Further analysis revealed that from the first to the second year the prevalence of generic
antibiotic items increased from 54.89% to 59.89%, while there was a decrease in the
prevalence of originalantibioticitems. However,when taking the cost of original antibioticitems
into account itwas revealed that the total cost for originalantibioticitems was much higher than
for generic antibioticitems. The cost-prevalence index for original and generic antibiotics were,
1.5 and 0.7 respectively for the two-year period.
The implementation of the MPL resulted in a variety of effects regarding the prevalence and
cost of beta-Iactam antibiotics. As previously mentioned there was an increase in the
prevalence of generic medicine items after the implementation of the MPL. Further, it was also
revealed that there was an increase in the prescribing of different generic medicine items. For
example during the first year Augmaxil@ 375mg tablets was the main generic
amoxicillin/clavulanic combination product prescribed, but during year two there was an
increase in the prescribing of other generic products such as RanclaV@375mg tablets,
ClavumoX@,etc.
Another effect that was noted is the fact that there was an increase in the prescribing of
products that may be therapeutically substituted, but not on a generic (same active ingredient)
bases. For example during the second year Zinnat@had the highest prevalence of all beta-
lactam products. It is, however, possible to substitute Zinnat@therapeutically with a cheaper
medicine. The same was found with products such as Orelox@and Lorabid@.
Results of the general and specific analyses are reviewed in Table 5.14.
131
-----
ChaDter 5: Results and Discussion
Table 5.14: Summary of data. May 2001 to April 2003.
. Mily2(J02tO
April2(J()3
_~.."~~",',',','.w,
14347442
Descrip
Number of medicine items
21820911
R3097064602.00
16030994
5789917
R2686324992.00
R410739609.00
1772674
1812001
R232312831.04
817333
994668
R148240582.95
R84072248.59
1022800
1028817
R119213799.18
Medicine cost
Number of original items
Number of generic items
Cost of original items
Cost of generic items
Number of antibiotic prescriptions
Number of antibiotic items
Cost of antibiotics
Number of original antibiotic items
Number of generic antibiotic items
Cost of original antibiotic items
Cost of generic antibiotic items
Number of beta-Iactam prescriptions
Number of beta-Iactam items
Cost of beta-Iactam items
Number of beta-Iactam items
Cost of beta-Iactam items
Number of original beta-Iactam items
Number of generic beta-Iactam items
Cost of original beta-Iactam items
Cost of generic beta-Iactam items
Number of penicillin items
Cost of penicillin items
Number of original penicillin items
Number of generic penicillin items
Cost of original penicillin items
Cost of generic penicillin items
Number of cephalosporin items
Cost of cephalosporin items
Number of original cephalosporin items
Number of generic cephalosporin items
Cost of original cephalosporin items
Cost of generic cephalosporin items
27277825 49098736
R4053280295.00 R7150344897.00
18799816 34830810
8478009 14267926
R3410492539.00 R6096817531.00
R642760360.00 R1053499969.00
2232284 4004958
2280494 4092495
R293996448.38 R526309279.43
914622
1365872
R179753405.54
R114243042.34
1294786
1303464
R157142778.38
811310
R66656166.51
23051
788252
R2649435.05
R64006731.46
776413
R62034577.62
21242
755171
R2275876.56
R59758701.06
34897
R4621588.89
1809
33088
R373558.49
R4248030.40
1731955
2360540
R327993988.49
R198315290.93
2317586
2332281
R276356577.56
132
ChaDter 5: Results and Discussion
5.8 CHAPTER SUMMARY
In this chapter the results of the empirical study were discussed. The prevalence and cost of
medicine, specifically antibiotics, were established according to the central medicine claims
database. The effect of a reference medicine price list on the prevalence and cost of beta-
lactam antibioticswas also analysed.
Hereby the research questions eight to fourteen have been answered and their research
objectives reached.
133
Chapter 6
Conclusions, Recommendations and Limitations
6.1 INTRODUCTION
In this chapter the conclusions, recommendations and limitations based on the results will be
discussed.
6.2 CONCLUSIONS
The conclusions will be divided into those deduced from the literature review (research
objectives one to seven) and those deduced from the empirical investigation (research
objectives eight to twelve).
6.2.1 Conclusions deduced from the literature review (chapters 2 and 3)
o The first research objective was to conceptualise from the literature what health care entails
in South Africa, as well as internationally. A concise overview regarding the private and
public health care sectors in South Africa was discussed in paragraph 2.2. Access to health
care, health care expenditure and financing of health care also formed part of the
discussion. In paragraph 2.3 various aspects regarding health care in other countries were
discussed.
o The second research objective was to determine from the literature which factors contribute
to the high health care costs in the private health care sector of South Africa, as well as
internationally. A concise overview regarding this objective was reviewed in paragraphs
2.3.1, 2.3.3 and 2.4.
o The third research objective was to investigate from the literature the possible influences of
the new legislation on medicine cost in the private health care sector. Amendments to
legislation regarding the costs of medicine were reviewed in paragraphs 2.2.3.3, 2.5.2.3 and
2.6.1.
o The fourth research objective was to review from the literature the influences of generic
substitution on the prevalence and cost of medicine. An overview regarding the prevalence
and costs of original and generic products and possible effects of generic substitution on the
costs of medicine is given in paragraph 2.5.
134
ADDendix A
Table 1A: Medicine items and prescriptions claimed. May 2001 to April 2002.
tnw"~~"M,~~!~~.,. JI
I May 1524296 II 740708 I
June 1230754 II 595871 I
July 1266101II 616329 I
August 2014988 I 998795 I
September 1722109 8723051
October 1708168 885892
November 1400453 Il 724293
December 1596781 812710 I
January 2311879 1187338 I
February 2237776 1148370 I
March 2360273 12171851
April 2447323 1261200 I
2.07 :f: 1.26
2.05 :f: 1.25
2.02 :f: 1.23
1.97 :f: 1.22
1.93:t 1.20
1.93:t 1.20
1.96:f: 1.21
1.95:f: 1.21
1.95:f: 1.20
1.94:f: 1.20
1.94:f: 1.20
ADDendix A
Table 2A: Medicine items and prescriptions claimed. May 2002 to April 2003.
JP~lifIJUiijiber"OfnreiliC1mti~$~~ir-]["-"ofali:ulj~rp~P!esc~et1~nS"c~~
May 1229381II 650519
June 2385440II 1211046
July 244004811 1257723
August 242724411 1260648
September 20988131 1107865
October 2149888 1146070
November 1983465 1058583
December 1881793 997993
January 2434555 1304379
February 2228799 1188840
I March 2414253 1289640
I April 2310016 1233177
Average number 0:
1.97:i: 1.20
1.94:i: 1.18
1.93:i: 1.16
1.89 :i: 1.15
1.88 :i: 1.13
1.87 :i: 1.13
1.89:i: 1.14
1.87 :i: 1.14
1.87:i: 1.13
1.87:i: 1.13
1.87 :i: 1.12
ADDendixB
Table 1B: Prevalence of the top 10 main pharmacological groups (e.g. antimicrobial agents). May 2001 to April 2002.
Main pharmacological groups.
1...~~ILi.J~~.,]
I Respiratory system 253798 16.65 210133 17.0711 217882 17.21 II 326866 16.22 232607 13.51 217537 12.741
I Antimicrobials 178315 11.70 147574 11.90 II 152742 12.0611 234847 11.66 180280 10.47 159188 9.321
I Cardiovascular agents 173131 11.36 142074 11.5411 152571 12.0511 248183 12.32 242216 14.07 247490 14.491
Analgesics 132195 8.67 108361 8.80 II 111071 8.7711 172922 8.58 134788 7.83 134683 7.881
Endocrine system 130277 8.55 106172 8.631 110253 8.71 I 180639 8.96 170951 9.93 169444 9.921
Central nervous system 119983 7.87 94188 7.65 95407 7.54 158898 7.89 140628 8.17 135278 7.921
Musculoskeletal agents 91005 5.97 71470 5.81 72861 5.75 117635 5.84 104595 6.07 105381 6.171
Gastro-intestinaltract 84197 5.52 65350 5.31 63294 5.00 106318 5.28 93667 5.44 97508 5.71 I
Ear, nose and throat 79558 5.22 63583 5.17 63543 5.02 102873 5.11 83827 4.87 I
Dermatologicals 82502 4.83 I
Other 281837 118.49 221847 18.03 226475 17.89 365807 17.38 338548 19.66 359157 25.871
Total 1524296 I 100 1230754 100 1266101 100 2014988 100 11722107 I 100 111708168 100 I
* The prevalence percentage of the main pharmacological group is he prevalence of the pharmacological group divided by he total number of medicine items claimed for the specific
month multiplied by hundred.
ADDendixB
Table 1B continues:
J=~prirJ~-:~1
IU~f_" l[r~§ZJ
I Respiratorysystem 180738 12.91 180026 11.2711 227452 9.84 268683 12.01 II 289468 II 12.26 319669 13.061
I Antimicrobials 132832 9.48 156839 9.82 247258 10.70 244509 10.9311 25626311 10.86 265958 10.871
Cardiovascular agents 203606 14.54 241949 15.15 312457 13.52 296816 13.2611 32032711 13.57 329050 13.451
Analgesics 110057 7.86 117876 7.38 197227 8.53 193897 8.66 204401 8.66 210154 8.591
Endocrine system 139693 9.971 168111 10.53 I 222110 9.61 212429 9.49 229301 9.72 233999 9.561
Central nervous system 107239 7.66 I 119611 7.49 208782 9.03 196622 8.79 205417 8.70 209361 8.551
Musculoskeletal agents 83160 5.94 94884 5.94 144100 6.23 132552 5.92 136921 5.80 141740 5.791
Gastro-intestinal tract 79526 5.68 93556 5.86 149931 6.49 131033 5.86 132675 5.62 134886 5.51 I
Ear, nose and throat 119316 4.881
Dermatologicals 69843 4.99 84674 5.30 I 133642 5.78 114549 5.12 117426 4.98 I
Other 293759 20.98 339255 I 21.2511 468920 20.28 446686 19.96 468074 19.83 483190 19.741
Total 1400453 100 1596781 II 100 II 2311879 100 2237776 100 2360273 100 2447323 100 I
* The prevalence percentage of the main pharmacological group is the prevalence of the pharmacological group divided by the total number of medicine items claimed for the specific
month multiplied by hundred.
ADDendixB
Table 2B: Prevalence of the top ten main pharmacological groups (e.g. antimicrobial agents). May 2002 to April 2003.
Mainpharmacological groups
t = May~~:~=I
~~is~ I! L~".~"_ ~ . ~~ .0.
Respiratory system 222341 18.09 424407 1117.7911 393022 1116.11 326866 II 16.22 291147 13.87 268684 12.50 I
Antimicrobials 136304 11.09 281930 1111.8211 286442 I 11.74 234847 11.66 231987 11.05 238091 11.071
Cardiovascularagents 144737 11.77 305292 12.80 321321 13.17 248183 12.32 294197 14.02 301052 14.00 I
Analgesics 111279 9.05 209282 8.77 211111 8.65 172922 8.58 173985 8.29 179264 8.34 I
Endocrine system 104944 8.54 217800 9.13 227518 9.32 180639 8.96 206819 9.85 211599 9.84 I
Central nervous system 96229 7.83 180171 7.55 187531 7.69 158898 I 7.89 165689 7.89 173576 8.071
Musculo-skeletalagents 64547 5.25 122532 5.14 131209 5.38 117635 5.84 115464 5.50 121286 5.641
Gastro-intestinal tract 61679 5.02 106318 4.46 111329 4.56 106318 5.28 97578 4.65 108474 5.051
Ear, nose and throat 65774 5.35 121094 5.08 123754 5.07 102873 5.11 105509 5.03 106348 4.951
Dermatologicals I I
Other 221547 18.02 I 416641 17.4611 446811 18.31 365817 18.15 416438 19.84 I 441514 20.541
Total 11229381 100 II 2385440 100 II 2440048 100 I 2014998 100 2098813 100 II 2149888 100 I
* The prevalence percentage of the main pharmacologica group is the prevalence of the pharmacological group divided by the total number of medicine items claimed for the specific
month multiplied by hundred.
ADDendixB
Table 2B continues:
Main1>h~'1J1f1~fJ199lca'gf!:!f!~ ~r .'mN~~em~e~m=-J .. ____
[}'~i~ II ~i~] L.:'~U,':~'--'[' n}'IJr~--'J.m'~J[ %.. JI0L_,~, IlIr~lr m~nn'~~}]
Respiratorysystem II 239086 II 12.0511 205175 II 10.90 263771 10.83 II 267724 I 12.01 323672 II 13.41 331844 14.371
Antimicrobials 215700 10.8711 194461 II 10.33 277743 11.41 II 259302 11.63 28035911 11.61 269041 11.651
Cardiovascular agents 286713 14.4611 286029 II 15.20 338349 13.90 II 291859 13.09 31403811 13.01 305149 13.21 I
Analgesics 164384 8.2911 15363611 8.16 225859 9.2811 209854 9.42 22470911 9.31 I 212195 9.191
Endocrine system 199179 10.04 194604 I 10.34 229328 9.4211 202498 9.09 21708711 8.991 207237 8.971
Central nervous system 156784 7.90 141824 7.54 215991 8.8711 190619 8.55 199150 II 8.25 185082 8.01 I
Musculo-skeletal agents 110177 5.55 104826 5.57 1441012 5.9211 126998 5.70 13586611 5.63 127148 5.50 I
Gastro-intestinal tract 103899 5.24 108437 5.76 149223 6.1311 128081 5.75 13305811 5.51 123708 5.361
Ear, nose and throat 117622 4.8311 110322 4.95 123459 II 5.11 118646 I
Dermatologicals 97905 4.94 100473 5.34 II II 1
Other 409638 20.65 I 392328 20.85 472657 I 19.41 II 441542 19.81 462855 II 19.17 429966 18.61 I
Total 1983465 I 100 I 1881793 100 2434555 I 100 II 2228799 100 2414253 II 100 2310016 100 I
* The prevalence percentage of the main pharmacological group is the prevalence of the pharmacological group divided by the total number of medicine items claimed for the specific
month multiplied by hundred.
ADDendix8
Table 38: Prevalence of individual medicines with special emphasis on the top 10 drugs claimed. May 2001 to April 2002.
IndMdl!al medicines
~,'" .. .i~=~~uJ
AlcophylleX@SYR 10373 0.68 8681 0.71 I 9320 0.74 13091 0.65 II I
Coversyl@TAB 8794 0.51 887511 0.521
DapamaX@2.5mg TAB 7531 0.49 6531 0.53 7004 0.55 10296 0.51 10148 0.59 1036611 0.61
Disprin CV@100mg TAB II
Ecotrin@81mg TAB 9647 0.56 999611 0.59
Eltroxin@0.1mgTAB 13015 0.85 10367 0.84 11323 0.89 18942 0.94 18379 1.07 18543 1.09
FlixonaseAques@SPR 9327 0.61 7398 0.60 7388 0.58 11794 0.59 11049 0.64 10706 0.63
Lipitor@10mg TAB 15718 1.03 12951 1.05 14112 1.11 24407 1.21 24896 1.45 26127 1.53
Myprodol@CAP 23856 1.57 18936 1.54 20574 1.62 30739 1.53 23821 1.38 21440 1.26
Premarin@0.625mg TAB 10427 0.68 8388 0.68 8796 0.69 14680 0.73 14258 0.83 14282 0.841
SolphylleX@SYR 8188 0.54 6992 0.57 7579 0.60 10852 0.54 I
Stilpane@TAB 10206 0.67 7916 0.64 8633 0.68 14147 0.70 10550 0.61 9758 0.571
~~~ I
Zyrtec@ 1Omg TAB I
Other 1415655 I 92.87 1142594 92.84 1171372 I 92.52 1866040 92.61 1590565 92.36 1578075 92.381
Total I 1524296 I 100 II 1230754 100 1266101 I 100 2014988 I 100 1722107 100 1708168 100 I
* The prevalence percentage of the individual medicine is the prevalence of the individual medicine divided by the total number of medicine items claimed for the specific month
multiplied by hundred.
ADDendix 8
Table 38 continues:
L~~ ~c)\leitl~~t~:.=][=:'~~c~~~~r..~=II=:~~~~~ii{=" .'J 1 m.~...:~~~l"litfii::=~]IL~.""....~~~(:lj::1
t~ %*mJt n IL'%~'II n I.~.']
I AlcophylleX@SYR II II II II
Coversyl@TAB 7377 0.53 I II II
DapamaX@2.5mg TAB 8470 0.60 10469 0.66 13001 II 0.56 12260 0.55 13392 0.5711 13728 0.56
DisprinCV@1OOmg TAB II II
Ecotrin@ 81mg TAB 8140 0.58 9492 I 0.59 12908 0.56 I 12528 0.56 13561 0.5711 14213 0.58
Eltroxin@0.1mgTAB 15578 1.11 1877911 1.18 23826 1.031 22570 1.01 24925 1.06 25328 1.03
Flixonase Aques@SPR 8789 0.63 1159311 0.73 14587 0.63 13312 0.59 13786 0.58 14345 0.59
Lipitor<ID10mg TAB 21809 1.55 2592711 1.62 33006 1.43 31752 1.42 34559 1.46 35975 1.47
Myprodol@CAP 16246 1.16 1959211 1.23 33768 1.46 31843 1.42 33706 1.43 34806 1.42
Premarin@0.625mg TAB 11992 0.86 145661 0.91 18469 0.80 17473 0.78 18744 0.79 19243 0.79
SolphylleX@SYR
Stilpane<IDTAB 7757 0.55 9295 0.58 18149 II 0.79 16217 0.72 17496 0.74 18781 0.77
VoiXX@25mgTAB 12407II 0.54 11807 0.53 12366 0.52 13170 0.54
Zyrtec@10mg TAB 8971 0.56 II
Other 1294439 92.43 146809711 91.94 2131758 II 92.21 2068014 92.41 2177738 92.27 2257734 92.25
Total 140045311 100 1596781 II 100 231187911 100 2237776 I 100 236027311 100 2447323 100
* The prevalence percentage of the individualmedicine is the prevalence of the individualmedIcinedividedbythe total number of medicine it ms claimed for the specificmonth
multiplied by hundred.
ADDendix 8
Table 48: Prevalence of individual medicines with special emphasis on the top 10 drugs claimed. May 2002 to April 2003.
[',!:::.J
AlcophylleX@SYR 1203211 0.98 23180 0.9711 21626 0.89 20610 0.85 14435 0.69
Coversyl@TAB II II
DapamaX@ 2.5mg TAB I II 13942 0.57 13916 0.57 13233 0.62
Disprin CV@1OOmgTAB
Ecotrin@81mg TAB 13107 0.55 13941 0.57 14090 0.58 12812 0.61 13076 0.61
Eltroxin@0.1mg TAB I 11345 0.92 23521 0.99 24665 1.01 24959 1.03 22905 1.09 23380 1.09
Flixonase@ Aques SPR
Lipitor@10mg TAB 15988 I 1.30 33749 1.41 I 35550 1.46 36145 1.50 33098 1.58 33801 1.57
Mybulen@TAB 12806 1.04 28032 1.18 32459 1.33 30904 1.27 24105 1.15 19940 0.93
Mypaid@CAP 7028 0.57
Myprodol@CAP 10365 0.84 16009 0.67 16811 0.69 15587 0.64 13692 0.65 19546 0.91
Premarin@0.625mg TAB 8479 0.69 17190 0.72 18050 I 0.74 17949 0.74 16383 0.78 16916 0.79
SolphylleX@SYR 6819 0.55 13639 0.57
Stilpane@TAB 9404 0.76 18086 0.76 19922 0.82 19736 0.81 16725 0.80 17612 0.82
VoiXX@25mg TAB
ZyrteC@10mg TAB 13131 0.63 14702 0.68
Other 1135115 92.33 2198927 92.18 2243082 91.93 2233078 92.00 1931527 92.03 1977682 91.99
Total 1229381II 100 2385440 100 2440048 100 I 2427244 I 100 II 2098813II 100 2149888 100
* The prevalence percentage of the individual medicine is the prevalence of the individua medicine divided by the total number of medicine items claimed for the specific month
multiplied by hundred.
ADDendix8
Table 48 continues:
Individual medicines ~R~c;~I~~r Ilr~:Ci;~~~H~l" .]1
I. 'n.s]ll~~::'IIIII['. .~.'lrj~~ I[rj::~T'~"1 :1' ~1ty
I AlcophylleX@ SYR II II II 13856 0.6211 17348 0.72 18563 0.80
I Coversyl@TAB I II II II
I DapamaX@2.5mg TAB 12957 0.65 12691 0.6711 II 13005 0.56
I Disprin CV@ 1OOmgTAB II II
I Ecotrin@ 81mg TAB 12705 0.64 12577 0.67 15922 0.6511 13826 0.62 14952 0.62 14587 0.63
Eltroxin@ 0.1mg TAB 22429 1.13 22348 1.19 25375 1.0411 21987 0.99 23989 0.99 23336 1.01
Flixonase@Aques SPR 14511 0.60 II
Lipitor@10mg TAB 32131 1.62 32277 1.72 35951 1.4811 30288 1.36 I 32403 1.34 30574 1.32
Mybulen@TAB 15643 I 0.79 13691 0.73 20431 0.841 18320 0.82 18908 0.78 17296 0.75
Mypaid@CAP I
Myprodol@CAP 19902 1.00 20394 1.08 31960 1.31 29623 1.33 32741 1.36 31296 1.35
Premarin@0.625mg TAB 16035 0.81 16132 0.86 17271 0.71 14938 0.67 16004 0.66 15685 0.68
SolphylleX@SYR I
Stilpane@TAB 14354 0.72 12498 0.66 21884 0.90 19597 0.8811 19678 0.82 18597 0.81
VoixX@25mgTAB II
Zyrtec@10mgTAB 13729 0.69 13067 0.69 16061 0.66 13934 0.6311 13650 0.57
Other 1823580 91.94 11726118 91.73 2235189 91.81 2052430 92.0711 2224580 I 92.14 2127077 92.08
Total 19834651 100 I 1881793 100 2434555 II 100 2228799 100 II 241425311 100 2310016 100
* The prevalence percentage of the individual medicine ISthe prevalence of the individual medicine divided by the total number of medicine items claimed for the specific month
multiplied by hundred.
ADDendix8
Table 58: Prevalence of the type (original vs. generic) of medicine items claimed. May 2001 to April 2002
MI
May 1137441 74.62 386855 25.38
June 913491 74.22 317263 25.78
July 935998 73.93 330103 26.07
August 1487472 73.82 527526 26.18
September 1277418 74.18 444691 25.82
October 1264403 74.02 443765 25.98
November 1033791 73.82 366662 26.18
December 1182315 74.04 414466 25.96
January 1684564 72.87 627315 27.13
February 1630700 72.87 607076 27.13
March 1712506 72.56 647767 27.44
April 1770895 72.36 67642811 27.64
* The prevalence percentage of originalproducts is the prevalence of original products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
ADDendix8
Table 68: Prevalence of the type (original vs. generic) of medicine items claimed. May 2002 to April 2003.
Month
I ",. "',,,,,:~,. . ."...~...] [\. %~:=~~. . J[] :: :..::.~=. "-' 1
I May 870266 70.7911 359115 29.21
I June 1679268 70.40 II 706172 29.60
I July 1707375 69.9711 732673 30.03
August 1682257 69.31 I 744987 30.69
September 1450748 69.12 648065 30.88
October 1481572 68.91 668316 31.09
November 1373390 69.24 610075 30.76
December 1306602 69.43 575191 30.57
January 1646785 67.64 787770 32.36
February 1501304 67.36 727495 32.64
March 1632647 67.63 I 781547 32.37
April I 1558530 67.4711 751486 32.53
* The prevalence percentage of original products is the prevalence of original products divided by the total number of medicine items claimed for he specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
ADDendixB
Table 7B: Prevalence of the top ten main pharmacological groups according to type (original vs. generic) of medicine. May 2001 to April
2002.
Endocrine system
1","Ir:PJr .. .'1 r="~~ii~~s!II"$~Pte11Jb~f~~...1
In==JI 201607 II 166129 172046 256581 184127 II 172394
I~~?=]:!II 17.7211 18.19 18.38 17.25 14.41 II 13.63
I~.'II 52191 44004 45836 70285 48480 II 45143
I 13.49 13.87 13.89 13.32 10.90 II 10.17
II~"~~!]I 93068 77115 79510 121792 91920 80231
I 8.18 8.44 8.49 I 8.19 7.20 6.35
I~.~.I]I 85247 70459 73061 113055 88360 78957
L!'~.1111 22.04 I 22.21 22.13 21.43 19.87 17.79
~:=.,~=II 139383 113519 121734 196784 191779 195616
I 12.25 12.43 13.01 13.23 15.01 15.47
I 33748 28555 31008 51399 50437 51874
I 8.72 9.00 9.39 9.74 11.34 11.69
[~L ..11 82410 66623 67839 104311 81821 80263
I.~"=JI 7.25 7.29 7.25 7.01 6.41 6.35
I 49785 41738 43232 68611 52967 54420
[%" II 12.87 13.16 13.10 13.01 11.91 12.26
I 112764 91493 94855 156212 148519 147786
I 9.91 10.02 10.13 10.50 11.63 11.69
[!:='=JI 17513 14679 15398 24427 22432 21658
I~~ II 4.53 4.63 4.66 4.63 5.04 4.88
I 77924 61284 61745 101773 90778 87172
Antimicrobials
Cardiovascular agents
Analgesics
ADDendix B
Musculo-skeletal agents
Gastro-intestinal tract
Ear, nose and throat
Dermatologicals
"Generic
. product
I 6.85 6.71 6.60 II 6.84 7.11 6.89
I 42059 32904 31008 II 57125 49850 48106
I 10.87 10.37 9.391 10.83 11.21 10.84
I 62581 48716 49230 81452 71762 71973
I~j. ..,:~III 5.50 5.33 5.26 5.48 5.62 5.69
II~]I 28424 I 22754 23631 36183 32833 33408
I 7.351 7.17 7.16 6.86 7.38 7.53
I 66825 51844 50275 83849 73343 75096
I 5.88 5.68 5.37 5.64 5.74 5.94
[Jj II 17372 13506 I 13019 22469 32833 22412
I 4.49 4.26 3.94 I 4.26 7.38 5.05
~ n II 73530 58685 5857311 94107 75577 72940
I 6.46 6.42 6.26 6.33 5.92 5.77
Iii;. II 6028 4898 4970 8766 8250 9121
I 1.56 1.54 1.51 1.66 1.86 2.06
I 68046
[~s_L\111 5.38
I 14456
I ~u
* The prevalence percentage of original products is the prevalence of original products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
ADDendix 8
Table 78 continues:
Antimicrobials
Cardiovascular agents
Analgesics
Endocrine system
Central nervous system
I==,~~~~'¥I
I 143355 144220 II 18212 211612 II 226373 248916
r~~ . ~I 13.87 12.20 II 10.81 12.98 II 13.22 14.06
~~~n. ~I 37383 3580611 45331 57071 II 63095 70753
I 10.20 8.64 7.23 9.40 II 9.74 10.46
I 66866 77791 122708 122243 125131 128856
I 6.47 6.58 7.28 7.50 7.31 7.28
I 65966 79048 124550 122266 131132 137102
li~: ]1 17.99 19.07 19.85 20.14 20.24 20.27
~,r2J1 160327 190509 244368 231956 250476 256917
I:"~II 15.51 16.11 14.51 14.22 14.63 14.51
I 43279 51440 68089 64860 69851 72133
I 11.80 12.41 10.85 10.68 10.78 10.66
I 65007 71502 120031 117611 123250 1252061
~*JII 6.29 6.05 7.13 7.21 7.20 7.07
[~'~j11 45050 46374 77196 76286 81151 84948
~ . II 12.29 11.19 12.31 12.57 12.53 12.56
I 121546 146392 191865 183942 197989 201505
I 11.76 12.38 11.39 11.28 11.56 11.38
I 18147 21719 30245 28487 31312 32494
~.. II 4.95 5.24 4.82 4.69 I 4.83 4.80
l? ~.~nll 69099 I 76651 130101 12316511 128285 130145
I 6.6811 6.48 7.72 7.5511 7.49 7.35
I 38140 II 42960 78681 73457 II 77132 79216
ADDendix B
I 10.40 10.37 12.54 12.10 11.91 11.71
['f:~~]1 56587 64409 98035 89817 92399 94727
Lr'* ill 5.47 5.45 5.82 5.51 5.40 5.35
I 26573 30475 46065 42735 44522 47013
I 7.25 7.35 7.34 7.04 6.87 6.95
I 60875 70989 112358 99156 99575 101285
I 5.89 6.00 6.67 6.08 5.81 5.72
~Lfl. II 18651 22567 37573 31877 33100 33601
I 5.09 5.44 5.99 5.25 5.11 4.97
I 105330
[1~j II 5.95
I 13986
p~~j ~I 2.07
nr:~>,]1 57496 70989 111575 96156 98059
t=~/~I 5.56 6.00 6.62 5.90 5.73
ULZ1JI 12347 13685 22067 18393 19367
,~~. II 3.37 3.30 3.52 3.03 I 2.99
* The prevalence percentage of original products is the prevalence of original products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
Musculo-skeletal agents
Gastro-intestinal tract
Ear, nose and throat
Dermatologicals
6enenc
product
ADDendix8
Table 88: Prevalence of the top ten main pharmacological groups according to type (original vs. generic) of medicine. May 2002 to April
2003.
product
J [)~?e ~'.,'::] 1'~'~~/Y I..~~,~~~~~~" III "'~$i~f!:?!f.~!!="~1 J'~~'O~~~~f':=
I?:===!II 173808 333398 308634 30065411 228463 211355
~.., 'JI 19.97 19.85 18.08 17.8711 15.75 14.27
Ii? "JI 48533 91009 84388 I 84837 62684 57329
I 13.51 12.89 11.521 11.39 9.67 8.58
I 66867 139633 I 142378 138447 111243 114533
li~~]1 7.68 8.32 8.34 8.23 7.67 7.73
t? .1:,]1 69437 142297 144064 143371 120744 123558
['%: II 19.34 20.15 19.66 19.24 18.63 18.49
I 111261 234753 245885 248609 224835 229715
I 12.78 13.98 14.40 I 14.78 15.50 15.50
I 33476 70539 7543611 76548 69362 71337
li?)1 56480 99898 100444 II 99462 83252 90238
1%" ~I 6.49 5.95 5.88 II 5.91 5.74 6.09 I
I 54799 109384 110667 II 110745 90733 89026 I
I 15.26 15.49 15.10 I 14.87 14.00 13.31 I
I 89005 183368 190292 192053 173010 176097 I
11%..=',11 10.23 10.92 11.15 11.42 11.93 11.89 I
~.",.~.'.,...I"=II15939 34432 37226 37890 33809 35502 I
II%~-'1 4.44 4.88 5.08 5.09 5.22 5.31 I
I 57386 108182 111800 112005 98298 1029181
I 6.59 6.44 6.55 6.66 6.78 6.95 I
Antimicrobials
Cardiovascular agents Original
product
Analgesics
Endocrine system
Central nervous system
ADDendix B
Musculo-skeletal agents
Gastro-intestinal tract
Ear, nose and throat
Dermatologicals
I 38843 71989 II 75731 7697 67391 70658
1""11 10.82 10.1911 10.34 10.33 10.40 10.57
I 41442 77164 II 82169 77343 66389 68360
I 4.76 4.60 4.81 4.60 4.58 4.61
I 23105 45368 49040 53392 49075 52926
I~" II 6.43 6.42 6.69 7.17 7.57 7.92
I:" .~(II 44656 I 77327 81877 80997 71238 77520
I 5.13 4.60 4.80 4.81 4.91 5.23
I 17023 28991 29452 29976 26340 30954
I 4.74 4.11 4.02 4.02 4.06 4.63
I 58276 106584 107627 105710 89640 89010
I 6.70 6.35 6.30 6.28 6.18 6.01
~.:':JI 7498 14510 16127 16444 15869 17338
"~II 2.09 2.05 2.20 2.21 2.45 2.59
I
I
I
I
* The prevalence percentage of original products is the prevalence of original products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
ADDendix B
Table 8B continues:
Central nervous system
['=~~!!!!~r~~W'1
I 188635 II 163998 209385 20978711 25291411 257973
I 13.7311 16.48 12.71 13.9711 15.4911 16.55
I 50451 I 41177 54386 57937 7075811 73871
I 8.27 7.16 6.90 7.96 9.05 " 9.83
~~. 0:/]11 105147 95641 129404 121729 132743 128183
I 7.66 7.32 7.86 8.11 8.13 8.22
I 110553 98820 148339 137573 147616 140858
I 18.12 17.18 18.83 18.91 18.89 18.74
I 218861 215353 251879 215991 231267 222977
I~~ II 15.94 16.48 15.30 14.39 14.17 14.31
lL'p cdl 67852 70676 86470 75868 82771 82172 I
~,~~ .LII 11.12 12.29 10.98 10.43 10.59 I 10.931
I 87278 84207 120953 111833 119687 I 113375 I
I 6.35 6.44 7.34 7.45 7.33 7.27 I
I'~~ ',~I 12.64 12.07 13.32 13.47 13.44 13.151
In III 166204 163366 188990 165427 177766 169823 I
t~.. .11 12.10 12.50 11.48 11.02 10.89 10.90 I
Iii ' "311 32975 31238 40338 37071 39321 37414 I
I 5.41 5.43 5.12 5.10 5.03 4.98 I
I 93407 84628 124808 107465 112169 102800 I
["*'==JII 6.80 6.48 7.58 7.16 6.87 6.60 I
~.(;enet!~JLIJ eLil1 6337711 57196 9118311 83154 86981 822821
Antimicrobials
Cardiovascular agents
Analgesics
product
Endocrine system Original
product
ADDendix B
* The prevalence percentage of original products is the prevalence. of original products divided by the total number of medicine items claimed for the specific month multiplied by
hundred.
# The prevalence percentage of generic products is the prevalence of generic products dividedby the total number of medicine items claimed for the specific month multipliedby
hundred.
product
}I."-"JI
10.39 9.94 11.57 11.43 11.13 10.95
Musculo-skeletal agents Original
,n '"'=]1
61189 57906 79831 69821 75631 70576
product
L.' . I
4.46 4.43 4.85 4.65 4.63 4.53
Genenc'
1:n'.:]1
48988 46920 64181 57177 60235 56572
product
t". JI
8.03 8.16 8.15 7.86 7.71 7.53
Gastro-intestinal tract
Or@nal
ln" . I
74353 76873 104193 88869 91924 86404
product
L.:", I
5.41 5.88 6.33 5.92 5.63 5.54
Generic,..
[Ii II
29546 31564 45030 39212 41134 37304
product
p."dJI
4.84 5.49 5.72 5.39 5.26 4.96
Ear, nose and throat
nriglnal
r . " JlI
99377 93503 105388 101400
product
I.. .".'.,'."i I
6.03 6.23 6.46 6.51
Generic' n
U
18245 16819 18071 17246
product
%."
II
2.32 2.31 2.31 2.29
Dermatologiesls Original
Ii n " "I
78863 80701
product
I; %."...null
5.74 6.18
Genenc
In"''"'11
19042 19772
product
[: JI
3.12 3.44
ADDendix C
Table 1C: Average cost of all medicine items claimed. May 2001 to April 2002.
L:: J
,
Average cosfper meaicine {tein
M/riim""; cost Maximum cost Total cost
Total number of medicine items claimed
(R) (R) (R) (R)
May
1524296 130.80:t 164.23 0.01 38793.12 199379399.00
June 1230754 131.49:t 166.89 0.01 19248.28 161836026.00
July
1266101 132.20:t 159.13 0.01 12019.01 167376142.00
August
2014998 132.55:t 154.13 0.01 19248.28 267079044.00
September
1722109 139.82:t 161.05 0.01 19248.28 240778497.00
October 1708168
140.10:t 163.14 0.01
10787.14 239312390.00
November 1400453
141.08:t 165.24
0.01 10123.68 197569799.00
December 1596781 146.40:t 167.42 0.01 17736.21 233770458.00
January
2311879 148.12:t 167.29 0.01 21837.88 342444664.00
February
2237776 147.78:t 166.74 0.01 19474.36 330702915.00
March 2360273 149.33:t 167.51 0.01 21837.88 352449547.00
April
2447323 148.88:t 166.82 0.20 21837.88 364365722.00
ADDendix C
Table 2C: Average cost of all medicines items claimed. May 2002 to April 2003.
._..._=.w
Average cOst per medicine Item
Minimum cost. Maxitnumcost Total cost
Month Total number of medicine Items claimed
(R) (R) (R) (R)
May
1229381 135.63:t:160.94 0.01 21837.88 166740336.00
June 2385440 141.69:t:163.88 0.01 11777.79 337998335.00
July
2440048 145.29:t:169.12 0.01 20403.92 354516468.00
August
2427244 144.26:t:168.02 0.01 33084.05 350165125.00
September
2098813 148.88:t:199.49 0.01 83769.48 312465164.00
October 2149888 150.66 :t:235.62 0.01 73304.28 323904056.00
November 1983465 153.62:t:212.90 0.01 73304.28 304691145.00
December
1881793 157.69:t:246.49 0.01 73304.28 296742825.11
January
2434555 154.93:t:203.33 0.01
73304.28 377173643.00
I February
2228799 151.09:t:172.40 0.01 33084.10 336741645.00
I March
2414253 148.29 :t:170.10 0.02 33048.10 358014042.00
I April
2310016 147.35:t: 172.94 0.01 29321.37 340379016.00
ADDendix C
Table 3C: Average medicine cost per prescription. May 2001 to April 2002.
A~COSf::-~=="' I~:~- 7tfiii/iiI~ I TQ7mc6it ]
May II 740708 269.17:1:313.57 0.01 38942.21 199379399.00
June II 595871 271.60:1:318.87 0.01 24531.06 161836026.00
July 616329 271.57:1:306.53 0.01 20660.22 167376142.00
August 998795 267.40:1:293.15 0.01 24531.06 267079044.00
September 872305 276.03 :!:305.28 0.01 24531.06 240778497.00
October 885892 270.14:!: 307.83 0.01 11479.41 239312390.00
November 724293 272.78:!::312.27 0.01 10123.68 197569799.00
December 812710 287.64:1:314.04 0.01 24040.38 233770458.00
January 1187338 288.41 :!:314.10 0.01 24067.38 342444664.00
February 1148370 287.98:1:314.63 0.06 23761.15 330702915.00
March 1217185 289.56:1:315.38 0.09 24552.01 352449547.00
April 1261200 288.90:1:313.93 0.03 24552.01 364365722.00
Month
Total number of prescriptions
ADDendix C
Table 4C: Average medicine cost per prescription. May 2002 to April 2003.
t. M::_J
Average cost per prescription
Minimumcost
Max1;rl[omcost ]
Total number of prescriptions
(R) (R)
I May
650519 256.32 :I:295.20 0.01 24573.80
166740336.00
I June
1211046 279.10 :I:306.00 0.02 14547.35 337998335.00
I July
1257723 281.87:1: 307.57 0.05 20403.92 354516468.00
I August
1260648 277.77:1: 303.40 0.01 33084.05 350165125.00
I September
1107865 282.04 :I:346.96 0.05 96152.96 312465164.00
I October
1146070 282.62 :I:432.17 0.04 129490.32 323904056.00
I November
1058583 287.83:1: 386.98 0.03 129490.32 304691145.00
I December
997993 297.34:1: 454.13 0.06 129490.32 296742825.00
I January
1304379 289.16:1: 373.42 0.02 129490.32 377173643.00
I February
1188840 283.25:1: 310.03 0.03 33084.10
336741645.00
I March
1289640 277.61 :I:303.73 0.02 33084.10 358014042.00
I April
1233177 276.02:1: 305.31 0.05 29321.37 340379016.00
ADDendixC
Table 5C: Average cost of medicine items according to the top ten main pharmacological groups. May 2001 to April 2002.
I
'""=':,':":==" Afay' ":. .,.
----Jt
:-:
. June
. -=:.....:..:._.
'Ir' --: -----.. --:.::=?!!Y
---=-=- -
J
Main pharmacological group
D
Averagecost -
Totalcost
D
Average cost
Totalcost .
D
Average cost
Total cost
(R) (R) (R)
(R) . (R) (R)
Respiratory system
253798 81.82:1: 163.36 20766956.76 210133 81.57:1: 94.70 17141180.67 217882 82.28 :I:95.45 17928010.54
Anti-microbials 178315 168.01 :I:237.72 29959243.03 147574 172.15 :I:245.22
25405428.74 152742 172.39 :I:243.91 26302288.65
Cardia-vascular agents
173131 215.48:1: 115.33 37305732.27 142074 216.32:1: 114.32 30732941.48 152571 216.18:1: 115.66 33020010.34
Analgesics
132195 60.74:1: 62.98 8029584.01 108361 59.25 :I:61.62 6419893.52 111071 59.26:1: 60.18 6581811.72
Endocrine system
130277 142.13:1: 169.14 18516722.43 106172 143.23:1: 174.41 15206552.06 110253 142.36:1: 166.03 15695874.60
Central nervous system
119983 171.48:1: 177.68 20573767.68 94188 173.81 :I: 179.82 16371187.86 95407 176.05:1: 181.09 16796466.86
Muscula-skeletal agents
91005 138.07:1: 121.75 12565897.83 71470 135.97:1: 118.17 9717769.99 72861 136.06:1: 120.97 9913475.99
Gastra-intestinal tract 84197 148.85 :I:170.25 12532541.47 65350 146.52:1: 149.36 9575047.85 63294 149.34:1: 150.69 9452064.30
Ear, nose & throat
79558 101.25:1: 79.12 8055014.87 63583 101.64:1: 79.18 6462663.44 63543 101.18:1: 78.94 6429518.10
Dermatologicals
ADDendix C
Table 5C continues:
Main pharmacological
group
Totalcost
'September
Average cost.
~.JIL n (R) ;I.. _ L (8) II !~~___JII . n(~~.,w---U . (R) ~
I Respiratory system 326866 84.58:t 100.02 27647302.13 232607 96.79:t 112.92 22514258.09 II 217537 99.54:t 116.75 21654049.30
I Anti-microbials 234847 163.73:t219.99 38451622.99 180280 173.00:t246.36 31187833.9011159188 183.02:t268.30 29134445.90
1 Cardio-vascularagents 248183 216.96:t115.77 53845759.62 242216 217.96:t115.36 52792633.2711 247490 218.24:t113.84 54013147.72
I Analgesics 172922 59.55:t 61.28 10296920.09 134788 60.45:t 62.71 8147650.2311 134683 59.84:t 69.89 8058840.95
I Endocrine system 180639 141.69:t 166.78 25595464.49 170951 144.34:t 171.80 24675164.81 II 97508 140.92:t 147.65 13741097.50
1 Central nervous system 158898 175.00:t 181.68 27806485.55 140628 181.51 :t 187.30 25525416.52 135278 183.54:t 185.62 24828270.19
1 Musculo-skeletalagents 117635 139.77:t 123.51 16442215.79 104595 144.58:t 126.64 15122284.50 105381 147.68:t 130.58 15563132.66
I Gastro-intestinaltract 106318 148.32:t 151.70 15769475.90 93667 150.35:1:153.13 14082471.66 97508 140.92:t 147.65 13741097.50
I Ear, nose &throat 102873 101.90:t 77.93 10483261.58 83827 108.53:t 81.45 9097367.57
I Dermatologiesls 82502 146.23 :t 223.16 I 12064355.39
n
ADDendix C
Table 5C continues:
L November _ (' December ]1== January
Main pharmacological group II Average cost Totifcost
D.
.
.
' Averagecost Tota'.cost
[J.
.
..
.
..
.. .
.
Average cost
n n . n .
(R) (R)' (R) (R)'.' I (R) L (R)
I Respiratory system 180738 101.19 :I:118.67 18288320.70 180026 113.34 :I:126.99 20404032.77 227452 116.28 :I:131.10 26448629.22
I Anti-microbials 132832 189.80:1:276.78 25211156.45 156839 193.62:1:275.61 30368420.25 247258 180.24:1:224.14 44565171.94
I Cardio-vascularagents 203606 217.85:1:113.55 44355363.87 241949 219.64:1:112.10 53140613.19 312457 223.53:1:115.12 6984474.12
I Analgesics 110057 58.74:1: 64.83 6464544.46 117876 62.14:1: 68.50 7325338.34 197227 68.82:1: 77.11 13572529.19
I Endocrine system 139693 145.91:1:178.49 20381977.35 168111 144.64:1:172.64 24315382.71 222110 155.03:1:190.48 34434214.15
I Central nervous system 107239 187.03:1:191.04 20056773.71 119611 189.01:1:192.61 22607443.35 208782 184.67:1:198.69 38556625.09
I Musculo-skeletalagents 83160 148.73:1:130.95 12368313.19 94884 152.36:1:129.81 14456389.30 144100 154.38:1:136.12 22245792.80
I Gastro-intestinaltract 79526 140.74:1:148.66 11192540.60 93556 145.05:1:151.81 13570454.05 149931 156.25:1:171.58 23427222.94
I Ear, nose &throat
I Dermatologicals 69843 144.11 :I:121.96 10065401.38 84674 144.04:1:210.04 12196829.18 133642 143.66:1:203.56 19199657.27
ADDendix C
Table 5C continues:
Main pharmacological
I.r:~~ . FOb'!..W: .:::II.~~~~~ ::cM.."'~: ..~].=~._. ..;;;. A~~~=__ ~g
rou
p
.
D
Averagecost Totalcost
D
.
...
Averagecost Totalcost
D
.
.....
1 Average cost Totalcost
n n . I n
i (R) (R):. "i (R) (R) . H' (R) (R)
Respiratory system 268683 104.95:t 122.11 21897592.98 289468 105.80:t 122.32 30625147.09 319669 104.22:t 122.12 33316329.62
Anti-microbials 244509 180.42:t 220.49 44115153.71 256263 182.09:t 223.69 46663758.19 265958 182.66:t 225.23 48579056.38
Cardio-vascular agents 296816 225.90:t 115.88 67051191.40 320327 227.38:t 118.15 72837216.36 329050 228.82:t 117.95 75293961.88
Analgesics 193897 68.94:t 80.46 13367254.90 204401 71.50:t 84.34 14615493.87 210154 70.70:t 82.59 14857499.38
Endocrine system 212429 160.69:t 204.90 34135809.43 229301 159.86:t 193.05 36655758.26 233999 159.36:t 199.86 37289933.11
Central nervous system 196622 188.83:t 201.39 37128142.57 205417 192.08:t 204.06 39457416.49 209361 192.53:t 203.44 40307231.75
Musculo-skeletal agents 132552 157.26:t 138.62 20845264.78 136921 163.70:t 142.23 22414138.50 141740 162.97:t 138.97 23099761.42
Gastro-intestinal tract 131033 163.67:t 162.40 21446409.93 132675 162.64:t 173.12 21578275.61 134886 162.03:t 172.69 21855748.44
Ear, nose & throat 119316 114.89:t 82.23 13707695.32
Dermatologicals 114549 147.76 :t 208.21 16925365.95 117426 151.35 :t 217.42 17771899.68
ADDendix C
Table 6C: Average cost of medicine items according to the top ten main pharmacological groups. May 2002 to April 2003.
Main pharmacological L '__:=~=.>May::.. :=c__c "~ ... Jii~~...:.:.:.~n._=:~~..:,][:.:..~:.= July '. I
group II~
.
..
.
I ~""gO cost To"'! cost !
.
[
.
-~~:
..
] A..fagO cost TotB! cost [
..
--
... .~l AVerageCOSt TotiJ-
(R) (R) .'. i (R) (R). (R) (R)
I Respiratory system 222341 85.30:i: 103.06 18965731.96 424407 90.73:i: 109.26 38507648.35 393022 94.99:i: 113.70 37335045.65
I Anti-microbials 136304 170.43:i:205.51 23230047.45 281930 176.46:i:216.40 49747964.09 286442 185.62:i:224.24 53170653.43
I Cardia-vascular agents 144737 226.43:i: 117.05 32773344.62 305292 227.29:i: 116.26 69389970.22 321321 226.03:i: 115.45 72627238.91
I Analgesics 111279 61.43:i:73.82 6835444.72 209282 61.11 :i:74.99 12788947.90 211111 63.43:i:74.08 13390425.50
I Endocrine system 104944 155.31 :i:197.75 16298831.81 217800 155.60:i: 188.55 33889453.45 227518 158.03:i: 201.45 35954528.40
I Central nervous system 96229 186.37:i: 202.73 17934056.73 180171 194.39:i: 206.92 35023425.78 187531 193.27:i: 203.47 36243749.45
I Musculo-skeletal agents 64547 151.56:i: 138.39 9782570.93 122532 159.15:i: 139.48 19500756.14 131209 158.22:i: 137.93 20760053.78
IGastro-intestinaltract 61679 146.75:i:182.14 9051561.51 106318 158.58:i:170.31 16860086.67 111329 161.81:i:180.85 18014203.96
I Ear, nose & throat 65774 98.65:i: 82.82 6488571.83 121094 102.54:i:77.45 12417551.28 123754 105.60:i:78.04 13068815.18
I Dermatologicals
ADDendix C
Table 6C continues:
Main pharmacological
L...... Aiigusf':< .>_... -] I:-' .- -..
'SepteiiiDer' .... ....<. .
u=:< .'=... . . OctoC".::...=....__jl
" '__,'__'_',-'..0>,'.,...,....",-"..,.w.".",."....." ..... ....,.....c._..._.,.,.....,.,.......,..,.,
group
D
Averagecost
Tota/cost
D
Average cost
Totalcost
D
-Averagecost
Totalcost
(R) (R) (R) (R) (R) (R)
I Respiratory system
326866 95.20 :t 114.36 36697820.93 291147 103.81 :t 123.56 30222561.03 268684 110.40 :t 130.33 29662729.97
I Anti-microbials
23484 7 183.89:t 224.77 51823186.49 231987 195.30 :t 389.54 45306687.92 238091 201.95 :t 531.25 48082496.99
I Cardio-vascularagents
248183 225.06:t 113.98 73179786.76 294197 225.96 :t 113.85 66476956.04 301052 255.85 :t 113.84 67992791.81
I Analgesics
172922 62.17 :t 76.83 13067913.69 173985 63.40:t 74.68 11030084.74 179264 64.45:t 77.24 11553039.66
I Endocrinesystem
180639 155.83 :t 191.63 35832235.31 206819 157.20:t 197.09 32511598.85 211599 156.95:t 231.00 33209921.26
I Central nervous system
158898 193.12:t 203.59 36497469.44 165689 195.11 :t 203.00 32327864.42 173576 193.59:t 200.74 33601764.94
IMusculo-skeletal agents
117635 151.01 :t 133.40 19742826.99 115464 153.00:t 134.61 17666144.06 121286 150.26:t 128.91 18223850.78
I Gastro-intestinaltract
106318 159.13:t 166.83 17659060.54 97578 158.55:t 171.19 15470717.99 108474 150.62 :t 165.68 16338480.06
I Ear,nose& throat
102873 106.25:t 78.13 12978890.88 105509 111.25 :t 88.13 11737672.59 106348 115.21 :t 81.26 12252576.38
I Dermatologicals
ADDendix C
Table 6C continues:
~ "'!ovember ~ 1[==.,=.m'~~15!~~iriber"~."m~=lr~. .=~~.::=~i~u~ry I
Mainphannacologlcail/rOUp1m Avetagecost Tota'cost C
,
n _
"
I Aver.>gecost . Tota' cost r-:-l
,
.
,
n
,
Average cos
~ (R) (R) (R) (R) L-J (R) (R)
I Respiratory system 239086 114.64:1:132.78 27409251.07 205175 125.81:1:142.55 25813797.70 II 263771 119.98:1:143.25 31646816.29 I
I Anti-microbials 215700 209.62:1:432.78 45215644.20 194461 223.46:1:579.54 43454883.0511 277743 203.12:1:391.81 56416137.36
I Cardia-vascularagents 286713 226.83:1:113.30 65035690.59 286029 227.40:1:114.48 65044231.46I 338349 230.61:1:117.96 78025894.42
I Analgesics 164384 66.12:1:82.71 10868732.12 153636 67.89:1:74.22 10430325.55 225859 71.82:1:85.57 16221488.08
I Endocrinesystem 199179 156.45:1:223.61 31161229.65 194604 157.36:1:224.59 30623103.92 229328 163.02:1:213.16 37385136.62
I Central nervous system 156784 198.51 :I:202.47 31122812.29 141824 203.74:1: 206.98 28895416.51 215991 199.39:1: 210.84 43067439.62
I Musculo-skeletalagents 110177 155.91:1:133.17 17178219.28 104826 160.87:1:136.43 16863107.22 1441012 156.78:1:138.34 22578010.02
I Gastro-intestinaltract 103899 153.16:1:184.95 15912892.18 108437 150.06:1:186.29 16271524.20 149223 154.38:1:169.67 23036888.75
I Ear, nose & throat 117622 119.36:1: 83.90 14039749.49
I Dermatologiesls 97905 166.74:1:259.00 16324661.44 100473 162.40:1:220.35 16316859.93
ADDendix C
Table 6C continues:
It Febiiia~~~,.., ..n .,.'U~ ~~,.~...n:.~~_Mar~~ .H ~.:~pr~!::.~:-:m.=]
Main phannacological group I, ... .. ..
n
....~ .
...
.
] AViif.igeciiSf . To..l r~
.
.. Averagecost , Totalcost m Average cost Tota'cost
. .. ~ ~ ~ ~ ~ ~ ~
Respiratory system 267724 111.40:1:135.71 29823224.13 323672 104.42:1:128.47 I 33798105.79 331844 101.91:1:124.33 33817206.55
Anti-microbials 259302 197.54 :I:242.75 51222146.36 280359 196.21 :I:240.54 55009791.53 269041 200.74 :I:247.40 54007171.04
Cardio-vascular agents 291859 229.67:1: 118.05 67030558.61 314038 228.98:1: 117.45 71909142.02 305149 227.21:1: 117.08 69333965.51
Analgesics 209854 67.69:1:83.23 14205947.97 224709 66.03:1:78.79 14836630.96 212195 66.25:1:82.47 14058404.77
Endocrine system 202498 163.89:1:213.50 33187933.33 217087 162.11 :I:200.40 35192720.46 207237 161.25:1:229.73 33416524.59
Central nervous system 190619 195.46:1:206.95 37258483.83 199150 196.83:1:207.06 39198246.68 185082 195.47:1:205.59 36178378.87
Musculo-skeletal agents 126998 154.61:1:137.66 19634966.42 135866 153.35:1:137.66 20835707.74 127148 153.30:1:139.00 19492071.25
Gastro-intestinal tract 128081 153.52:1:167.74 19662690.27 133058 151.49:1:163.71 20156417.17 123708 154.69:1:164.42 19136793.15
Ear, nose & throat 110322 116.30:1:89.55 12830922.71 123459 112.11:1:82.17 13841590.70 118646 110.50:1:83.31 13110292.01
Dermatologicals
ADDendixC
Table 7C: Average cost of medicine items according to type (original vs. generic) of medicine. May 2001 to April 2002.
-I ,~ -~"-Ongif'lal ProductS "., .. . ... .,..- " GenericProducts
Month II n~lve~cOs' T.~) os. ~ ~-' I A::C~'lr T:7~___m
May 1137441 153.16:t 181.26 174211269.00 386855 65.06 :t 62.29 25168130.38
June 913491 154.34:t 184.71 140992512.00 317263 65.70:t 63.02 20843513.83
July 935998 155.62:t 175.42 145663196.00 330103 65.78 :t 62.43 21712945.57
August 1487472 156.02:t 169.34 232079205.00 527526 66.35:t 62.80 34999839.70
September 1277418 164.46:t 176.40 210085736.00 444691 69.02:t 65.53 30692761.34
October 1264403 164.90:t 179.11 208494741.00 443765 69.45:t 65.59 30817648.25
November 1033791 166.28:t 181.58 171899517.00 366662 70.01 :t 67.01 25670281.98
December 1182315 172.23:t 183.46 203630342.00 414466 72.72:t 68.17 30140115.51
January 1684564 176.02:t 183.62 296510901.00 627315 73.22:t 70.02 45933762.55
February 1630700 175.15:t183.00 285622567.00 607076 74.26:t71.44 45080347.45
March 1712506 177.26:t 183.89 303563760.00 647767 75.47:t 72.95 48885787.04
April 1770895 177.07:t 183.28 313571245.00 676428 75.09:t 72.21 50794476.19
ADDendix C
Table 8C: Average cost of medicine items according to type (original vs. generic) of medicine. May 2002 to April 2003.
t.
.. ngJiiar'Proi:Jucts-
. .' . ., -=""
II
Generic Products
. ,......"O". " . .' "' ." . .
Month
I --.
Average cost
Total Cost
. .
L="<Jl =AVC-=-]
, , .""""""",',','","0
Total Cost
n
(R) (R) (R)
".
May
1779338 172.52:t 182.81 306962819.00 744173 71.93 :t 68.83 53526011.18
June 1679268 171.20 :t 182.32 287496279.00 706172 71.52 :t 68.43 50502055.84
July
1707375 176.14:t 188.80 300739196.00 732673 73.40 :t 69.25 53777271.98
August
1682257 175.68 :t 188.24 295530890.00 744987 73.34 :t 68.60 54634234.71
September
1450748 181.86:t 227.74 263826547.00 648065 75.05 :t 69.91 48638617.48
October 1481572 184.53 :t 273.16 273401803.00 668316 75.57 :t 70.69 50502253.04
November 1373390 187.11 :t 243.80 256978009.00 610075 78.21 :t 73.09 47713135.28
December 1306602 191.52 :t 285.16 250245496.00 575191 80.84:t 74.52 46497329.12
January
1646785 190.83:t 232.92 314259541.00 787770 79.86:t 77.64 62914101.75
February
1501304 186.65:t 193.74 280221510.00 727495 77.69:t 74.79 56520134.29
March 1632647 182.46:t 191.17 297895360.00 781547 76.89:t 73.70 60091286.53
April
1558530 181.54:t 195.56 282935087.00 751486 76.44 :t 71.91 57443928.64
ADDendix D
Table 1D: Antibiotic items and prescriptions claimed. May 2001 to April 2002.
* The prevalence percentage of antibiotic items is the prevalence of antibiotic items divided by the total number of items claimed for the specific month multiplied by hundred.
# The prevalence percentage of antibiotic prescriptions is the prevalence of antibiotic prescriptions divided by the total number of prescriptions claimed for the specific month multiplied
by hundred.
=;
lotat nu_meiontlbocTa/e=. ]1 .
.Totatnumberof prescnptlonscontalnlngaritlblocs . ..... .]
.Average number of antibiotics
.
n
. "-- ..1 - ". ..- JL
. .
It:
_::: . 1
per prescription
n
. .
May
144359 9.47
14139411
19.09 1.02 :t 0.15
June 118424 9.62
116092 I
19.48 1.02 :t 0.14
July
123291 9.74 120888 19.61 1.02 :t 0.14
August
192048 9.53 188529 18.88 1.02:t0.14
September
140468 8.16 137600 15.77 1.02 :t 0.15
October 118952 6.96 116482 13.15 1.02 :t 0.15
November 98693 7.04 96613 13.34 1.02 :t 0.15
December 114386 7.16 112065 13.79 1.02:t 0.14
January
182271 7.88 177247 14.93 1.02:t 0.17
February
185223 8.28 180812 15.75 1.02:1:0.16
March 193398 8.19 189073 15.53 1.02:1:0.15
April
200488 8.19 195879 15.53 1.02:1:0.16
ADDendixD
Table 2D: Antibiotic items and prescriptions claimed. May 2002 to April 2003.
[
.
-~ ~,;;;;;;- : - I. ~:riJumber~~;bli>6~c/aJmed ~] I TntAlnumber of ..-~~tIonS containnganfiblOfIcS . Average number of an.blnncs
.. '. .. [- n _ JI:~~~_ .. % , ~_ _'MII . .~_ __" _~ .. .>n~ .. .. ,.~>=__ L ~ % I per prescription
May 226496 18.42 222036 34.13 1.02:1:0.15
June 224103 9.39 220101 18.17 1.02 :I:0.14
July 219692 9.00 215351 17.12 1.02:1:0.14
August 217833 8.97 213540 16.94 1.02:1:0.14
September 170685 8.13 167173 15.09 1.02:1:0.15
October 171104 7.96 167435 14.61 1.02:1:0.15
November 151300 7.63 148152 14.00 1.02:1:0.15
December 131653 7.00 128782 12.90 1.02:1:0.15
January 192686 7.91 187679 14.39 1.03:1:0.16
February 183686 8.24 179173 15.07 1.03:1:0.16
March 200589 8.31 196225 15.22 1.02:1:0.15
April 190667 8.251 18663711 15.13 1 1.02:1:0.15
* The prevalence percentage of antibiotic items is the prevalence of antibiotic items divided by the total number of items claimed for the specific month multiplied by hundred.
# The prevalence percentage of antibiotic prescriptions is the prevalence of antibiotic prescriptions divided by the total number of prescriptions claimed for the specific month multiplied
by hundred.
ADDendixE
Table 1E: Prevalence of the pharmacological groups of antibiotics (e.g. Beta-Iactam agents). May 2001 to April 2002.
P(Jt!t1J!t!f;Q!og(C,
" . ."%*JI!=~!. ".i;~r%~";JI[ ..~~..Jjl:~t\';Jr\I1~=JJl.u~JC In .IIJ %~i!
Beta-Iactams 83260 57.67 69775 58.9211 73429 59.56 115134 1 59.95 82345 58.62 67469 56.72
Erythromycinand other Macrolides 21657 15.00 17468 14.751 17841 14.47 27589 I 14.37 17690 15.59 13958 11.73
Aminoglycosides 41 0.03 26 0.02 32 0.03 28 0.01 21 0.01 27 0.02
Tetracyclines 12440 8.62 9957 8.41 9978 8.09 15249 7.94 12608 8.98 11318 9.51
Chloramphenicols 126 0.09 111 0.09 111 0.09 155 0.08 111 0.08 104 0.09
Sulphonamides 8733 6.05 7397 6.25 7115 5.77 10354 5.39 9342 6.65 9436 7.93
Quinolones 15463 10.71 11634 9.82 12806 10.39 20079 10.46 15375 10.95 14036 11.80
Other 2639 1.83 2056 1.74 1979 1.61 3460 1.80 2976 2.12 2604 2.19
Total 114359 I 100 118424 100 123291 I 100 192048 100 140468 100 11118952 100
* The prevalence percentage of the pharmacological group is the prevalence of he pharmacological group divided by the total number of antibiotic items claimed for the specific month
multiplied by hundred.
ADDendix E
Table 1E continues:
"The prevalence percentage of the pharmacological group is the prevalence of the pharmacological group divided by the total number of antibiotic items claimed for the specific month
multiplied by hundred.
c "".... c , """.,.' '.,-,," ,.. """" co' ,'.,.>,",.. <-__ """"'-'.,"_A ..
I:.ovember "!bei '..:n=- .Ja=:JI=:?:.=][='*fa_ . :JIrirw.
Pharma(:Qloglcal group$.
r.. njl. .%* _ .....I *., . ...... n n, _ .It ......n .JI . *. JI- .. I.,_ n ."wn_U _::,.':!
Beta-Iactams 56241 56.99 64560 56.44 95508 52.40 102745 55.47 107309 55.49 111042 55.39
Erythromycinand other Macrolides
11551 11.70 13163 11.51 21012 11.53 22381 12.08 24904 12.88 25172 12.56
Aminoglycosides
16 0.02 13 0.01 70 0.04 20 0.01 30 0.02 53 0.03
Tetracyclines
9526 9.65 10937 9.56 19027 10.44 17416 9.40 17410 9.00 18789 9.37
Chloramphenicols
86 0.09 128 0.11 219 0.12 150 0.08 158 0.08 208 0.10
Sulphonamides
7947 8.05 9459 8.27 13524
7.42 12331 6.66 12924 6.68 13981 6.97
Quinolones
11102 11.25 13723 12.00 28043 15.39 25608 13.83 26028 13.46 26585 13.26
Other 2224
2.25 2403 2.10 4868 2.67 4572 2.47 4635 2.40 4658 2.32
Total
98693 100 114386
100 I 182271
100 185223 100 193398 100 200488 100
ADDendixE
Table 2E: Prevalence of the pharmacological groups of antibiotics (e.g. Beta-Iactam agents). May 2002 to May 2003.
Pharmacological groups
[~~ I[m~[][;~~iirnZ,JI"~. .j
Beta-Iactams 13334811 58.87 13776411 61.4711129051 58.74 130469 59.89 98197 57.53 96142 56.19
ErythromycinandotherMacrolides 29647 I 13.09 30240 13.49 29127 13.26 27970 12.84 20004 11.72 19840 11.60
Aminoglycosides 31 0.01 36 0.02 24 0.01 32 0.01 28 0.02 22 0.01
Tetracyclines 17657 7.80 15384 6.86 16522 7.52 15952 7.32 13975 8.19 14636 8.55
Chloramphenicols 223 0.10 161 0.07 183 0.08 265 0.12 296 0.17 263 0.15
Sulphonamides 14740 6.51 13748 6.13 14720 6.70 14715 6.76 13684 8.02 15210 8.89
Quinolones 26382 11.65 23024 10.27 25876 11.78 24350 11.18 20740 12.15 21149 12.36
Other 4468 1.97 3746 1 1.67 4189 1.91 4080 1.87 3761 I 2.20 3842 2.25
Total 226496 100 1 22410311 100 219692 100 217833 100 1 1706851 100 171104 100
* The prevalence percentage of the pharmacological group is the prevalence of the pharmacologica group divided by the total number of antibiotic items claimed or the specific month
multiplied by hundred.
ADDendixE
Table 2E continues:
"~ -"'~~~'" .. " ~~(JE=~~'~jl=:~2Dlrn<1]1[,~*J
Beta-Iactams 837541 55.36 71347 54.19 10092311 52.38 101091 55.03 113664 56.67 1077141 55.49
Erythromycin and other Macrolides 16831 1 11.12 14133 10.74 20568 II 10.67 19774 10.77 23390 11.66 21998 11.54
Aminoglycosides 21 I 0.01 11 0.01 27 0.01 31 0.02 37 0.02 21 0.01
Tetracyclines 13344 8.82 11839 8.99 18042 9.36 15233 8.29 16045 8.00 15146 7.94
Chloramphenicols 172 0.11 191 0.15 247 0.13 240 0.13 232 0.12 188 0.10
Sulphonamides 14335 9.47 13515 10.27 16919 8.78 15627 8.51 16800 8.38 16852 8.84
Quinolones 19344 12.79 17499 13.29 31133 16.16 27121 14.76 25937 12.93 24539 12.87
Other 3499 2.31 3118 2.37 4827 2.51 4569 2.49 4484 2.24 4209 1 2.21
Total 151300 100 1131653 100 192686 100 183686 1 100 200589 100 11190667 I 100
* The prevalence percentage of the pharmaco ogical group is the preva ence of the pharmacological group divided by the total number of antibiotic items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 3E: Prevalence of individual antibiotics of the Penicillin pharmacological group claimed. May 2001 to April 2002.
I[~~":J
I Amoxycillin 20430 38.54 16947 38.14 18280 II 38.80 II 27491 37.84 19649 36.97 16119 36.481
I Amoxycillin/Clavulanic 27718 52.29 23876 53.73 25051 II 53.1711 38872 53.51 28630 53.86 23500 53.181
I Amoxycillin/Flucloxacillin 2094 3.95 1523 3.43 166711 3.54 2779 3.83 2279 4.29 2000 4.531
I Ampicillin 636 1.20 448 1.01 392" 0.83 777 1.07 496 0.93 475 1.07
I Ampicillin/Cloxacillin 766 1.44 550 0.12 670 1.42 993 1.37 730 1.37 664 1.50
I Benzathine Penicillin 1 0.002 1 0.00
I Benzylpenicillin 2 0.004 1 0.002
Benzylpenicillin/Procaine penicillin 17 0.03 24 0.05 11 0.02 58 0.21 18 0.03 23 0.05
I Cloxacillin 427 0.81 353 1.20 370 0.79 601 0.83 458 0.86 490 1.11
I Flucloxacillin 233 0.44 199 0.45 161 0.34 156 0.22 200 0.38 203 0.46
I Penicillin VK 684 1.29 511 1.15 517 1.10 813 1.12 693 1.30 704 1.59
I Procaine Penicillin 3 0.006 3 0.01 I 1 0.00 9 0.02
I Total 53011 100 44435 100 I 47119 100 II 72641 100 53154 100 44187 100
* The prevalence percentage of the individual antibiotic is the prevalence of the ndividual antibiotic divided by the total number of penicillin items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 3E continues:
IndlvlduiJ/antlbloties
. . M . ,~.." "'M'. .. M.4'_~." .1 . _--A'~ ",_"" ,t"i,j<J
1 Amoxycillin 13758 37.52 15092 34.8211 21466 33.22 23745 35.51 24619 35.34 26355 36.421
I Amoxycillin/Clavulanic 19205 52.38 23208 53.551/ 35060 54.25 36085 53.96 37483 53.81 38843 53.671
I Amoxycillin/Flucloxacillin 1541 4.20 2353 5.43 3867 5.98 3292 4.92 3513 5.04 3274 4.52
I Ampicillin 335 0.91 402 0.93 591 0.71 550 0.82 600 0.86 662 0.91
1 Ampicillin/Cloxacillin 641 1.75 778 1.80 1412 2.18 1183 1.77 1330 1.91 1321 1.83
1 Benzathine Penicillin 8 0.01 10 0.01
I Benzylpenicillin 9 0.02 6 0.01 3 0.01
Benzylpenicillin/Procaine penicillin 18 0.05 22 0.05 37 0.06 17 0.03 6 0.01 41 0.06
1 Cloxacillin 370 1.01 603 1.39 949 1.47 799 1.19 840 1.21 725 1.00
1 Flucloxacillin 186 0.51 256 0.59 421 0.65 415 0.62 505 0.72 470 0.65
1 Penicillin VK 595 1.62 619 1.43 803 1.24 775 1.16 748 1.07 678 0.94
1 Procaine Penicillin 9 I 0.02 1 I 0.002 6 0.01 7 0.01 6 0.01
1 Total 366671 100 43340 1 100 6462311 100 66868 100 69660 I 100 723691 100
* The prevalence percentage of the individual antibiotic is the prevalence of the individual antibiotic divided by the total number of penicillin items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 4E: Prevalence of individual antibiotics of the Penicillin pharmacological group claimed. May 2002 to May 2003.
_I ~~II".~-~ ][Cjj~"J"JI[;~jl %~ 'I =~~-2w.1[~.':j~* 'JIE...tj'JI: ~.~~w"
I Amoxycillin 32620 38.35 33195 38.92 30831 37.2911 32246 38.39 25047 38.05 24098 37.10
I Amoxycillin/Clavulanic 45745 53.78 46026 53.96 45288 54.7811 45513 54.19 35517 53.96 35198 54.19
I Amoxycillin/Flucloxacillin 3158 0.37 2779 3.26 3039 3.6811 2950 3.51 2487 3.78 2715 4.18
I Ampicillin 556 0.65 583 0.68 598 0.721 536 0.64 437 0.66 391 0.60
I Ampicillin/Cloxacillin 1147 1.35 1111 1.30 1130 1.37 912 1.08 869 1.32 855 1.32
I BenzathinePenicillin 1 0.00 1 0.00 3 0.00 1 0.00 7 0.01
I Benzylpenicillin 7 0.01 I 1 0.00 5 0.01 1 0.00 2 0.00
Benzylpenicillin/Procaine penicillin 18 0.02 33 0.04 33 0.04 22 0.03 7 0.01 10 0.02
I Cloxacillin 696 0.82 580 0.68 653 0.79 662 0.79 552 0.84 683 1.05
I Flucloxacillin 369 0.43 327 0.38 345 0.42 395 0.47 262 0.40 271 .042
I Penicillin VK 752 0.88 654 0.77 744 0.90 744 0.89 642 0.98 721 1.11
I Piperacillin 1 0.00 3 0.00
I Procaine Penicillin 6 0.01 4 I 0.00 6 0.01 4 0.00 3 0.00
I Total I 85068 100 85300 II 100 82669 100 II 83992 100 65825 100 64954 100
* The prevalence percentage of the individua antibiotic is he prevalence of the individua antibiotic divided by the total number of penicillin items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 4E continues:
Ih=>~~~Jf~~>tJ
Iw~~JI"~~,:::~~J"=It_,,-!,'::1 ". ]C~W'n, "::. n~n:JUrJI[ ~*UQwl
1 Amoxycillin II 21427 37.9611 17344 35.22 24792 35.08 24657 35.83 27465 36.00 26582 36.941
I Amoxycillin/Clavulanic 29819 52.8311 26887 54.60 38295 54.19 37145 53.97 41950 54.99 39213 54.491
IAmoxycillin/Flucloxacillin 2528 4.48 II 2414 4.90 3576 5.06 3369 4.90 3229 4.23 2878 4.00 I
IAmpicillin 345 0.61 I 355 0.72 489 0.69 486 0.71 537 0.70 416 0.581
1 Ampicillin/Cloxacillin 867 1.54 779 1.58 1349 1.91 1141 1.66 1169 1.53 1022 1.421
1 Benzathine Penicillin 1 0.00 6 0.01 I 5 I 0.01 3 0.00 2 0.00 6 0.01 1
1 Benzylpenicillin 6 I 0.01 I I
Benzylpenicillin/Procaine penicillin 13 0.02 43 0.09 30 0.04 31 0.05 13 0.02 13 0.021
I Cloxacillin 598 1.06 563 1.14 983 1.39 914 1.33 778 1.02 764 1.06 I
IFlucloxacillin 286 0.51 286 0.58 448 0.63 399 0.58 415 0.54 343 0.481
IPenicillin VK 554 0.98 551 1.12 694 0.98 679 0.99 732 0.96 719 1.00 1
I Piperacillin I
1 ProcainePenicillin 3 1 0.01 I 5 0.01 3 0.00 3 0.00 1
1 Total 56441 1 100 49245 1 100 70672 II 100 68824 100 76293 1 100 71959 100 I
* The prevalence percentage of the individual antibiotic is the prevalence of the individual antibiotic divided by the total number of penicillin items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 5E: Prevalence of individual antibiotics of the Cephalosporin pharmacological group claimed. May 2001 to April 2002.
Individual antibiotics
.r'_.~~J
Cefaclor 2248 8.03 1659 7.04 1838 II 7.49 2654 6.71 1803 6.58 1455 6.691
Cefadroxil 609 2.17 424 1.80 432 II 1.76 634 1.60 441 1.61 396 1.821
Cefazolin 2 0.007 II 9 0.02 3 0.01 I
Cefepime II 3 0.01 I
Cefixime 541 1.93 431 1.83 544 II 2.22 778 1.97 490 1.79 373 1.721
Cefotaxime I 311 0.01 3 0.01 I
Cefpodoxime 8962 I 32.00 7844 33.31 7843 39.98 12514 31.66 8755 31.97 7026 32.321
Cefprozil 1649 5.89 1447 6.14 1382 5.63 2667 6.75 1834 0.49 1247 5.74 I
Ceftibuten I 605 2.16 498 I 2.11 487 1.99 797 2.02 545 1.99 452 2.08 I
Ceftriaxone 49 0.17 43 0.18 74 0.30 59 0.15 101 0.37 69 0.32 I
Cefuroxime 12059 43.06 10212 43.36 10893 44.41 17619 44.57 11993 43.79 9681 44.541
Cephalexin 1069 3.82 835 3.55 889 3.62 1646 4.16 1290 4.71 918 4.221
Cephalothin 3 0.00 I
Cephradine 215 0.77 152 0.65 142 0.58 158 0.40 132 0.48 I
Total 28008 100 23551 100 24527 I 100 39532 100 27387 100 I 21737 100 I
* The prevalence percentage of the individua antibiotic is he prevalence of the individual antibiotic divided by the total number of cephalosporin items claimed for the specific month
multiplied by hundred.
ADDendixE
Table 5E continues:
Individual antibiotics
~.
Cefaclor 1268 1566 7.8711 2159 7.4311 2518 7.49 2384 6.7511 2511 6.941
Cefadroxil 299 438 2.20 628 2.16 II 675 2.01 759 2.1511 739 2.04 I
Cefazolin 2 0.01 3 0.01 II 5 0.01 I
Cefepime II 3 0.01 I
Cefixime 287 1.56 321 1.61 586 I 2.0211 554 1.65 529 1.50 598 1.651
Cefotaxime 3 0.02 3 0.02 II 2 0.01 4 0.01 3 0.01 I
Cefpodoxime 6268 34.00 6352 31.94 870311 29.93 11332 33.73 I 11903 33.69 11945 33.021
Cefprozil 1056 5.73 694 3.49 I 1658 II 5.70 2246 6.6811 2107 5.96 2278 6.30 I
Ceftibuten 349 1.89 407 2.051 684 II 2.35 631 1.881/ 618 1.75 328 0.91
Ceftrazidime 6 0.02 4 0.01
Ceftriaxone 68 0.37 67 0.30 96 0.33 132 0.39 143 0.40 127 0.35
Cefuroxime 7936 43.05 8773 44.11 12998 44.70 13964 41.56 15522 43.93 16082 44.46
Cephalexin 795 4.31 858 4.31 1296 4.46 1262 3.76 1150 3.25 1322 3.65
Cephalothin
Cephradine I 106 0.57 137 I 0.69 261 II 0.90 276 0.82 204 0.58 242 0.67
Total I 18435 100 19888 I 100 29076 II 100 33601 I 100 35332 100 36175 100
* The prevalence percentage of the individual antibiotic ISthe prevalence of the individual antibiotic divided by the total number of cephalosporin items claimed or the specific month
multiplied by hundred.
ADDendixE
Table 6E: Prevalence of individual antibiotics of the Cephalosporin pharmacological group claimed. May 2002 to April 2003.
Ii ":~~ I
I! %* "1["~;j1~~~tO"...I!'~'~m2LIj871C~2:'l. h" .I[:=~~~'I n"II'/~11i~~=11 n 'I!~ .~.~ J
Cefaclor 297911 6.58 2889 5.88 2444 II 5.60 2412 5.51 1928 6.30 1790 6.061
Cefadroxil 594 1.31 478 0.97 481 II 1.10 543 1.24 345 1.13 303 1.03 I
Cefazolin 6 0.01 1 0.00 II 2 0.01 I
Cefepime II I
Cefixime 682 1.51 742 1.51 56811 1.30 513 1.17 462 1.51 453 1.53
Cefotaxime 2 0.00 5 0.01 I I
CefoxitinSodium II
Cefpodoxime 15732 34.75 18444 37.5311 15939 36.49 16041 36.66 11298 36.90 10569 35.79
Cefprozil 2935 6.48 3009 6.1211 2761 6.32 2876 6.57 1958 6.39 2266 7.67
Cefradine 9 0.02 I 4 0.01 I 1 0.00 2 0.01
Ceftibuten 310 0.68 214 0.44 265 I 0.61 268 0.61 194 0.63 219 0.74
Ceftrazidime
Ceftriaxone 123 0.27 108 0.22 125 0.29 135 0.31 94 0.31 96 0.33
Cefuroxime 20498 45.28 21850 44.47 19815 45.36 19813 45.28 13398 43.76 12944 43.83
Cephalexin 1208 2.67 1247 2.54 1101 2.52 953 2.18 870 2.84 791 2.68
Cephalothin
Cephradine 192 0.42 148 0.30 182 I 0.42 96 0.22 68 0.22 100 0.34
Total 45270 100 49139 100 I 43681 I 100 43755 100 30619 100 I 29531 100
* The prevalence percentage of the individua antibiotic is he prevalence of the individual antibiotic divided by the total number of cephalosporin items claimed for the specific month
multiplied by hundred.
- ---
- - - - - -- --
ADDendixE
Table 7E: Prevalence of individual antibiotics of the other Beta-Iactam pharmacological group claimed. May 2001 to April 2002.
Individual antibIotics
Table 7E continues:
I N~v,tillfiii;""~J[=""'=p~cet1Jb~r ,. II . .' J~~~!!..)=I]li==~~~~!1=~][ Mai;cft=: ~
fL=n~lr==.!~:':n:'il1.JI %* Il.)~' .0' '~~MJIE.)~...,n '~l...,','I ~::=][J~~.'JI;'~:.I]
I Loracarbef I~I 100 II 1330 9908511 180811 99.9411 2276 100 231711 100 2492 990761
I MeropenemlTrihydrate IDI II II II II II 6 00241
Ilmipenem/Ciiastatin IDI II 2 001511 1 II 000611 II I
I Total 111139 II 100 II 1332 100 II 1809 II 100 II 2276 100 2317 II 100 2498 100 I
* The prevalence percentage of the individual antibiotic is the prevalence of the individual antibiotic divided by the total num er of other beta-Iactam items claimed for the specific
month multiplied by hundred.
ADDendixE
Table 8E: Prevalence of individual antibiotics of the other Beta-Iactam pharmacological group claimed. May 2002 to April 2003.
Ir~=~-=1['=/f,}}JIL.%:,,]1., . a,T/?~':~L,.~~w>rall}n:lr=~:>}2j
Iloracarbef II 3010 II 100 II 3325 II 100 I~I 100 II 2722 II 100 II 1753 II 100 II 1657 II 100 I
I MeropenemlTrihydrate II II 101 101 II II II II II II I
IlmiPenem/Cilastatin II II 101 101 II II II II II II I
I Total II 3010 II 100 I~I 100 I~I 100 II 2722 II 100 II 1753 II 100 II 1657 II 100 I
* The prevalence percentage of the individual antibiotic is the prevalence of the individual antibiotic divided by the total number of other beta-Iactam items claimed for the specific
month multiplied by hundred.
Table 8E continues:
.. ..r '..}=~~',:!,,!!,!:.j IILw 3~~u~~>! 11"-:~~,!i~.II[=ww'f~~h '=}]I ~pffr?>.wJ
[=}.~}=II=}~~.}}Jlr[2;n. If;%* . i11.!.}~}I[."~f'lt~.,.~..I[a'~:"=]IEC~!!=II:>~'!~
Iloracarbef II 1622 100 1216 II 100 II 1526 II 99.80 1690 99.761~1 99.951~1 99.941
I MeropenemlTrihydrate II II II 3 II 0.20 IDI 0.051DI 0.06 I
Ilmipenem/Ciiastatin II II" II 4 0.24101 101 I
I Total II 1622 100 1216 II 100 II 152911 100 16941 100 I~I 100 I~I 100 I
* The prevalence percentage of the individual antibiotic is he prevalence of the individual antibiotic divided by the total number of other beta-Iactam items claimed for the specific
month multiplied by hundred.
ADDendixE
Table 9E: Prevalence of the top 10 individual antibiotic products claimed. May 2001 to April 2002.
I M~iI=~=1
f/<,~~1:jllb;>I][:[:J~~=]lro"2~,JI,~:dl['iji~:] l.. .~:<"II,., n >']
Augmaxil@375mgTAB 7370 5.11 6322 5.3411 6585 II 5.34 9805 5.11 6738 4.80 5950 5.00 I
Augmentin@1000BDTAB 3495 2.42 3143 2.65 3728 II 3.02 5804 3.02 4391 3.13 3465 2.91 I
Ciprobay@250mg TAB 3605 2.50 2524 2.13 2729 II 2.21 4311 2.24 3647 2.60 3412 2.871
Ciprobay@500mg TAB
Orelox4!1100mg TAB 3669 2.54 3256 2.75 3716 3.01 5792 3.02 3553 2.53
Orelox4!1Junior SUS 5293 3.67 4588 3.87 4127 3.35 I 6722 3.50 5202 3.70 4121 3.46
PurbaC@480mgTAB 3137 2.17 3907 2.03 3326 2.80
PurbaC@ DS TAB 2879 2.43 2780 2.25 3709 2.64 3865 3.25
Zinnat@ 125mg/5ml SUS 4267 2.96 3672 3.10 3257 I 2.64 5712 2.97 4479 3.19 3745 3.15
Zinnat@250mg TAB 6017 4.17 4977 4.20 5682 II 4.61 8967 4.67 5587 3.98 4304 3.62
Zithromax4!1500mgTAB 4527 3.14 3784 3.20 431611 3.50 6925 3.61 4072 2.90 3217 2.70
Other 102979 71.34 83279 70.32 I 86371 II 70.05 134103 69.83 99090 70.54 83547 70.45
Total 144359 100 118424 100 II 123291 II 100 I 192048 100 140468 I 100 118952 100
* The prevalence percentage of the individual antibiotic products is the prevalence of the individual antibiotic products divided by the tota number of antibiotics items claimed or the
specific month multiplied by hundred.
ADDendixE
Table 9E continues:
Individual antibiotic products
Augmaxil@ 375mg TAB
l~,,.,,~\'~~~~r . . J
. ~"JI:.. .~~'11 ~0Slll_,~~'II" n U~*}II:'J}: IJ'U ~.~"'.j
4953 5.02 6035 5.2811 9147 5.02 8732 4.71 8548 II 4.42 9134 4.561
2732 2.77 3210 2.81 II 5540 3.04 5203 2.81 536511 2.77 5502 2.741
2915 2.95 3200 2.80 II 5751 3.16 II I
I II 5014 2.75 II 1
3991 4.04 3728 3.26 4520 2.48 6554 3.54 7261 3.75 7155 3.571
2573 2.61 3135 2.74 5084 2.79 4356 2.35 4534 2.34 4982 2.481
3370 3.41 3961 3.46 5300 2.91 5006 2.70 5237 2.71 5699 2.84/
3328 3.37 3422 2.99 4777 2.58 5839 3.02 5937 2.96 1
Zinnat@250mg TAB 3483 3.53 3923 3.43 6516 3.57 6570 3.55 7327 3.79 9024 4.50 I
ZithromaX@500mg TAB 2617 2.65 2826 2.47 4931 2.71 5428 2.93 5494 2.84 5562 2.771
Other 68731 I 69.64 I 80946 70.77 130468 71.58 1133819 72.25 139151 71.95 142703 71.181
Total 98693 I 100 I 114386 100 182271 I 100 1185223 100 11193398 II 100 200488 100 I
* The prevalence percentage of the individual antibiotic products is the prevalence of the Individual antibiotic products divided by the otal number of antibiotics items claimed for the
specific month multiplied by hundred.
Ciprobay@ 250mg TAB
Augmentin@ 1OOOBD TAB
Ciprobay@ 500mg TAB
OreloX@ 1OOmg TAB
OreloX@ Junior SUS
PurbaC@ 480mg TAB
PurbaC@ OS TAB
Zinnat@ 125mg/5ml SUS
ADDendixE
Table 10E: Prevalence of the top 10 individual antibiotic products claimed. May 2002 to May 2003.
I -=~?iifr~=~:=J
I$*']IL .n::.~
I AugmaxiI@375mg TAB 10580 4.67 10059 4.49 10297 4.69 8724 4.00 6086 3.57 4856 2.84/
I Augmentin@1000BD TAB 5971 2.64 5458 2.44 6416 2.92 6166 2.83 4830 2.83 5082 2.97
I ClavumoX@375mg TAB
I OreloX@100mg TAB 6762 2.99 8016 3.58 7922 3.61 7486 3.44 4643 2.72 4210 2.46
I OreloX@JuniorSUS 8970 3.96 10428 4.65 I 8017 3.65 8555 3.93 6655 3.90 6359 3.72
I PurbaC@480mgTAB 4890 2.16 4356 1.941 4806 2.19 I 4787 2.20 4254 2.49 4815 2.81
I PurbaC@DS TAB 6118 2.70 5935 2.65 6661 3.03 6695 3.07 6550 3.84 7204 4.21
I RanclaV@ 375mg TAB
I Utin@400mg TAB
IZinnat@125mg/5ml SUS 7717 3.41 8947 3.99 6567 2.99 7430 3.41 5239 3.07 5282 3.09
IZinnat@250mgTAB 11885 5.25 12197 5.44 12694 5.78 11863 5.45 7774 4.55 7302 4.27
I ZithromaX@500mgTAB 6838 3.02 6517 2.91 6890 3.14 6341 2.91 4389 2.57 4279 2.50
lather 156765 69.21 152190 67.71 149422 68.01 149786 68.76 120265 70.46 121715 71.14
I Total II 226496 I 100 I 224103 100 219692 I 100 1217833 100 170685 I 100 17110411 100
* The prevalence percentage of the individual antibiotic products is the prevalence of the ndividual antibiotic products divided by the total number of antibiotics items claimed for the
specific month multiplied by hundred.
ADDendix E
Table 10E continues:
[~~~LJr'j~/:'l [=~::'I ,~nllw~-..J [jjpJ
2999 1.9811 10
4007 2.65 3645 2.77 5840 3.03 5168 2.81 5862 2.92 5784 II 3.031
4047 2.02 4015I~
3484 2.30 2805 2.13 I 4326 2.25 4281 2.33 4941 2.46 4621 II 2.421
5545 3.66 4267 3.241 5316 2.76 6477 3.53 7718 3.85 739911 3.881
4275 2.83 3912 2.97 5342 2.77 4750 2.59 4975 2.48 502211 2.63/
7045 4.66 6752 5.13 7928 4.11 7478 4.07 8319 4.15 8461 II 4.441
2832 2.15 3732 2.03 10
4204 ~18 10
Zinnat@125mg/5ml SUS 4792 3.17 4076 3.10 4375 2.27 5293 2.88 6995 3.49 621911 3.261
Zinnat@250mg TAB 6083 4.02 4612 3.50 7665 3.98 7410 4.03 7603 3.79 762511 4.00 I
ZithromaX@500mgTAB 3628 2.40 2704 2.05 4561 2.37 4294 2.34 4652 2.32 447211 2.351
Other 109442 72.33 96048 72.96 143129 74.28 134803 73.39 145477 I 72.52 10
Total 1151300 100 131653 100 11192686 100 183686 100 200589 I 100 190667I~
* The prevalence percentage of the individual antibiotic products is the prevalence of the individual antibiotic products divided by the total number of antibiotics items claimed for the
specific month multiplied by hundred.
(ndlvidual an6biotlc products
Augmaxil@ 375mg TAB
Augmentin@ 1000BO TAB
ClavumoX@ 375mg TAB
OreloX@ 1OOmg TAB
OreloX@Junior SUS
Purbac@ 480mg TAB
Purbac@ OS TAB
Ranclav<ID 375mg TAB
Utin@ 400mg TAB
ADDendixE
Table 11E: Prevalence of the type (original vs. generic) of antibiotic items claimed. May 2001 to April 2002
'0
----
I May 69968 48.47 74391 51.53
I June 56707 47.88 61717 52.12
I July 59664 48.39 63627 51.61
I August 93676 48.78 98372 51.22
I September 65159 46.39 75309 53.61
I October 53001 44.56 65951 55.44
I November 43083 43.65 44510 56.35
I December 48082 42.03 66304 57.97
I January 79767 43.76 102504 56.24
I February 81989 44.27 103234 55.73
I March 82088 42.45 111310 57.55
I April 84149 41.97 116339 58.03
* The prevalence percentage of original antibiotic products is the prevalence of original antibiotic products divided by the total number of antibiotic items claimed for the specific month
multiplied by hundred.
# The prevalence percentage of generic antibiotic products is the prevalence of generic antibiotic products divided by the total number of antibiotic itmes claimed for the specific month
multiplied by hundred.
ADDendixE
Table 12E: Prevalence of the type (original vs. generic) of antibiotic items claimed. May 2002 to May 2003
Month
May 97948 43.2411 128548 56.76
June 99438 44.3711 124665 55.63
July 95785 43.60 II 123907 56.40
August 92926 42.661 124907 57.34
September 67123 39.33 103562 60.67
October 66387 38.80 104717 61.20
November 58048 38.37 93252 61.63
December 49594 37.67 82059 62.33
January 71245 36.97 121441 63.03
February 68945 37.53 114741 62.47
March 75949 37.86 124640 62.14
April 71234 37.36 119433 62.64
* The prevalence percentage of original antibiotic products is the prevalence of original antibiotic products divided by the total number of antibiotic items claimed for the specific month
multiplied by hundred.
# The prevalence percentage of generic antibiotic products is the prevalence of generic antibiotic products divided by the total number of antibiotic itmes claimed for the specific month
multiplied by hundred.
ADDendixF
Table 2F: Average cost of antibiotics claimed. May 2001 to April 2002.
[ on=
Average cost ofantibioUcs
Minimum cost Milxiiniiin cost TotiJlcost-
Total number antibiotics claimed
(R) (R) (R) (R)
May
144359 124.99:1:104.48
0.11 4006.26 18042841.63
June 118424 125.43:1:91.16 0.05 11009.46
14854005.52
July
123291 127.35:1:96.02 0.05 12019.01 15700616.71
August
192048 127.81 :I:87.99 0.01 5096.24 24544710.27
September
140468 124.93 :I:89.88 0.01 5205.53
17548854.53
October 118952 123.34 :I:85.44 0.13 1590.14 14671591.54
November 98693 122.90:1:86.54 0.11 3368.36 12129679.16
December 114386 124.90:1:89.77 0.01 3764.70 14287367.11
January
182271 133.08 :I:100.07 0.13 2917.51 24257287.38
February
185223 133.27 :I:99.20 0.01 3448.25 24685543.46
March 193398 131.25:1:99.54 0.11 11619.21 25384003.23
April
200488 130.71 :I:96.72 0.07 2805.92 26206330.81
ADDendix F
Table 2F: Average cost of antibiotics claimed. May 2002 to April 2003.
To.tal number antiblotil
May 226496 128.59:1:95.66 0.08 6617.72 29125923.31 1
June 224103 129.76:1:95.78 0.11 5251.18 29079578.331
July 219692 133.17:1:94.25 0.09 1959.43 29255558.69 I
August 217833 129.85:1: 92.58 0.05 2906.66 28285997.44 1
September 170685 127.14:1:94.36 0.07 3270.44 21700694.271
October 171104 124.87:1:104.48 0.07 28011.15 21366002.321
November 151300 124.99:1:93.52 0.11 7239.68 18910742.441
December 131653 127.77:1:93.71 0.07 3186.79 16821078.49 1
January 192686 131.99:1:100.58 0.12 6324.69 25432609.591
February 183686 130.08:1:99.01 0.10 3717.19 23894412.271
March 200589 128.38:1:95.92 0.04 3186.75 25752556.351
April 190667 127.82:1:96.52 0.15 3763.68 24371294.65 I
ADDendixF
Table 3F: Average antibiotic cost per prescription. May 2001 to April 2002.
r-;.]
Total (wmber of antibiQt/,:;prescrlption}s
Average cost per prescription '"Minimum cost
Maximum cost Total cost
(R) (R) (R) (R)
" ""
May
141394 127.61 :i:92.21 0.11 4363.22 18042841.63
June 116092 127.95:i:93.95 0.05 11009.46 14854005.52
July
120888 129.88:i: 107.08 0.05 20660.22 15700616.71
August
188529 130.19:i: 90.63 0.01 5096.24
24544710.27
September
117341 217.53 :i:254.19 0.01 5398.33 25525416.52
October 116482 125.96 :i:87.94 0.13 1653.36 14671591.54
November 96613 125.55:1:89.35 0.11 3368.36 12129679.16
December 112065 127.49 :i:92.44 0.01 3764.70 14287367.11
January
177247 136.86:i: 103.60 0.13 2917.51 24257287.38
February
180812 136.53:i: 102.24 0.01 3448.25 24685543.46
March 189073 134.26:i: 102.55 0.11 11619.21 25384003.23
April
ADDendixF
Table 4F: Average antibiotic cost per prescription. May 2002 to April 2003.
Total number of antibiotic prescriptions
I May
I June
I July
I August
I September
I October
I November
I December
I January
I February
I March
I April
222036
220101
215351
213540
167173
167435
148152
128782
187679
179173
196225
186637
verage coSlper p,
(~)
_~"'W.,,~~_ , W'."~" ~ I ~ I Ie",.,,, .. j 1". , _x_'
131.18:1: 98.20 II 0.0911 6617.72 29125923.31 I
132.12:1: 98.3211 0.11 I 5251.18 29079578.33/
135.85 :I:96.62 II 0.09 2240.56 29255558.69
132.46:1: 95.0311 0.05 2906.66 28285997.44
129.81:1: 96.88 I 0.07 3270.44 21700694.27
127.61 :t:128.97 0.07 29719.28 21366002.32
127.64:1: 96.19 0.11 7239.68 18910742.44
130.62:1: 96.19 0.07 3325.93 16821078.49
135.51:1: 103.92 0.12 3947.82 25432609.59
133.36:1: 101.95 0.10 3717.19 23894412.27
131.24:1: 98.40 0.04 3186.75 25752556.35
130.58 :I:99.48 0.15 3763.68 24371294.65
ADDendixF
Table 5F: Average cost of antibiotics according to the pharmacological groups. May 2001 to April 2002.
Pharmacological group
(R)
. ~_'___'_~W< ="""",,,,,=,~,,>,,,,,"41 . ,;-'>11t;; n y ~ , '-"1~.~~ -. ::illI'i\ II _~=--=, I Ii <"
1 Beta-Iactams 83260 111.05t67.02 9246043.17 69775 112.63t66.89/ 7858863.74 73429 113.54t81.15 8337017.491
1 Erythromycin and othermacrolides 21657 155.81 t85.10 3374302.18 17468 157.22 t 85.72 2746365.12 17841 159.84t83.01 2840006.80 I
I Aminoglycosides 41 535.95t411.15 21974.05 26 204.43t193.68 5315.08 32 531.35t599.70 17003.291
I Tetracyclines 12440 125.20t 82.80 1557529.46 9957 126.48 t 86.55 1259333.73 9978 127.06 t 82.85 1267783.28 I
1 Chloramphenicols 126 26.14t16.93 3924.02 111 32.22t25.18 3575.89 111 27.49t21.30 3051.831
1 Sulphonamides and combinations 8733 43.67t 37.04 381403.99 7397 46.40 t 37.18 343240.31 7115 48.35 t 109.11 343979.28 I
1 Quinolones 15463 202.57t 135.54 3132384.33 11634 204.09t 124.02 2386032.57 12806 206.68t 119.86 2646800.981
1 Other 2639 123.50 t 97.26 325910.43 2056 122.22 t 250.19 251279.08 1979 123.79 t 96.43 244973.76 I
ADDendix F
Table 5F continues:
Pharmacological group
.. .~.L R) a (~J<w..~n._ II. (8) .JL.~~~
I Beta-Iactams 115134 114.37%68.22 13168339.21 82345 113.08%70.90 9311278.38 67469 111.96:i:67.10 7553799.69
I Erythromycin and other macrolides 27589 158.93 %84.23 4384814.21 17690 157.48 %107.90 2785887.15 13958 153.36:i: 90.24 2140611.53
I Aminoglycosides 28 264.60 %231.25 7408.73 21 303.43 %328.68 6371.99 27 248.74:i: 279.16 6715.93
I Tetracyclines 15249 127.07 %83.38 1937742.37 12608 130.42 %83.44 1644294.73 11318 132.69:!: 82.81 1501830.91
I Chloramphenicols 155 24.47 %21.70 3793.42 111 28.76 %24.60 3192.28 104 27.84:i: 22.81 2895.85
I Sulphonamides and combinations 10354 44.79 %36.42 463783.37 9342 46.09 %40.12 430546.57 9436 47.65:i: 38.19 449597.64
I Quinolones 20079 206.86 %124.43 4153573.89 15375 196.27 %120.39 3017621.51 14036 193.75:i: 120.47 2719487.50
I Other 3460 122.91 %148.68 425255.07 2976 117.49 %77.96 349662.11 2604 113.92:i: 48.76 296652.49
ADDendix F
Table 5F continues:
Pharmaco/,
.. ..L.. ~ U. (RL,.. I~ . .lll. .. (8) m.m.JL~ JR) JIL. 1L. (R)
I Beta-Iactams II 56241 11112.59:t 69.08 II 6331959.4211 64560 II 113.85:t 72.37 7349966.51 955081/ 120.02:t 75.16 114628761
I Erythromycin and other macrolides 1111551 11151.69:t 93.10 II 1752135.48 1113163 II 153.20:t 100.09 2016559.83 21012 II 155.12:t 108.86 3259443.451
Aminoglycosides I~ 489.00. ~~ 513.69>806.35 6677.96r-rol 326.31'401.73 22841.771
L-J 857.91 ~
I Tetracyclines 952611 134.48:t 81.5511 1281029.59111093711 138.26:t 84.21 1512101.86 19027 134.03:t 83.74 2550128.38 I
IChloramPhenicols 8611 36.15:t29.95II 3108.9211 12811 23.82:t14.17 3049.45 219 21.54:t12.89 4717.471
I Sulphonamides and combinations 794711 47.34:t 36.0711 376201.6311 945911 46.53:t 33.90 440156.02 13524 45.66:t 37.50 617524.261
QulnoJones f'TI02\ 190.83> 2118579.751'37231 195.6" 120.14 2£84330.98 [280431 202.40. 137.14 5676430.40
L-J 121.46
I Other II 2224 II 116.38:t 50.89 II 258838.92 II 2403 II 114.24 :t 53.52 II 274524.50 II 4868 II 136.26:t 124.78II 663324.76I
I
I
I
I
I
I
I
I
I
I
I
I
I
ADDendix F
Table 5F continues:
[- .. . _.." '."Febiua,!
..
.' .. .==:.Jr..='====:'':==c=='::':==:::'::.J t===:====='>:.>f!!!=»'>'»'H I
Pharmacocloglcalgroup
D
: Averagecost
Totalcost
D
'Average cOSt
Totalcost..
[J
.. Average cost
Total cost
(R) (R) > (R) > (R) (R) (R)
Beta-Iactams 102745 121.21 :i: 75.54 12454082.34 107309
119.32 :i: 83.28 12804385.12 111042 120.09:i: 78.12 13335187.22
Erythromycin and other macrolides
22381 152.55:i: 117.03 3414298.83 24904 163.97:i: 118.84 4083631.56 25172 164.87:i: 121.03 4150039.13
Aminoglycosides
20 261.91 :i: 299.45 5238.13 30 371.95 :i:341.33 11158.50 53 225.68 :i: 160.63 11961.15
Tetracyclines
17416 137.93:i: 88.47 2402212.61 17410 134.59 :i: 92.63 2343155.10 18789 130.03:i: 90.73 2443071.80
Chloramphenicols
150 23.86 :i: 14.61 3578.36 158 32.31 :i:24.99 5104.56 208 34.43 :i: 28.68 7160.75
Sulphonamides and combinations
12331 47.39 :i: 35.03 584326.87 12924 49.12 :i:40.58 634790.87 13981 48.35:i: 37.25 676045.76
Quinolones 25608 203.37 :i: 134.29 5207955.18 26028 187.57:i: 122.21 4882195.11 26585 186.74:i: 122.10 4964445.09
Other 4572
134.26:i: 125.78 613851.14 4635 133.67:i: 95.38 619582.41 4658 132.77:i: 86.12 618419.91
ADDendix F
Table 6F: Average cost of antibiotics according to the main pharmacological groups. May 2002 to April 2003.
I .' ..- "a~..,. ,. ='=,=~,:c=1I - ..-'--June "'.lr'H.~:U ~ Ju1y~.==::.:- 'j
Pharmacologicalgroup J
D
verage cost Total cost
D
"
.
. .. .
.
.
.
.
.
A.ieragecost Total cost'
D
. Average cost Total cost
n . . n . n
(R) (R).', (R) (R) (R) (R)
Beta-Iactams 133348 119.05:1:74.51 15874494.10 137764 121.11:1:76.54 16685037.53 129051 122.98:1:76.98 15870663.54
Erythromycin and other macrolides 29647 163.99:1:113.54 4861775.49 30240 161.02:1:110.06 4869279.53 29127 171.15:1:110.88 4985201.19
Aminoglycosides 31 432.34:1:637.57 13402.66 36 241.13:1:124.77 8680.55 24 403.43:1:474.68 9682.23
Tetracyclines 17657 120.40:1:90.91 2125880.57 15384 120.45:1:92.14 1852964.61 16522 119.89:1:91.44 1980763.91
Chloramphenicols 223 31.40:1:26.61 7002.66 161 29.89:1:25.75 4812.43 183 24.21 :I:16.35 4431.07
Sulphonamides and combinations 14740 41.43:1:35.09 610607.24 13748 43.89:1:32.94 603392.91 14720 47.18:1:34.06 694427.97
Quinolones 26382 190.74:1:114.14 5032228.79 23024 197.56:1:118.87 4548679.18 25876 199.67:1:117.04 5166565.37
Other 4468 134.41:1:189.58 600531.80 3746 135.27:1:207.13 506731.59 4189 129.82:1:81.84 543823.41
ADDendix F
Table 6F continues:
Pharmacological group
. ~~..~ ~<. .l. (R) J~ ~.. !B} II. 'I.. (R}"JL~r!!
Beta-Iactams 130469 120.67:1:76.11 15743646.12 98197 117.28:1:74.77 11516881.12 96142 117.42:1:75.29 11288601.071
Erythromycin and other macrolides 27970 165.80 :I:108.32 4637458.67 20004 162.42 :I:109.85 3248995.28 19840 162.89 :I:111.78 3231693.73 I
Aminoglycosides 32 268.68:1:191.19 8597.90 28 308.32:1:284.78 8633.07 22 215.58:1:238.16 4742.681
Tetracyclines 15952 119.05:1:94.53 1899057.27 13975 122.24:1:93.19 1708254.07 14636 123.28:1:92.13 1804268.241
Chloramphenicols 265 31.14:1:45.01 8253.30 296 28.84:1:21.86 8538.07 263 29.58:1:15.60 7780.951
Sulphonamides and combinations 14715 46.71:1:33.54 587376.54 13684 49.12:1:32.82 672211.75 15210 49.99:1:33.75 760352.761
Quinolones 24350 195.03:1:114.19 4748944.48 20740 192.32:1:116.86 3988809.84 21149 175.22:1:111.23 3705738.771
Other 4080 135.46:1:107.81 552663.16 3761 145.80:1:160.33 548371.07 3842 146.49:1:554.46 562824.121
ADDendix F
Table 6F continues:
_ .IM~~?n. 'I (R). .~.....~I ~w]L @I~? ...Il. (8).JI . @~:!II (8)
Beta-Iactams 83754 118.46:1:76.72 9921102.23 71347 119.27:1:76.17 8509871.93 100923 122.16:1:80.67 12329231.39
Erythromycin and othermacrolides 16831 165.26:1:117.54 2781454.15 14133 186.68:1:118.55 2638285.77 20568 200.10:1:133.66 4115688.20
Aminoglycosides 21 276.45 :i:298.17 5805.38 11 262.84 :i:200.79 2891.26 27 303.70 :i:279.66 8199.81
Tetracyclines 13344 126.22:i:93.29 1684226.40 11839 130.94:i:93.95 1550218.25 18042 121.35:i:98.59 2189472.16
Chloramphenicols 172 25.74:i: 14.66 4426.54 191 30.32:i: 21.56 5791.21 247 29.94:i: 23.41 7396.30
Sulphonamides and combinations 14335 52.95:i: 35.20 759107.43 13515 52.55:i: 32.87 710278.65 16919 51.06:i: 35.95 863824.17
Quinolones 19344 170.39:i: 106.43 3296109.26 17499 170.60:i: 107.18 2985367.51 31133 169.58:i: 113.78 5279392.98
Other 3499 131.04:i: 165.14 458511.05 3118 134.18:i: 136.37 418373.91 4827 132.46:i: 108.83 639404.58
ADDendix F
Table 6F continues:
(R)
1-'-=""""""'0""""'''''''''' ,=>,,',", "mw=~" If II 'IF Ir~, ~I -=m
I Beta-Iactams 101091 122.12~83.96 12344067.44 113664 122.12~79.76 13880850.62 107714 122.35~81.44 13178331.29
I Erythromycinand othermacrolides 19774 191.39~123.51 3784472.35 23390 188.12~119.45 4400124.93 21998 187.92~121.96 4133834.01
I Aminoglycosides 31 554.37 ~ 700.16 17185.44 37 366.59 ~ 390.54 13563.65 21 306.33 ~ 259.74 6432.98
I Tetracyclines 15233 121.30 ~ 95.83 1847742.61 16045 123.86 ~ 98.34 1987377.59 15146 123.42 ~ 94.56 1869316.50
I Chloramphenicols 240 32.73 ~ 28.05 7854.64 232 30.17 ~ 24.42 6998.71 188 27.50 ~ 18.16 5169.23
I Sulphonamides and combinations 15627 51.82 ~ 36.98 809776.65 16800 51.82 ~ 33.16 870530.53 16852 50.26 ~ 32.15 847020.56
I Quinolones 27121 165.23 ~ 113.80 4481226.72 25937 154.49 ~ 114.87 4007009.94 24539 152.69 ~ 110.32 3746767.78
I Other 4569 131.78~93.83 602086.42 4484 130.71~114.30 586100.38 4209 138.85~137.05 584422.30
ADDendix F
Table 7F: Average cost of Amoxycillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
M_ ~~-;~;.. ~;=" ~~~.. ."" ~~~
.
'.'..
l
.." IL,., JI~ . ..,~, .... ,
1 May 1597 66.98:f:38.71 " 106964.00I 18833 37.92:f:16.27 714108.58
IJune 1269 67.84:f: 38.4411 86091.51 15678 38.05:f: 16.89 596528.15
I July 1362 66.67:f: 35.6611 90808.02 16918 38.62:f: 15.96 653388.19
1 August 2011 67.81:f:45.4511 136367.89 25480 38.16:f:15.99 972280.65
1 September 1386 64.30:f: 35.57 89124.68 18263 37.77:f: 17.02 689767.20
I October 1072 59.17:t 31.15 63431.16 15047 37.85:t 16.69 569468.37
I November 855 61.87 :t 32.77 52898.21 12903 37.70 :t 15.87 486464.32
1 December 928 61.57:f: 33.73 57138.61 14164 37.79:f: 16.55 535273.68
I January 1456 65.31 :f:37.37 95096.06 20010 39.03:f: 18.61 780983.68
I February 1569 65.37:f: 39.29 102571.67 22176 39.33:f: 24.62 872088.80
1 March 1522 64.18:f: 43.95 97676.44 23097 38.90:f: 25.29 898559.58
1 April 1448 62.61 :f:35.30 90660.78 24907 38.95:f: 17.24 970231.28
ADDendix F
Table SF: Average cost of Amoxycillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
~"U . . J ~ (~) m""~.~U ::. . -., JL. '.. (~! .d~ f!!
May 1275 61.24:1: 34.57 78083.7711 31345 38.39:1:16.09 1203273.75
June 1242 60.75:1:35.92 75448.5911 31953 38.46:1:17.39 1228926.52
July 923 59.61 :I:35.40 55018.40 II 29908 39.59:1:22.02 1183994.46
August 702 59.65:1:40.59 41877.191 31544 39.10:1:16.53 1233456.19
September 507 54.64:1:35.45 27704.81 24540 39.19:1:16.99 961669.44
October 497 59.53:!: 42.29 29588.35 23601 38.83:!: 22.32 916462.24
November 696 68.47:1:42.58 47653.96 20731 39.69:1:22.89 822789.29
December 999 100.41:1:53.30 100311.61 16345 39.28:1:18.68 642103.13
January 995 90.71:1:57.87 90253.93 23797 38.97:1:18.22 927441.74
February 947 95.22:1:59.76 90172.59 23710 38.82:1:18.09 920325.77
March 704 66.44:1:50.45 46775.99 26761 38.85:1:18.59 1039722.94
April 554 44.91:1:24.18 24881.97 26028 37.75:1:23.76 982683.13
ADDendixF
Table 9F: Average cost of Amoxycillin/Clavulanic according to type (original vs. generic) of medicine. May 2001 to April 2002.
(R) ....1 (Ig)
...' ',." =..,.". ~I';, h' ".".,,_,,<>v I. 'c A>;< " ::
I May 6431 175.78:i:59.29 1130436.05II 21287 I 109.14 :i:35.16 2323208.55
I June 5520 179.22:i:60.59 989272.67II 183561 109.56:i: 37.80 2011129.83
I July 5950 181.23:i:56.08 1078291.11I 19101 110.30:i:35.12 2106918.23
August 8653 185.56 :i:60.63 1605615.38 30219 111.59 :i:35.36 3372124.78
September 6566 185.61 :i:57.07 1218695.79 22064 111.19:i: 56.66 2453368.48
October 5017 183.31:1:52.34 919657.25 18483 111.77:1:38.22 2065871.19
November 3756 194.89:1:67.22 732001.33 15449 113.55:1:40.62 1754310.85
December 4425 194.35:i: 67.90 859976.78 18783 114.12:i: 39.73 2143583.66
January 7403 201.79:i:64.53 1493865.88 27657 117.57:i:41.53 3251661.99
February 7111 199.08:i:67.86 1415644.52 28974 117.25:i:41.59 3397219.72
March 7180 198.25:i:63.51 1423468.72 30303 111.67:i:41.82 3383957.19
April 7017 202.19:i:65.86 1418737.95 31826 112.92:i:36.73 3593834.16
ADDendix F
Table 10F: Average cost of Amoxycillin/Clavulanic according to type (original vs. generic) of medicine. May 2002 to April 2003.
I (R)~-2~<mn (~)Ij: ~. . U m. (R) )I (R)
May 7354 202.33:1:64.55 1487948.57 38391 112.60:1:39.08 4322772.83
June 6798 206.20:1:70.91 1401766.42 39228 112.33:1:38.10 4406581.84
July 7557 207.34:1:64.32 15660931.10 37731 114.82:1:41.24 4332354.59
August 7271 207.60:1:74.34 1509482.72 38242 113.67:1:38.36 4335333.43
September 5807 206.41:1:72.59 1198597.45 29710 112.66:1:38.81 3347172.98
October 6154 203.15:1:71.46 1250196.82 29044 112.87:1:38.09 3278170.87
November 4998 200.08:1:70.12 999999.33 24821 112.25:1:38.29 2786112.81
December 4502 203.92:1:74.65 918038.44 22385 111.46:1:36.60 2494933.86
January 6659 212.20:1:64.38 1413043.59 31636 112.85:1:37.17 3570209.60
February 6057 211.67:1:69.09 1282091.48 31088 110.01 :I:37.68 3419841.35
March 6745 212.70:1:68.59 1434671.04 35205 109.55:1:37.06 3856716.70
April 6527 213.86:1:68.52 1395844.46 32686 110.73:1:37.12 3619201.40
ADDendix F
Table 11F: Average cost of Amoxycillinl Flucloxacillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
May 187 145.86:f: 43.63 27275.51 1907 99.29:f: 32.06 189350.581
June 106 131.33:f:48.81 13921.31 1417 96.26:f:23.63 136404.661
July 116 137.78:f:52.50 15982.14 1551 96.13:f:24.26 149096.20
August 162 1 134.46:f: 53.37 21781.85 2617 92.90:f: 24.32 243128.17
September 148 I 146.78:f: 55.66 21723.01 2131 92.95:f: 23.83 198150.96
October 100 135.58:f: 44.54 13557.70 1900 93.03:f: 24.67 176755.33
November 50 136.66:f:40.06 6832.94 1491 93.71 :f:31.79 139719.46
December 93 119.28:f:41.47 11093.28 2260 92.06:f:22.24 208051.51
January 160 133.63:f: 52.65 21381.00 3707 94.35:f: 32.04 349749.89
February 133 120.74:f: 44.36 16058.66 3159 94.11 :f:28.73 297278.27
March 143 120.54:f: 48.40 17237.88 3370 88.53:f: 24.05 298337.62
April 136 123.38:f: 48.06 16779.03 3138 88.72:f: 26.06 278405.84
ADDendixF
Table 12F: Average cost of Amoxycillin/Flucloxaciliin according to type (original vs. generic) of medicine. May 2002 to April 2003.
r1
Original product
. . Jr. .
..Genenci)"roQuct
. ..
..
Month
[ I
Averagecost
TotarcoSf:' .'.' :="
Average cost
Tota/cost
n
(R)
(R) ..... . .. . ..
(R) (R)
May
109 110.96 :t 39.92 12095.00 3049 88.63 :t 24.38 270229.37
June 104 143.47:t 59.08 14920.63 2675 88.80:t 25.44 237547.59
July
99 115.29 :t 39.42 11413.70 2940 87.40 :t 23.29
256958.10
August
96 120.79:t 58.67 11595.80 2854 86.86 :t 22.92 247894.47
September
65 117.98 :t 43.21 7668.46 2422 88.71 :t 32.98
214844.61
October 60 107.34:1: 42.12 6440.66 2655 89.22:1:27.22 236873.85
November 64 102.69:t 37.99 6571.87 2464 86.48 :t 20.48 213085.83
December 76 103.69:t 43.72 7880.49 2338 87.50 :t 21.72 204570.94
January
75 94.82 :t 23.85 7111.47 3501 87.09:t 22.28
304906.50
February
60 92.75:t 27.14 5565.25 3309 89.00 :t 44.39 294485.08
March 77 99.77:t 33.97 7682.43 3152 87.06:t 25.32 274416.54
April
108 88.20 :t 21.56 9526.11 2770 87.21 :t:24.73 241564.64
ADDendix F
Table 13F: Average cost of Ampicillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
(R)
I~,._.~=,=">",,, y, 'JI.~. c =>. ",
IMay 3 36.00:1: 17.06 107.9911 633 29.35:1:10.62 18576.48
IJune 1 16.30 16.30 II 447 28.58:1:13.33 12773.51
July II 392 31.14:1:13.25 12208.07
August 1 23.82 23.8211 776 31.06:1:13.84 24100.00
September II 496 32.92:1:15.29 16326.78
October II 475 34.27::!:37.08 16278.30
November 335 30.04:!: 14.46 10063.73
December 402 32.49:1:15.70 13061.23
January 5 51.35:1:39.17 256.69 586 30.80:1:12.86 18050.11
February 2 94.25 188.50 548 31.37:1:13.85 17190.19
March 2 80.11 160.22 598 34.75 :I:16.70 20789.11
April 662 36.69 :I:41.60 24289.13
ADDendix F
Table 14F: Average cost of Ampicillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
.~O ~,. ...,t (81 .., :1 l (B1
I May II 556 30.25:1:14.39 16820.68
I June 583 30.35:1:14.87 17694.56
I July 598 34.81:1:18.47 20815.60
IAugust 536 32.91 :I:16.29 17640.06
ISeptember 437 33.90:1:17.94 14812.84
I October 391 31.38:t 13.62 12271.10
I November 345 29.61:I:14.76 10317.66
I December 355 32.93 :I:15.36 11690.83
I January 489 34.12:1:20.23 16686.78
I February 486 31.32:1:18.64 15220.62
I March 537 34.14:1:17.36 18331.13
I April 416 31.75:1:16.23 13207.00
ADDendix F
Table 15F: Average cost of Ampicillin/Cloxacillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
~ . (~) ~'II.. . fffl . JI~,.. . ~ I {8!...m_. .1J (R)
May 263 117.54:1:51.67 30912.91 503 91.57:1:44.16 46061.51 I
June 133 110.61:1:30.89 14711.76 417 89.17:1:32.94 37185.351
July 216 103.78:1:33.28 22416.30 454 87.17:1:31.90 39575.61 I
August 235 105.05:1:43.11 24686.31 758 86.31 :I:27.34 65421.36
September 195 105.65:1:47.71 20602.17 535 91.73:1:42.96 49077.76
October 136 107.17:1:46.17 14575.49 528 85.07:1:33.07 44917.50
November 137 95.18 :I:54.85 13039.26 504 85.54 :I:38.87 43109.76
December 171 93.88:1:71.36 16053.40 607 83.35:1:28.59 50592.39
January 314 99.31:I:52.80 31181.88 1098 84.40:1:31.26 92675.89
February 248 106.25:1:37.72 26349.41 935 84.14:1:33.65 78667.20
March 241 103.59:1:49.48 24965.01 1089 82.60:1:30.22 89950.78
April 241 111.08:1:52.30 26770.00 1080 86.78:1:33.89 93721.72
ADDendix F
Table 16F: Average cost of Ampicillin/Cloxacillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
I (R). . .JI m~ (R) . 'I... 11 (R). .._~.I ~~)
I May 207 110.43:1: 45.40 22858.51 940 85.35:1: 33.86 80228.67
I June 162 105.76:1:41.15 17132.96 949 87.79:1:30.22 83313.72
July 163 116.34:1: 56.66 18963.41 967 94.97:1: 30.94 91835.63
August 145 104.26:1:42.53 15117.78 767 91.78:1:29.87 70398.15
September 102 121.63:1: 40.57 12406.43 767 95.30:1: 40.06 73094.32
October 125 105.30:t 44.03 13162.80 730 95.60:t 42.64 69788.78
November 81 115.55 :I:61.21 9359.64 786 95.71 :I:35.57 75229.65
December 90 113.84:1:63.28 10245.21 709 93.71:1:31.83 66439.23
January 124 84.77:1:19.72 10511.66 1225 91.44:1:34.41 112012.50
February 125 106.92:1:100.13 13364.74 1016 86.85:1:27.77 88236.73
March 116 87.14:1:32.80 10108.31 1053 86.79:1:24.89 91386.07
April 121 79.12:1:19.87 9573.74 901 82.35:1:31.01 74196.41
ADDendix F
Table 17F: Average cost of Benzathine Penicillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
" , J (BJ, . ',IL, (BJ . .JIL,~ n (8!
May 1 11.51 11.51
June
July
August
September 1 14.18 14.18 I
October
November
December
January 8 14.18 113.44
February
March 10 26.12:1:16.65 261.18
April
ADDendix F
Table 18F: Average cost of Benzathine Penicillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
May 1 15.60 15.60
June
July 1 14.98 14.98
August 3 16.93 50.79
September 1 19.19 19.19
October 7 19.19 134.33
November 1 19.19 19.19
December 6 19.19 115.14
January 5 19.19 95.95
February 3 19.19 57.57
March 2 136.24 272.48
April 6 18.44 110.64
ADDendixF
Table 19F: Average cost of Benzylpenicillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
I May 1 38.11 II 38.11 1 44.12 44.12
I June 1 38.11 II 38.11
July
August
September
October
November 9 14.94:!:5.56 134.46
December 6 24.74 148.44
January 3 190.04 570.12
February
March
April
ADDendix F
Table 20F: Average cost of Benzylpenicillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
(R)
t1 111 ,= ~9W,,"'< If
May
June 7 25.45:t: 14.78 178.18
July 1 23.51 23.51
August 3 13.60 40.80 2 66.29 132.58
September 1 27.66 27.66
October 2 25.61::I:3.58 51.22
November
December
January 4 45.28:t: 34.27 181.10 2 25.60:t: 2.96 51.20
February
March
April
ADDendix F
Table 21F: Average cost of Benzylpenicillin/Procaine according to type (original vs. generic) of medicine. May 2001 to April 2002.
Original product
II
Generic product
"
I ,
o cOif
Month
=-
I
Aveiagecost
-_T ]
.' ". -v'
Aveiage'cOst
Totalcoit
n
(R)
'W , ........ "
(R) (R)
,
" >M-.>.>
May
17 18.12:t6.14 308.01
June 24 22.38 :t 13.01 537.18
July
11 15.93 :t 4.24 175.19
August
58 13.47:t1.41 781.42
September
18 13.89:t 1.03 249.99
October 23 21.52:t 16.63 494.85
November 18 13.36:t 1.55 240.42
December 22
19.56:t 13.40 430.27
January
37 26.95:t 18.50 997.31
February
17 33.70:t 32.05 572.89
March 6
21.12:t 8.36 126.65
April
41 13.73:t 2.27 562.78
ADDendix F
Table 24F: Average cost of Cloxacillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
(81
It ,I IP
I May 54 94.99:t 43.79 5129.25 I 642 I 108.02:t 76.90 69346.42
I June 60 95.90:t 42.84 5753.95 520 105.86 :t 85.61 55046.76
I July 40 89.91 :t'34.29 3596.45 613 103.01 :t 83.42 63142.13
I August 42 117.55:t42.35 4937.27 620 114.11:t 79.83 70749.14
I September 34 110.18:t 63.67 3746.03 518 116.36:t 85.22 60272.97
I October 38 121.51 :t69.54 4617.25 645 115.98:1:121.18 74807.30
I November 29 116.09:t 60.81 3366.57 569 125.27:t 148.06 71279.90
I December 28 82.23:t23.79 2302.38 535 110.13:t85.63 58921.30
I January 20 118.62:t 53.35 2372.46 963 122.88:t 105.13 118330.66
I February 30 82.10:t32.84 2462.99 884 114.77:t69.15 101461.07
I March 15 127.10:t 32.93 1906.48 763 118.62:t 70.88 90508.20
I April 18 121.69:t59.35 2190.40 746 134.15:t96.61 100078.20
ADDendix F
Table 25F: Average cost of Flucloxacillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
(R) .U .~,. ~~~~} .. .11. . ~~.w~ nil. (R) ..11 .~ (~) . ~
May 104 105.88%50.64 11011.37II 129 129.40%100.68 16692.80
June 85 130.44%109.26 11087.2211 114 124.58%71.05 14202.21
July 76 100.85 %60.83 7664.41 II 85 118.03 %62.66 10032.69
August 113 113.59%43.37 12835.4311 143 145.89%147.75 20861.73
September 81 108.09 %46.03 8755.35 I 119 139.84 %113.74 16640.99
October 82 103.14%33.75 8457.09 121 141.45:t129.26 17114.85
November 98 101.33:t33.85 9930.44 88 129.31 :t71.17 11378.87
December 125 95.66 %22.65 11957.33 131 133.64 %107.88 17506.67
January 182 107.46%43.81 19556.82 239 115.91%57.47 27701.39
February 182 99.49%30.13 18107.16 233 134.70%81.34 31386.20
March 309 114.73 %57.57 35451.62 196 133.78 %76.09 26221.51
April 221 111.49 %46.31 24640.35 249 133.46 %59.72 33232.54
ADDendix F
Table 26F: Average cost of Flucloxacillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
(BJ
I _"I' II . ,
IMay 166 120.97:1: 63.60 II 20080.30 203 139.01 :I:78.46 28218.10
June 122 103.47:1:34.31 II 12623.21 205 141.18:1:67.64 28942.37
July 147 114.81:I:53.93 II 16876.66 198 132.72:1:77.91 26279.48
August 175 113.07 :I:74.49 19787.53 220 155.35 :I:138.65 34177.72
September 126 116.94:1:81.63 14735.01 136 147.66:1:77.38 20081.82
October 170 129.13 i: 99.93 21952.67 101 132.78i:56.84 13410.90
November 203 125.85:1:72.57 25547.23 83 128.98:1:78.60 10705.18
December 210 120.22:1:66.36 25246.62 76 143.14:1:57.50 10878.67
January 330 125.95:1:60.99 41563.98 118 173.98:1:88.12 20529.31
February 225 116.11:1:69.31 26124.94 174 173.65:1:92.74 30215.521
March 234 148.53:1:92.37 34755.09 181 168.66:1:76.34 30526.74I
April 190 125.84:1:61.60 23910.34 153 161.57:1:73.10 24720.611
ADDendix F
Table 27F: Average cost of Penicillin VK according to type (original vs. generic) of medicine. May 2001 to April 2002.
.Month
L~" "",~,~"~"~,,,,,,~,~,,,, I '" '" """" "",,",~ ~~",,, "" ',~" """ """ W',,,, , " '" .1 _ (B) , ,II, (R)
I May 68411 32.89:t 21.55 22499.96
I June 511 II 32.76:t 19.85 16740.18
I July 51711 35.40:t21.63 18301.77
I August 1 20.50 20.50 8121 34.18:t 21.58 27750.97
I September I 693 35.08 :t 29.58 24307.01
I October I 704 35.32 :t 21.64 24866.59
I November 595 38.71 :t 24.38 23031.58
I December 619 36.01 :t 21.30 22290.40
I January 803 35.34:t 21.70 28374.16
I February 775 35.25:t 23.05 27319.00
I March 748 35.49:t 20.76 26548.57
I April 678 34.43:t 21.71 23343.75
ADDendix F
Table 28F: Average cost of Penicillin VK according to type (original vs. generic) of medicine. May 2002 to April 2003.
'R)
["", ~" ,~o QD v III!: y , ~}I[n ,~,_,,___v___~" )11 }I
May 752 I 34.45:1: 22.0711 25909.07
June 654 36.93:1: 24.1911 24152.49
July 744 32.95:1:22.18 24511.50
August 744 31.08:1: 19.69 23121.98
September 3 83.73 251.19 639 31.68:1: 21.26 20240.88
October 721 32.98 :f:20.97 23775.91
November 554 35.04:1: 21.65 19411.77
December 551 34.99:1:30.92 19280.52
January 5 26.32:1: 7.06 131.62 689 32.26:1: 20.89 22226.171
February 679 31.25:1:20.69 21217.43 I
I March 7 19.76:1:1.66 138.33 725 33.08:1:20.12 23984.271
1 April 6 49.16:1:45.16 294.93 713 32.27:1:21.19 23011.251
ADDendixF
Table 29F: Average cost of Piperacillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
i3i"iililc.pioil,J"ct
liI~cost L~~
May II
June I
July
August
September
October
November
December
January
February
March
April
ADDendix F
Table 30F: Average cost of Piperacillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
'~"~_'_~ W,' ,'M'~~
May I
June 1 583.42 583.42 I
Ju~ I
~~ I
September I
October 3 160.30 480.90 I
N~~~ I
~~ I
~~ I
February I
Maroh I
A~I I
ADDendix F
Table 31F: Average cost of Procaine Penicillin according to type (original vs. generic) of medicine. May 2001 to April 2002.
L.,""" . ".'. ~""'"_.,". tJ jl~~~~""(R}_~""JI\_ "" ,w_w~.,J,2wt81~ ,w (I!)
I May 3 12.16 36.48 I
I June 3 16.13 48.39 I
I July I
IAugust 1 10.69 10.69 I
September I
October 9 12.50 i: 2.72 112.53 I
November 9 10.69 96.21 I
December 1 17.60 17.60 I
January 6 11.77 i: 0.53 70.59 I
February 7 19.72 i: 4.51 138.04 I
March 6 42.35 i: 33.25 254.07 I
April I
ADDendix F
Table 32F: Average cost of Procaine Penicillin according to type (original vs. generic) of medicine. May 2002 to April 2003.
n
(~) ~MIL n (R)... I
IMay 3 12.92 38.76 II 3 17.74 53.22 I
June 4 12.92 51.6811 I
July 6 12.92 t 0.01 77.49 I I
August 4 12.92 51.68 I
September 3 12.92 38.76 I
October I
November 3 23.04 69.12 I
~~ I
January 5 12.92 64.60 I
I February I
I March 3 24.13 72.39 I
I April 3 14.19 42.57 I
ADDendix F
Table 33F: Average cost of Cefaclor according to type (original vs. generic) of medicine. May 2001 to April 2002.
~ II . ml --~~~I ~;Oi<~]L..~ ~1 ~~. .ltL~~oSfl
I May 232 168.27:i: 76.99 39039.50 2016 125.59:i: 41.71 II 253197.66
IJune 156 160.98:i: 74.63 25112.71 1503 125.76:i: 35.02 II 189011.30
July 158 166.38:i: 75.27 26287.71 1680 127.62:i: 47.66 II 214398.49
August 240 173.05:i: 85.37 41533.04 2414 126.90:i: 37.01 II 306332.16
October 172 161.31 :t 70.54 27746.08 1283 127.16:t 34.85 163152.30
November 102 154.12:t82.54 15720.23 1166 127.23:t47.85 148358.50
December 149 154.18:i: 78.02 22972.58 1417 134.56:i: 47.48 190667.26
January 180 159.04:i: 77.33 28626.50 1979 132.24:i: 49.94 261707.93
February 218 185.10:i: 135.28 40352.42 2300 129.10:i: 42.67 296928.83
March 203 168.29:i: 120.33 34162.75 2181 135.43:i: 42.69 I 295377.68
April 240 167.09:i: 102.26 40101.08 2271 133.57:i: 45.62 II 303339.40
ADDendix F
Table 34F: Average cost of Cefaclor according to type (original vs. generic) of medicine. May 2002 to April 2003.
~~ _"], t8J ]f _. 111)
May 158 191.04 :t 140.50 30184.71 2821 134.45 :t 43.62 379269.52 I
June 96 175.64:t 92.71 16861.26 2793 136.07:t 41.52 380033.07
July 83 154.32:t 59.35 12808.29 2361 137.93:t 39.52 325652.57
August 115 162.40 :t73.63 18686.40 2401 134.60 :t 39.27 323173.04
September 65 157.40 :t 78.36 10230.89 1863 137.67 :t 46.19 256485.62
October 102 160.64:t68.14 16384.92 1688 135.85:t40.92 229317.47
November 80 161.45:t 87.97 12915.77 1466 139.66:t 44.67 204737.21
December 79 159.28:t 63.82 12582.75 1384 136.75:t 46.68 189256.32
January 88 148.19:t 66.76 13041.15 1900 144.77:t 53.01 275054.84
February 73 152.42:t 82.77 11126.89 1782 139.79:t 56.73 249097.64
March 67 146.49 :t 61.53 9814.81 1799 133.15 :t 44.14 239528.16
April 41 134.20:t21.73 5502.00 1815 138.89:t48.10 252084.50
ADDendixF
Table 35F: Average cost of Cefadroxil according to type (original vs. generic) of medicine. May 2001 to April 2002.
',JJii1iiiiiPdtjct'
~Tottil cost
Average cost
~.. "H~~! . It (R) I I (R).~
1 May 82 114.54:1:32.83 119391.90 1 524 97.93:1:28.26 51315.23
I June 29 93.96:1: 39.0311 2724.971 395 100.71:1: 36.07 39779.83
I July 13 98.02:1: 13.6411 1274.20 1 419 98.58:1: 29.85 41306.81
August 33 108.44:1: 38.771 3578.67 1 601 105.80:1: 42.48 63587.01
September 26 87.42:1:10.73 2272.91 I 415 101.62:1:36.18 42171.45
October 31 91.76:f:37.49 2844.47 365 101.91 :f:37.10 37195.39
November 8 114.26:f:61.04 914.06 291 103.32:f:34.27 30065.56
December 9 79.52:1:2.65 715.68 429 112.10:1:51.40 48090.83
January 11 90.67:1:13.01 997.33 617 98.54:1:33.21 60800.75
February 15 99.60:1:34.26 1493.96 660 105.15:1: 39.43 69401.96
March 31 97.27:1: 42.87 3015.31 728 117.24:1:39.75 85348.88
April 25 98.80:1: 15.66 2470.12 714 116.27:1: 34.44 83017.13
ADDendix F
Table 36F: Average cost Cefadroxil according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
(~) II (~) . . ,~J I (R). wwwwJ " ~...w._ . ""
I May 32 100.64 :t: 11.36 3220.55 562 120.11 :t:42.91 67500.08
I June 4 107.08 :t: 0.02 428.33 474 114.12:t: 40.54 54091.32
I July 9 119.08:t: 54.38 1071.75 472 116.87:t: 37.89 55163.82
I August 9 126.61 :t: 29.28 1139.46 534 109.66:t: 26.89 58556.70
I September 345 117.84:t:43.59 40655.61
I October 4 107.09:f: 0.01 428.37 299 129.21 :f:66.96 38634.68
I November 6 107.10:t: 0.01 642.57 257 125.53:t: 53.68 32260.28
IDecember 4 100.46:t: 12.90 402.56 256 130.39:t: 61.78 33380.06
I January 3 213.16 639.48 389 121.28:t:45.43 47176.35
I February 6 94.18:t: 14.13 565.08 341 130.54:t: 59.55 44514.28
IMarch 6 81.29 487.74 360 120.91 :t:46.97 43526.70
I April 3 81.29 243.87 403 131.28:t: 65.66 52904.56
ADDendix F
Table 37F: Average cost of Cefazolin according to type (original vs. generic) of medicine. May 2001 to April 2002.
(Il) II (R) J" n (R) . I
I May 2 540.11 ::I:338.44 I
June I
July I
August 3 194.33 582.99 3 I 70.19 210.571
September 3 164.99 494.97 II I
October II I
November II I
December 2 584.99 1169.9811 I
January 3 1371.19 4113.5711 I
February II I
March 5 155.86::1:52.68 779.30II I
April II I
ADDendixF
Table 38F: Average cost Cefazolin according to type (original vs. generic) of medicine. May 2002 to April 2003.
OiTgTnarpiTJilJI'ct.
Month
Average cost
fWHwAL (BJ H JIL~H~~' HHI11~. w.. ww ,J., O!Jw. n _(8)~ I
May 4 342.41t 118.27 1369.63II 2 129.28 258.56
June 1 390.18 390.1811
July II
August II
September II 2 70.19 140.38
October II
November I 3 37.04 111.12
December
January 9 97.33 t 0.25 875.94
February
March
April 3 1454.74 4364.2211 10 66.71 t 41.36 667.12
ADDendix F
Table 39F: Average cost of Cefepime according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
I May II II II
I June II II II
July I II I
August II
September II
October
November
December
January 3 615.52 1846.56 I
February I II
March II II
April II II
ADDendixF
Table 40F: Average cost Cefepime according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
n
(R) (R)
May I II
June II
July II
~~ I
September
October
November I
~~ I
January
February
March
April 1 1658.43 1658.43
ADDendix F
Table 41 F: Average cost of Cefixime according to type (original vs. generic) of medicine. May 2001 to April 2002.
(~)III (R)lr 11 "=,
IMay 541 152.01:1:41.84 82239.2611
June 431 160.72:1: 52.68 69269.1211
July 544 163.17:1: 55.75 88765.7911
August 778 156.03:1:46.87 121394.22 II
September 490 155.73:1:51.16 76306.67 I
October 373 161.63:1:54.24 60289.81
November 287 170.38:1:80.74 48898.14
December 321 151.20:1:60.48 48534.66
January 586 135.21:I:75.76 79232.90
February 554 143.38:1: 59.54 79431.09 I
March 529 148.74:1:67.89 78685.37I II
April 598 147.59:1:72.93 88257.92 II II
ADDendix F
Table 42F: Average cost Cefixime according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
(RJ I Tm;~ost t ..
I May II 682 159.53:t 75.981 108797.41 I
June 742 155.29:t 76.53 115227.12 I
July 568 148.60:t 86.52 84404.80 I
August 513 144.75:t67.58 74258.33 I
September 462 152.44 :t 52.13 70426.20 I
October 453 156.90:i: 78.47 71075.95 I
November 376 155.03:t 79.98 58291.65 I I
December 356 154.10 :t 97.01 54859.64 I
January 471 186.63:t 88.29 87903.18 I
February 396 183.07:t 60.71 I 72493.80 I
March 410 202.61:t 81.2811 83070.75 I
April 392 199.83:t67.39 II 78332.74 I
ADDendix F
Table 43F: Average cost of Cefotaxime according to type (original vs. generic) of medicine. May 2001 to April 2002.
~el1~tlcpfifili!~t
~ ~ ~o ~ ~-_:~W;;I
n "A~;posj. . L~~2=
May II II II
June II II
July 3 1474.11 II 4422.33 II
August II II
September I II
October 3 329.04 987.12
November 3 163.79 491.37
December 3 237.58 982.74
January
February 2 378.20 756.40
April 3 188.36 565.08
ADDendix F
Table 44F: Average cost Cefotaxime according to type (original vs. generic) of medicine. May 2002 to April 2003.
(R)
I" o~,".'N,',,"~ "=., O"_W_.=',VV'h',','=" :1" I '-tl' 'W,'" '..~WN"WO.=
May I 2 II 683.78 1367.56
June 1 201.54 I 201.54 411 2580.83:t 1672.74 10323.33
July II
August II
September
October
November
December 1 71.74 71.74
January
February 4 364.11 :t 284.86 1456.44
March
April 3 187.76 563.28
ADDendixF
Table 45F: Average cost of Cefoxitin Sodium according to type (original vs. generic) of medicine. May 2001 to April 2002.
Totalcost
(R) (R)
IMay I I II
I June I
I July
August
September
October I
November II
December II
January II
February II
March II
April II
ADDendix F
Table 46F: Average cost Cefoxitin Sodium according to type (original vs. generic) of medicine. May 2002 to April 2003.
I May II I
I June I I
I Ju~ I
I-~ I
I~~~ I I
I~~ I
I November I
I December I
I January I
I~~~ I
I March I
I April 3 170.34 511.02 I
ADDendix F
Table 47F: Average cost of Cefpodoxime according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
n
(~_ 1[. ~.tB~coSi_~~'.1I!~~1. ~~~~:~I
I May II 8962 I 150.79:1:43.72 1351352.55 I
I June II 7844 153.07 :I:46.43 1200668.15
IJuly II 7843 153.42 :I:42.18 1203252.41
I August I 12514 153.93:1:42.05 1926312.13
I September 8755 152.99:I:46.70 I 1339389.82
I October 7026 151.16:1:43.1311 1062057.77
I November 6268 149.90:1:44.60 II 939571.66 I
I December 6352 152.44:1:44.60 II 968285.31 I I
I January 8703 163.26:1:46.9711 1420882.85 II
I February 11332 163.85:1:47.89 II 1856744.30 II
I March 11903 163.43 :I:53.31 II 1945348.59 II
IApril 11945 164.25:1:51.3911 1961981.75 II
ADDendix F
Table 48F: Average cost Cefpodoxime according to type (original vs. generic) of medicine. May 2002 to April 2003.
(R)
v.. II .~l JIlL ~ .1
1 May 15732 1 164.94:1:47.43 2594819.13 I
1 June 184441 170.09:1:48.21 3137055.34 I
1 July 15939 173.37:1:49.66 2763367.08 1
1 August 16041 172.96:1:48.88 2774455.85 1
ISeptember 11298 168.45:1:48.96 1903125.81 1
IOctober 10569 168.73:1:49.88 178335.82 I
1 November 9029 182.83:1:55.79 1650777.89 I
1 December 7072 185.02:1:54.16 1308494.84 I
1 January 9642 187.46:1:55.66 1807515.04 1
1 February 10758 184.23:1:56.45 1981901.21 1
IMarch 12659 184.10:1:54.08 2330497.27 1
I April 12020 183.58:1: 55.13 2206584.99 1
n
ADDendixF
Table 49F: Average cost of Cefprozil according to type (original vs. generic) of medicine. May 2001 to April 2002.
'ng!ija!iir6quct'
Month
Average cost Totltlcost
cc"'n~~;~iWI~ _(8J ~, .. (~1, ..1. w mnn .,.. J }8J, 'w II ~L~~_I
May 1649 143.59::1:49.05 I 236777.51 I I
June 1447 147.33::1:48.36 I 213187.68 I I
July 1382 148.61 ::I:53.65 I 205373.64 I I
August 2667 149.92 ::I:51.56 399844.49 I I
September 1834 147.61::1:53.96 270711.53 I
October 1247 148.01::1:52.42 184571.19 I
November 1056 147.45::1:55.36 155708.82 I
December 964 149.18::1:55.89 143808.83 I
January 1658 167.64::1:56.76 277945.22 I
February 2246 167.60::1:58.59 376432.20 I I
March 2107 167.21::I:62.23 352305.91 II I
April 2278 166.87::1:59.12 380133.50II I
ADDendix F
Table 50F: Average cost Cefprozil according to type (original vs. generic) of medicine. May 2002 to April 2003.
rQtal
I . ",. ..~ ,LH (R) I~ (8) k .. ... II. (8)
I May 2935 170.22 t 57.20 499599.31
I June 3009 172.08t 73.46 517798.40
I July 2761 173.93 t 62.52 480220.16
I August 2876 I 169.98 t 59.39 488870.10
I September 19581 165.53t61.15 324106.32
I October 2266 164.94 t 60.52 373760.89
I November 2084 163.75 t 56.00 341251.57
I December 1339 166.95 t 59.95 223540.77
I January 1779 190.11 t 76.40 338198.86
I February 2060 185.33 t 74.79 381773.84
I March 2727 177.07 t 65.77 482860.00
I April 2459 180.40 t 68.41 443613.66
ADDendixF
Table 51F: Average cost of Cefradine according to type (original vs. generic) of medicine. May 2001 to April 2002.
~w~o~~~~""w < ,<,>','>'««=w,", ~~.=,,_
I ~ffl coM ]
May
June
July
August
September
October
November
December
January
February
March I
April II
(R)
"C3eneric productOriginal product
(R)
Month
j\'verage cost' veragec
ADDendixF
Table 52F: Average cost Cefradine according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
rg/nalproduct
"OlalcOSt
"" Generic produCt
veragecost
n
r,u ~"~ 'II II (R) II (R) JI (8),j t (R)
May 9 242.00:1:130.53 2178.03 II
June 4 226.93:1:44.91 907.73 I
~ I
August 1 204.48 204.48 I
September 2 610.98 1221.96
~~ I
November
December
January 36 195.00 :I:26.17 7020.11
February 11 179.70:1:42.44 1976.73
March I 4 178.23:1:17.50 712.92
April II 5 204.48 1022.40
ADDendix F
Table 53F: Average cost of Ceftibuten according to type (original vs. generic) of medicine. May 2001 to April 2002.
~~ij~tii;pio:rJu(;t
Totalcost
Average cost
Totalcost
n
~,",'~m~' I~ . ,I . . (8) .~"U ' ('!) ., II n . (8) _ IL ...~R}
May 591 193.02 t 73.12 114076.09 14 229.44 t 45.03 3212.26
June 489 209.73 t 79.29 102557.62 9 209.20 t 71.53 1882.83
July 478 206.05 t 75.25 98293.57 9 153.69 t 59.79 1383.18
August 797 215.78 t 76.63 171978.66
September 543 212.25 t 76.87 115253.14 2 244.31t15.70 488.61
October 449 217.58 t 78.34 97694.04 3 256.89 770.67
November 346 231.85t100.23 80222.92 3 233.19 699.57
December 406 206.04 t 78.25 83652.66 1 256.89 256.89
January 677 220.47 t 90.58 149255.36 7 305.04 t 200.36 2135.25
February 622 207.40 t 76.07 129005.71 9 113.83 1024.47
March 606 222.14 t 90.28 134614.66 12 113.83 1365.96
April 318 224.83 t 103.48 71497.18 10 213.97 t 69.10 2139.72
ADDendixF
Table 54F: Average cost Ceftibuten according to type (original vs. generic) of medicine. May 2002 to April 2003.
Original pf9diict
H
iteiii;pfOdiJi;(
'_R
]---.'-'--'.'.'---
Month
-= If "AAO r
"rg...n=="" ! r " "... [
totiifcost
I
(R)
W,"= ,
May
29611
271.02:1:109.51 80223.20 14 226.23 :I:60.92
3167.28
June
214 II
260.25 :I:86.30 55693.94
July
2651
298.47 :I:80.14 79093.92
August
268 265.96:1: 102.69 71276.41
September
194 290.72 :I: 120.66 56398.92
October 219
309.57 :f:98.26
67795.81
November 301 310.56:1: 118.84 93478.93
December 334 298.05:1: 104.47
99549.88 I
January
291 315.72:1: 99.75
91875.68 II
February
269 292.24:1: 97.88
78613.78 II
I March
297 315.26:1: 119.47
93632.0611
I April
323 314.40:1: 104.49
101551.3911
ADDendix F
Table 55F: Average cost of Ceftrazidime according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
(R)
n
(R)
1:ff/glijiffiiOdiict
rA~]
May II
June 3 177.53 532.59
July
August
September
October
~~ I
~~ I
January
February 6 1268.47:t 462.27 7610.82
I March 4 3063.25 :t 5703.98 12252.96
I April
ADDendixF
Table 56F: Average cost Ceftrazidime according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
(R)
, ~Total cost
(R) (R)
I May I II
I June II
I July . II
I August II
IS~~m~ I
I October
I November
I December
I January
I February
I March
I April
ADDendixF
Table 57F: Average cost of Ceftriaxone according to type (original vs. generic) of medicine. May 2001 to April 2002.
Originalpro u~l" ~i .. ". Giriiiit:proquct ,
M"~ h~- l-jy~coSI 11~~J[r~-C'][~~-ll ~T.(a~-l
I May 4911 330.10:1: 578.31 II 16174.98 II II
I June 40 II 227.37:1: 188.2211 9094.95 311 411.6311 1234.89
I July 62 II 495.30:1: 1512.77 II 30708.56 12 II 169.63:1: 32.83 II 2035.50
I August 59 I 289.86:1: 514.4311 17101.69 I
I September 98 273.10:1: 175.24 26763.61 3 201.06 603.18
I October 68 217.54:1:182.64 14792.91 1 400.65 400.65
I November 64 217.74:1:132.38 13935.04 4 471.50:1:141.71 1886.01
I December 64 271.04:1:269.38 17346.58 3 138.19 414.57
I January 93 384.97:1:394.99 35801.91 3 201.06 603.18
I February 129 239.76:1:182.94 30929.34 3 616.23 1848.69
I March 138 248.35:1:199.37 34272.19 I 5 572.99:1: 421.34 2864.93
I April 124 325.64:1:283.08 40379.4911 3 411.30 1233.90
ADDendixF
Table 58F: Average cost Ceftriaxone according to type (original vs. generic) of medicine. May 2002 to April 2003.
Mod~ 1.- .~. "r._=;=- '[~~~] ~X I A~~ L:~
May 117 265.29:i: 232.94 I 31038.45 II 6 II 580.61 :i:487.97 3483.63 I
June 104 249.39:i: 174.78 25937.0511 4 170.59:i:60.95 682.351
July 117 236.00:i: 197.28 27611.9811 8 334.87:i: 135.15 2678.981
August 126 294.78:i:163.85 37142.09II 9 255.86:i:309.78 2302.74
September 91 274.29:i:232.04 24960.40 3 401.54 1204.62
October 96 291.45:1: 197.03 27979.64
November 83 212.62:i: 104.97 17647.81 4 126.66:i: 52.18 506.63
December 102 272.85 :i:225.64 27830.97 1 147.96 147.96
January 157 286.75:i: 207.67 45019.53 11 136.60:i: 15.76 1502.55
February 97 325.48:i:258.87 31571.95 10 619.01 :i:406.74 6190.09
March 112 238.61:i:162.49 26723.78 10 491.90:i:410.28 4918.97
April 89 313.69:i: 287.26 27918.77 47 190.09:i: 41.99 8934.07
ADDendix F
Table 59F: Average cost of Cefuroxime according to type (original vs. generic) of medicine. May 2001 to April 2002.
~it~rli;itf'!)duct
(~) . . U. nm~" (R) .. II. i ~ (~) ,-~IL, (~) I
May 12059 156.18:i: 63.87 II 1883328.90 II
June 10212 157.36:i:64.18 II 1606962.21 II
July 10893 161.97:i:65.93 II 1764303.5911
August 17619 I 160.83:i: 64.82 2833727.9511
September 11993I 157.75:i:64.32 1891884.5911
October 9681 157.13:t67.11 1521145.78 I
November 7936 162.16 :t 63.75 1286928.68
December 8773 167.44 :i:66.06 1468989.37
January 12998 174.26:i: 68.65 I 2265065.86
February 13964 172.52:i: 65.55 II 2409135.31
March 15522 170.05:i: 66.4611 2639477.97
April 16082 174.91:i:75.55 II 2812936.82
n
Tota/cost
Month
ADDendixF
Table 60F: Average cost Cefuroxime according to type (original vs. generic) of medicine. May 2002 to April 2003.
-, , "~~ ~"'~()ijgrnalpfijaucr' "-~, ,,'~,
(~) , I, (R) ,~~~ Jt, (R},_", II ,~" (~) I
May 20498 174.96:f: 72.13 I 3586301.28
June 21850 176.04:f:71.19 3846393.95
July 19815 181.11:f:74.42 3588603.00
August 19813 178.15:f:75.73 3529626.97
September 13398 I 176.34 :f:75.09 2362608.76 I
October 12944 174.52:!:73.28 2258925.57 II
November 11213 174.07:f:72.82 1951835.8311
December 9087 177.67:f:72.28 1614474.52
January 12570 194.73:f:83.29 2447802.40
February 13573 194.89:f:82.28 2645285.11
March 15746 192.42:f:80.69 3029889.89
April 15292 192.49:f:78.38 2943515.20
n
Average cOst"
Totafiiost
Month
ADDendix F
Table 61F: Average cost of Cephalexin according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
n
cosl
(R) '. ..,~., IIII~n..." ~~t ,~...~J ,."..,;111 (8).. . ....,ill (8). I
May 43 II 320.52:I:134.19I 13782.42I 1016 81.01 :I:33.32 II 82304.29
June 4311 340.98:1:120.44 14662.261 792 80.85:1:34.1711 64032.61
July 5311 311.65:1:143.50 165171 836 81.80:1:35.341 68391.76
August 169 II 272.50:1:161.42 46052.61 I 1477 84.50:1:35.02 124810.20
September 1151 317.05:1:166.60 36460.93 1175 87.07:1:32.54 102311.59
October 134 300.53:f:142.77 40270.55 784 89.36 :f:31.98 70060.40
November 71 333.89:f: 129.93 23706.26 724 82.90:f: 29.40 60018.60
December 85 379.32:1:109.52 32242.56 773 86.59:1:31.92 66936.11
January 257 375.51 :I:145.71 96506.02 1039 89.07:1:36.83 92546.42
February 260 435.76:1:173.48 113298.33 1002 92.69:1:35.64 92872.61
March 242 492.98:1:150.59 119301.02 908 87.51:1:34.39 79455.49
April 317 508.95:1:159.65 161335.64 1005 92.67:1:40.24 93131.69
ADDendixF
Table 62F: Average cost Cephalexin according to type (original vs. generic) of medicine. May 2002 to April 2003.
Origln~' product
(R) JL,..JR) ..11 .~ ~.H (R) U (R) . I
May 92 317.21:I:235.49 II 29183.37 1116 88.64 :I:35.02 98926.38
June 54 396.97:1:217.73 II 21436.26 1193 92.44:1:46.18 110284.26
July 55 346.37:1:220.29 19050.37 1046 88.87:1:38.12 92955.75
August 45 371.30:1:227.08 16708.58 9081 88.95:1:34.40 80765.10
September 34 345.11:1:191.86 11733.75 I 836 90.51:1:64.98 75668.99
October 46 298.37:t216.61 13725.17II 745 86.68:t 33.42 64579.87
November 61 273.47:1:246.13 16681.9511 641 92.27:1:41.52 59145.36
December 56 270.06:1:211.82 15123.5211 684 91.77:1:42.78 62774.00
January 75 159.54:1:171.54 11965.4211 1147 90.43:1:36.80 103718.48
February 66 97.83:1:65.12 6457.10 II 979 90.30:1:35.08 88405.21
March 52 259.18:1:281.62 13477.1311 1009 89.15:1:42.28 89956.60
April 43 137.76:1:152.52 5923.5611 960 88.16:1:33.34 84628.85
n
Month
ADDendixF
Table 63F: Average cost of Cephalothin according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
enencproduct
"~"="""""'"'''''''_'AW>''-_~_~_'''
!gec'
n
(R) (R)(RJ
May II I
June II 3 221.86 665.58
July II
August II
September II
October II
November II
December II
January II
February II
March II
April II
ADDendixF
Table 64F: Average cost Cephalothin according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
(R)
n
(R) (R)
(8)
May II II II II
June II I II II
July II II
August II
S~~m~ I
October
November
December
January
February
March
April
ADDendixF
Table 65F: Average cost of Cephradine according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
Totalcost'
(RJII ~J~J , ,~,IL"~,, .IL. (RJ ,H (RJ I
May 90 I 164.02:1: 88.58 14761.70 II 125 187.59:1:114.61 23448.18
June 73 153.84:1:62.15 11230.5211 79 163.48:1:57.31 12914.87
July 73 196.35 :I:264.46 14333.64 II 69 143.65 :I:54.93 9911.64
August 72 155.86:1:94.82 11222.0911 86 151.73:1: 58.01 13048.79
September 73 172.99:1:82.65 12628.33 59 150.83:1:66.38 8899.12
October 80 191.56i:124.56 15324.40 34 126.98i:44.43 4317.47
November 84 185.44 i: 106.37 15576.96 22 128.23 i: 64.66 2821.00
December 121 194.78:1: 81.58 23568.69 16 127.87:1: 32.78 2045.99
January 218 215.83:1:97.93 47051.12 47 130.08:1:37.51 6113.54
February 230 211.29:1:89.51 48595.98 46 138.57:1: 42.76 6374.34
March 176 238.59:1:115.93 41990.97 28 160.60:1: 57.63 4496.72
April 222 207.44:1: 109.56 46052.50 20 161.45:1:56.15 3229.09
ADDendixF
Table 66F: Average cost Cephradine according to type (original vs. generic) of medicine. May 2002 to April 2003.
~~iiiiincproduct
Month
.otalcost
~I ...~. IL __ (R) I[~ n .~ (R) lJm~
May 170 II 196.69:i: 114.79 33437.11 II 22 167.56:i:51.62 3686.36
June 136 II 226.10:i: 102.35 30750.11 I 12 204.47:i: 0.00 2453.67
July 171 II 258.23:i: 164.03 44157.75 11 207.65:i: 7.08 2284.15
August 9611 289.72:i: 131.78 27812.71
September 6511 258.58:i: 114.37 16807.82 3 316.62 949.86
October 9711 256.94:t 117.63 24923.48 3 204.47 612.41
November 87 I 262.44 :i:110.68 22832.07
December 128 253.63 :i:148.28 32465.13
January 154 324.24:i: 160.58 49932.46
February 148 285.11 :i:115.22 42196.36
March 113 266.15:i: 112.72 30075.19
April 102 302.96:i: 137.70 30901.96 3 169.46 508.38
ADDendix F
Table 67F: Average cost of Imipenem/Ciiastatin according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month:
n
(R) (R) (R)
May II II II
June II II II
July II II II
August II II I
September II II
October
November
December 2 3011.76:t 1064.82 6023.52
January 1 376.47 376.47
February
March
April
ADDendix F
Table 68F: Average cost Imipenem/Ciiastatin according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
1St
(R) (R)
May I I
June I
July I
August I
September I
October I
November I I
December I II I
January II I
February 4 3717.19 14868.7611 I
March II I
April 2492 222.73 :t 64.29 555031.19 II I
ADDendixF
Table 69F: Average cost of Loracarbef according to type (original vs. generic) of medicine. May 2001 to April 2002.
Month
Average cost
°1"" I ' ,~L. (R)_~ , ]l, '. . ~ ... (R) I ],. (R) I (R)
May I 225411 1702.41 :t 54.65 388611.51
June 1789 176.22:t 57.13 315262.47
July 1783 169.53:t 53.08 302275.75
August 2961 169.22:t 57.80 501071.12
September 1804 163.57:t 55.29 295075.91
October 2545 I 170.35:t61.52 263189.71
November 1139 I 163.89 :t 54.64 I 186668.07
December 1330 163.45:t 95.24 I 217388.29
January 1808 178.02:t 76.06 321857.67
February 2276 220.41 :t 61.14 501661.07 I
March 2317 218.85:t 57.22 507077.55 II
April 2492 222.73:t64.29 555031.1911
ADDendixF
Table 70F: Average cost Loracarbef according to type (original vs. generic) of medicine. May 2002 to April 2003.
" ",''''. ~.~. . (R) I (81 ~'!? .. J"... ..". (~~
May 3010 223.61 t 67.70 673059.44
June 3325 224.51 t 65.55 746483.35
July 2701 228.82 t 67.71 618032.29
August 2722 221.33 t 62.97 602448.33 I
September 1753 218.27 382622.40
October 1657 220.13:t 70.89 364754.80
November 1622 219.65 t 66.27 356275.80
December 1216 214.67 t 57.01 261044.69
January 1526 221.95 t 61.62 338692.91
February 1690 221.26 t 64.62 373926.46
March 1999 219.60 t 61.23 438975.34
April 1737 219.14 t 69.62 380653.97
'Tota/cost
Totalcost
ADDendix F
Table 71F: Average cost of Meropenem trihydrate according to type (original vs. generic) of medicine. May 2001 to April 2002.
IMay II
June II
July II
August
September
October
November
December
January I
February I
Mareh I
April 6 934.69 5608.14 I
ADDendixF
Table 72F: Average cost of Meropenem trihydrate according to type (original vs. generic) of medicine. May 2002 to April 2003.
Month
Origliiifprodiict
'"vW""""""<:'
Averagecost
To
n
C1enenc product
--
'ge cost
(R)
I May I ii ~.. ii -~"
June II II
July II I
~~ I
September
October
November
December
I January 3 936.17 2808.51
I February
I March 1 493.30 493.30 I
I April 1 494.78 494.78 II
ADDendixF
Table 73F: Average cost of antibiotics according to type of medicine claimed. May 2001 to April 2002.
:-l Origins Pioaucts : [ ::._=-==~~ ...-=: GenericPro~~~~
Month II n I A ge cOSi TOtalCost , n . Av8iagecost . . - ~o'-t8rCost'" , , " ' .
"
.
1
(R) (R).' < (R) (R):
" ~., 'M'W.',~~' =., w. 0:<'"" ~~. ~"N~'=~~''',''V' "=",'.',','.',',',,," <.~.,v ._
May 69968 173.67 t 92.50 12151366.32 74391 79.20 t 54.27 5891475.31 I
June 56707 174.77t 96.65 9910470.55 61717 80.10t 65.44 4943534.97I
July 59664 177.46t104.73 10587704.94 63627 80.36 t 54.93 5112911.77
August 93676 177.25 t 89.41 16604343.60 98372 80.72 t 54.36 7940366.67
September 65159 175.57 t 93.41 11440126.26 75309 81.12 t 59.49 6108728.46
October 53001 175.13:f:87.14 9282182.92 65951 81.72:f:56.35 5389407.62
November 43083 175.50:f:89.96 7560877.26 55610 82.16:f:56.72 4568801.90
December 48082 180.15t95.79 8661753.40 66304 84.85 t 58.58 5625613.71
January 79767 190.65:f: 109.37 15207455.58 102504 88.29 t 62.56 9049831.80
February 81989 188.16t108.21 15427421.92 103234 89.68t63.75 9258121.54
March 82088 188.25 t 110.01 15453167.96 111310 89.22 t 64.25 9930835.27
April 84149 189.59 t 105.12 15953712.24 116339 88.13 t 61.71 10252618.57
ADDendixF
Table 74F: Average cost of antibiotics according to type of medicine claimed. May 2002 to May 2003.
OngljiiJlPl'odiictS~ ~
c;enerli:'ProductS
M:: [==::J Ave,:.'" I TO~R~~]'_ J Ave~:;.ost :~;o= J
May 97948 187.49:1:101.18 18364811.06 128548 83.71:1:60.54 10761112.25
June 99438 188.10:1:99.13 18703890.46 124665 83.23:1:61.44 10375687.87
July 95785 195.23 :I:93.48 18699895.77 123907 85.19 :I:60.94 10555662.92
August 92926 192.25:1:92.61 17864826.31 124907 83.43:1:59.29 10421171.13
September 67123 193.32:1:98.73 12975895.50 103562 84.25:1:60.66 8724798.77
October . 66387 190.43:1:161.20 12641856.45 104717 83.31:1:58.97 8724145.87
November 58048 190.63:1:100.21 11065895.88 93252 84.13:1:59.88 7844846.56
December 49594 198.20:1:98.79 9829717.33 82059 85.20:1:58.14 6991361.16
January 71245 210.2:1:106.04 14982350.02 121441 86.05:1:61.21 10450259.57
February 68945 207.04:1:103.96 14274481.41 114741 83.84:1:59.18 9619930.86
March 75949 205.80:1:97.55 15630492.63 124640 81.21:1:55.96 10122063.72
April 71234 206.63:1:98.95 14719292.72 119433 80.82:1:55.84 9652001.93
ADDendixG
Comments of interest with the interpretation of the following tables:
(J Average package size: Due to the existence of more than one package size per product, the
average package size was calculated.
(J Total units: Refer to the total number of units that was claimed for the specific product (e.g.
capsules, tablets, vials, etc.).
(J Average cost: The average cost for that specific product claimed.
(J Total cost: The actual total cost for that specific product claimed by the service provider.
(J Cost per unit: The amount the MPL was reimbursing per unit for that specific product
(capsules, tablets, vials, etc.).
(J Total calculated cost: The total units claimed for that specific product multiplied by the cost
per unit reimbursed by the MPL for that specific product.
(J Effect: It is the total calculated cost subtracting the actual total cost. This value gives an
indication whether there was a saving or a loss regarding the specific product claimed.
When there was a negative value it means that the patient had to make a co-payment.
(J Saving %: Gives an indication of what percentage was saved through the MPL.
ADDendix G
2002 to Auaust 2002.
Product name
Average package
size
Tota;
units
Average CO$t ,jITotal. cost
(R)
Saving
%
f~'0tP==i] = ]
__1- ~. ,...~_~~
Amoxil250mgCAP(n=938) 16.51 :t4.17 15490 44.35:t21.25 41595.79 1.73 26797.70 -14798.09 -55.221
Amoxil250mg VIAL (n=3)* 15.00 45 331.51 994.53 I
Amoxil500mg CAP (n=1000) 17.01:t 6.30 17013 91.82:t 48.69 91819.63 3.07 52229.91 -39589.72 -75.80 I
AmoxilPeadDRP(n=1073)* 20.41:t 5.52 21900 56.29:t 14.95 60395.07 I
Amoxil S 125mg SUS (n=739) 105.41 :t 24.37 77900 38.87:t 14.93 28728.51 0.23 17917.00 -10811.51 -60.341
Amoxil SF 250mg SUS (n=334) I 107.23:t 30.42 35815 72.39:t 32.56 24177.41 0.38 13609.70 -10567.71 -77.65 I
Ranmoxy DISP250mg TAB (n=19)* I 19.74:t11.24 I 37511 55.37:t30.43 I 1052.06 I
Ranmoxy DISP TAB (n=36)* I 29.30:t 8.53 I 105511 46.25:t 12.89 II 1664.95 II I
~~enii16!'r!!:~~~~.::.1 ~. . . ., ,~:iU[ ::')" U:: .,L] ~!lil!lll:j!I!I!ii~I::ij.iU. it
A-Lennon Amoxy CAP 250mg 1[3
6 1 I
c:JQ
_ 18.03>6.84 4184 32.61< 18.00 7565.23 1.73 .
(n-232) 7238.32 -326.91 -4.52
A-Lennon Amoxy 125mg SUS
I
IG I l
a l I
c::JQ
_ 103.85 I 19.29 . 16200. 26.01< 5.62. 4066.44 0.23(n-156) 3726.00 -340.44 -9.14
A-LennonAmoxy250mgSUS 1[3
6 1
c:JQ
_ 91.33:t 25.07 9316 36.68 :t 8.86 3740.98 0.38
(n-102) 3540.08 -200.90 -5.68
I Acucil S 125mg SUS (n=9) 100.00 900 24.46:t 0.03 220.16 "0.23 207.00 -13.16 " -6.36 I
I AcucilSF250mgSUS(n=22) 100.00 2200 39.32:t0.31 864.9511 0.38 836.00 -28.9511 -3.46 I
I Adco-Amoxycil125mg SUS (n=2000) 102.50:t 17.43 205000 24.77:t 4.30 49535.9911 0.23 I 47150.00 -2385.9911 -5.061
I Adco-Amoxycil500mg CAP (n=2774) 16.32 :t4.06 45259 51.12:t 12.92 141817.95" 3.0711 138945.13 -2872.8211 -2.071
ADDendix G
,
Mei1ScfiemeP,,.;lJ:.!sJ .
., .
Ayege pc.c.l5agfJ
Total
Ayege cost.
Totalcost
Totif(iilJi;ij/atiit
f:l
Ptoductname
.
SY(IJ!J
unitS
unit co$t
,
%
(R)
(R)
(I1J
"
I Adco-Amoxycil250mg CAP (n=4078) II
18.80:1: 7.26 76660
33.20:1: 12.83
135409.64 II 1.7311
132621.80
-2787.841 -2.10 I
I Adco-Amoxycil250mg SUS (n=1366) I
104.22:1: 27.14 142368 40.03:1: 10.31
54684.50 I 0.3811
54099.84 -584.66
-1.081
I Amocillin125mgSUS(n=54)
100.00 5400
25.49:1:5.18 1376.44
0.231
1242.00 -134.44
-10.82 I
Amocillin 250mg CAP (n=243) 19.81 :I:9.32 4815 32.90 :I:20.39 7994.07 1.73
8329.95 335.88
4.031
Amocillin 250mg SUS (n=6) 100.00 600 39.48 236.88 0.38
228.00 -8.88
-3.89 I
Amocillin 500mg CAP (n=167) 15.84 :I:4.22 2645 50.43:1: 13.91 8422.25 3.07
8120.151
-302.10
-3.721
Amoxycillin-Hexal (n=1183)*
16.39:1:5.33 I
19391 I
59.38:1: 17.84 70246.02
1
Betamox 250mg CAP (n=5450)
18.46:1: 10.22 I
100583 I 31.16:1: 12.481169807.43
1.73
174008.59 4201.16
2.41 I
Betamox 500mg CAP (n=6128) 17.49:1:17.12 107160 51.42:1:38.20
315104.751 3.071
328981.20
13876.45 I 4.221
Betamox S 125mg SUS (n=1445) 101.90:1: 14.23 147250 24.84 :I:3.48 35894.12 0.23
33867.50 -2026.62
-5.981
I Betamox SF 250mg SUS (n=1482)
102.41 :I:22.52 151765
39.66 :I:8.64 58775.96 0.38
57670.70 -1105.26
-1.921
I C-Mox 250mg CAP (n=8)
I
14.63:1: 0.52 117 27.48:1: 0.23
219.86 1.73
202.41 -17 .45
-8.621
I C-Mox 500mg CAP (n=18)
15.00 270
47.64 :I:0.22 857.52 3.07
828.90 I
-28.62
-3.451
IIPcamox 250mg CAP (n=55)
28.85:1:17.14 1587 47.20:1:26.85 2595.86
1.73
2745.51 149.65
5.451
I MaxcilA 250mg CAP (n=7063)
17.76:1:8.39 125419 31.10:1:13.92
219684.81 1.73
216974.87 -2709.94
-1.251
16.7BI6.01
52.20:1:
1335414261C3
330665.051 -4729.23ID
Maxcil AF 500mg CAP (n=6426)
19.198
I MaxcilP 125mgSUS(n=3002)
101.91:1:17.23
305943 II 23.74:1:3.88 II 71275.11II 0.2311
70366.89
-908.2211 -1.291
I Maxcil PF 250mg SUS (n=2809)
102.69:1: 16.87
288457 II 38.45:1: 6.47 11107995.72 II
0.3811
109613.66
1617.94 II 1.481
I Moxan 250mg CAP (n=3740)
16.99:1: 5.19
63539 II 30.70:1: 9.24 11114827.37 II 1.7311
109922.47
-4904.90 II -4.46 I
ADDendixG
Medscheme Price Ust
, 0
Average package
Total
Average cost
Total cost
"Cost per
Total calculated E"ect +/-
Product name
Saving
size units
unit cost
%
(R) (R)
(R) (R) (R)
Moxan 500mg CAP (n=10029)
I 16.69:1:5.38 II 16739211 52.14 :I: 14.85 II 522949.52 II 3.071
513893.44
-9056.0811 -1.761
Moxan S 125mg SUS (n=1662)
101.94:1: 15.3711 169425 II 24.84:1: 3.6511 41278.24 II
0.23
38967.75 -2310.49
-5.931
Moxan SF 250mg SUS (n=2489)
105.33:1: 23.70 I
262163 II 40.82:1:9.22 I 101609.8711
0.38
99621.94 -1987.93 -2.00
Moxypen 125mg SUS (n=4435)
102.01 :I:15.71
452403 I
24.88 :I:3.85
110333.43 I
0.23
104052.69 -6280.74 -6.04
Moxypen 250mg CAP (n=10987)
17.87:1:7.08 196389 32.25:1:12.36 354320.85 1.73
339752.97 -14567.88 -4.29
Moxypen 250mg SUS (n=4423)
103.28 :I:21.64 456820 40.06 :I:8.43 177205.39 0.38
173591.60 -3613.79 -2.08
Moxypen 500mg CAP (n=8655)
16.53:1:4.48 143102 52.59:1: 14.71 455131.96 3.07
439323.14 I
-15808.82 -3.60
Penmox 250mg CAP (n=66)
21.41:1:15.50 1413 39.38 :I:26.97 2599.46
1.731 2444.49 I
-154.971
-6.34
Penmox 500mg CAP (n=94)
19.74:1:5.83 1856 69.87 :I:28.25 6567.86 3.07
5697.92 -869.94 -15.27
Penmox P 125mg SUS (n=33)
100.00 3300 25.36 :I:3.59 836.83 0.23
759.00 -77.83 -10.25
Penmox PF 250mg SUS (n=20)
100.00 2000 39.29:1: 0.31 785.86 0.38
760.00 -25.86 -3.40
Promoxil250mg CAP (n=1317)
I 21.09:1:8.82 I 27780 I 13.24:1: 13.241
42892.44 1.73
48059.40 5166.96 10.75
Promoxil S 125mg SUS (n=80)
100.00 8000 24.22 :I:0.28
1937.92 I
0.23
1840.00 -97.92 -5.32
Promoxil SF 250mg SUS (n=80)
108.75:1:28.43 8700 41.85:1:10.96
3347.85I
0.381 3306.00 I -41.851
-1.27
Ranmoxy 250mg CAP (n=3086)
18.87:1:8.47 58230 30.64:1:13.58 94547.78 1.73
100737.90 6190.12 6.14
Ranmoxy 500mg CAP (n=2818)
16.20 :I:4.33 45654 51.31:1:13.67 144601.98 3.07
140157.78 -4444.20 -3.17
Rolab-Amoxil250mg CAP (n=1026)
21.17:1:11.37 21720 34.53:1:16.23 35429.19 1.73
37575.60 2146.41 5.71
Saltermox 250mg CAP (n=10)
22.50 :I:6.77 225 40.96 :I:11.25 409.95 1.73
389.25 -20.70 -5.32
Saltermox 500mg CAP (n=6)
17.50:1:6.12 105 57.25 :I:23.22 343.44 3.07
322.35 -21.09 -6.54
Saltermox S 125mg SUS (n=13)
JI
100.00 1300 25.32 :I:1.67 329.14 0.23
299.00 -30.14 -10.08
ADDendix G
Product name
Average package
size
Total
units
Average cost
Totalcost
ostper
unit cost
Saving
~, " ~'" ,I ' ." (R) . II (~). 1[. (R) II (~) I. (R)
I Saltermox SF 250mg SUS (n=9) I 100.00 II 900 I 38.61 :t 1.6511 347.4911 0.3811 342.00 -5.4911 -1.61
I Spectramox 250mg CAP (n=124) 20.12:t 12.021 2495 36.62:t 22.90 II 4541.16II 1.7311 4316.35 -224.81 II -5.21
I Spectramox S 125mg SUS (n=104) 105.29:t 24.05 10950 27.62:t 5.7311 2872.28 I 0.23 I 2518.50 I -353.78 II -14.05
I Spectramox SF 250mg SUS (n=88) 100.00 8800 40.44:t 5.6911 3558.76 0.38 3344.00 I -214.761 -6.42
IXeracil250mg CAP (n=5) 15.00 75 20.48 I 102.40 1.73 129.75 27.35 21.08
I Zoxil250mg CAP (n=8181) 17.08:t 5.42 139753 30.73:t 9.78 251365.39 1.73 241772.69 -9592.70 -3.97
I Zoxil500mg CAP (n=5574) 16.28:t 5.32 90741 51.37:t 16.79 286322.55 3.07 278574.87 -7747.68 -2.78
I Zoxil S 125mg SUS (n=5690) 101.70:t 13.82 578653 24.78:t 3.37 141018.74 0.23 133090.19 -7928.55 -5.96
I Zoxil SF 250mg SUS (n=3628) 101.69:t 16.15 368918 39.53:t 6.67 1143429.26 0.38 140188.84 -3240.42 -2.31
* Not listed on Medscheme@ Price List.
%
ADDendix G
Table 2G: A .lIin. SeDtember 2002 to D ber2002_n
MedschemePriceList
Averagepackage Total Averagecost Totalcost Costper fotal calculatifd . Effect"l-
Productname Saving
size units : unit cost
, %
' (R) (R) (R) (R) (R)
" -"-diiii1n~1products lji =~".,,- .. ..i :__~ .11' .. J.] . 11;,iJiiJJiJ:~.~~J!;~iJ;0;;jll ..~ .. .. ~ ~ 'uf' "'.. ]1=""'" I
Amoxil250mg CAP (n=515) 16.69:t5.36 8597 42.55:t20.19 21914.98 1.73 14872.81 -7042.17 -47.351
Amoxil500mgCAP (n=631) 16.61 :t 5.97 10484 84.34:t 48.69 53220.43 3.07 32185.88 -21034.55 -65.35 I
AmoxilPead DRP(n=301)* 20.20:t 1.99 6080 56.49:t 5.59 17003.28 I
AmoxilS 125mg SUS (n=487) 106.57:t 27.18 51900 36.93:t 15.70 17982.63 0.23 11937.00 -6045.63 -50.65 I
AmoxilSF 250mg SUS (n=109) 100.92:t 9.58 11000 53.22:t 28.65 5800.47 0.38 4180.00 -1620.47 -38.77 I
Ranmoxy 250mg DISP (n=650)*
I Ranmoxy DISPTAB(n=6)* 20.67:t 10.9811
IM '.,, ~~ifinc productS li~~-- .. . '.- .-11 "'-
A-lennonAmoxyCAP250mg 3O.3H'9.'81~ 55.76H8.45~I ,.7311 I~r--I(n=555) ~ ~ 29167.80 ~~
A-LennonAmoxy125mg (n=194) 102.32:t 18.56 19850 I 25.94:t 5.3411 5031.541 0.231 4565.50 II -466.0411 -10.21
A-Lennon Amoxy 250mg (n=134) 91.54:t37.19 12266 38.14:t16.10 5110.97 0.38 4661.081 -449.8911 -9.65
A-Lennon Amoxy 500mg (n=89) 17.01 :t 4.49 1514 59.17:t 26.14 5266.00 3.07 4647.98 -618.02 -13.30
Acucil SF 250mg SUS (n=6) 100.00 600 39.48 236.88 0.38 228.00 -8.88 -3.89
Adco-Amoxycil125mgSUS (n=1297) 101.93 :t 15.35 132200 24.82 :t 3.74 32188.54 0.23 30406.00 -1782.54 -5.86
Adco-Amoxycil250mgCAP(n=2312) 19.10:t8.45 44120 32.11:t15.72 74227.64 1.73 76327.60 2099.96 2.75
Adco-Amoxycil250mgSUS (n=1062) 104.71 :t 26.89 111205 40.79:t 10.43 43317.43 0.38 42257.90 -1059.53 -2.51
Adco-Amoxycil500mg CAP (n=1890) 16.54:t 4.85 31264 50.95:t 15.78 96297.51 3.07 95980.48 -317.03 -0.33
ADDendixG
. Medscheme price LIst'
.U , ..
Average package
Total
Average cost
Total cost
Cost per
Total calculated . Effect +{-
Product name
Saving
size units
unit cost !
%
(R) (R)
(R) (R) (R)
" .
83970.93 I
Moxypen 125mg SUS (n=3610)
101.13:1:12.80
365091II
24.81 :I:3.22 89552.61 0.23
-5581.68 -6.65
Moxypen 250mg CAP (n=7505)
17.89:1:9.43
134239I
31.24:1:13.84 234474.16 1.73
232233.47 -2240.69 -0.96
Moxypen 250mg SUS (n=3349)
103.61 :I:23.03 346991 40.55 :I:9.36 135795.73 0.38
131856.58 -3939.15 -2.99
Moxypen 500mg CAP (n=6160)
16.55:1:5.18 101918
52.31:I:16.76 I 322230.44
3.07
312888.26 -9342.18 -2.99
Penmox 250mg CAP (n=7)
18.57 :I:5.56 130
49.00 :I:7.51 I
343.00
1.731
224.90 -118.10 -52.51
Penmox 500mg CAP (n=26)
15.58 :I:5.09 405 52.96:1:17.82 1377.02 3.07
1243.35 -133.67 -10.75
Penmox P 125mg SUS (n=6)
100.00 600 29.41 :I:7.64
176.46 I
0.23
138.00
-38.46 I
-27.87
Penmox PF 250mg SUS (n=6)
100.00 600 39.48 236.88 0.38
228.00 I
-8.88 -3.89
Promoxil 250mg CAP (n=845)
21.84:1:12.58
18459 33.52:1:18.82 28324.56 1.73
31934.07 3609.51 11.30
Promoxil S 125mg SUS (n=31)
I
103.23:1: 17.96 3200 25.02 :I:4.09 775.52 0.23
736.00 -39.52 -5.37
Promoxil SF 250mg SUS (n=50)
I
100.00
5000 I
38.54 1926.97 0.38
1900.00 -26.97 -1.42
Ranmoxy 250mg CAP (n=2564)
19.05:1:7.91 I
48851 30.81 :I:12.55 78999.78 1.73
84512.23 5512.45 6.52
3.071
-4341.47I
Ranmoxy 500mg CAP (n=2829)
16.51 :I:4.79 I
46711 52.22 :I: 15.05 147744.24
143402.77 -3.03
Rolab-Amoxil 250mg CAP (n=805)
22.82:1: 14.16 18369
34.89:1:21.35 I 28088.92I
1.73
31778.37 I
3689.45 11.61
Saltermox 250mg CAP (n=7)
20.86 :I:15.50 146 38.18:1:28.05 267.23 1.73
252.58 -14.65 -5.80
Saltermox S 125mg SUS (n=7)
100.00 700 24.48 171.36 0.23
161.00 -10.36 -6.43
Saltermox SF 250mg SUS (n=3)
100.00 300 39.92 119.76 0.38
114.00 -5.76 -5.05
Spectramox 250mg CAP (n=59)
18.14:1:7.06 1070 33.03 :I:13.09 1948.60 1.73
1851.10 -97.50 -5.27
Spectramox S 125mg SUS (n=96)
96.35 :I:33.44 9250 24.71:1:6.67 2372.36 0.23
2127.50 -244.86 -11.51
Spectramox SF 250mg SUS (n=46)
108.70:1:28.49 5000 40.23 :I:15.22 1850.43 0.38
1900.00 49.57 2.61
ADDendix G
* Not listed on Medscheme@ Price List.
---.,.",
1,IJedscniimfil!!f(ceLlst
, , '"
Ay,rag',t;l5agfi
Total
Avflragfl t;OS,t
Total 'cost
. 'Costp,r Total calcij/ateq
r::l
Product namfl
Savings/zfI
unit
coSt
%
(R) (8)
(8)
(8)It
I Zoxil250mgCAP(n=5211)
II
17.23 :I:6.27 89769 30.79:1: 10.91
160468.72 1.73
155300.3711 -5168.3511 -3.331
I Zoxil500mg CAP (n=4426)
II
16.45 :I:5.18 72788
52.18:1:16.16 230969.55 3.07
223459.1611 -7510.39 II -3.361
I Zoxil S 125mg SUS (n=4273)
II
101.53:1: 12.72 433845
24.75:1: 3.14 105742.07 0.23
99784.35 II -5957.72II -5.971
I Zoxil SF 250mg SUS (n=2373)
II
102.57:1: 15.83 243400
39.94:1:7.12 94785.17 0.38
92492.00 II -2293.17 II -2.48 I
ADDendixG
Table 3G: Amoxvcillin. Janua
Product name
Average package
size
Total
Average cost
Saving
%
()l:!gliiaI7;)r(fdu~1S:
.~",)I
Amoxil250mgCAP(n=541) 16.68:1:4.13 9026 30.55:1:13.77 16527.64 1.58 14261.08 -2266.561 -15.891
Amoxil250mgVIAL(n=2)* 15.00 30 361.81 723.62 I
Amoxil500mg CAP(n=563) 16.95:1:7.49 9542 56.74:1:39.54 31947.38 3.07 29293.94 -2653.44 -9.06 I
AmoxilPead DRP (n=548)* 20.26:1:2.25 11100 61.11 :I:6.99 33489.61 0.00 -33489.61 #DIV/O!I
AmoxilS 125mg SUS (n=347) 106.51 :I:27.12 36960 27.08:1:8.41 9395.20 0.23 8500.80 -894.40 -10.52 I
AmoxilSF 250mg SUS (n=143) 105.24:1:23.52 15050 I 44.31:1:20.04 6336.50 0.38 5719.00 -617.50 -10.80 I
Amozxil500mg VIAL(n=3)* 5.00 1511 234.42:1: 0.01 703.27 I
[::J
147.37:1:
aD D
Ranmoxy250mg DISP (n=1033)* 53.73:1:11.12 55500 152232.06
30.07
I Ranmoxy DISP TAB (n=20)*-11 29.55:1: 9.88 591 II 36.46:1: 20.3511 729.20 II II I
G,eliiific prrxlijt;tS
A-LennonAmoxy250';'~CAP ij . .. '1
[3
1 16
1 ID
_ 20.84< 12.09 11503 34.78 <20.04 18188.96. 1.58
(n-552) 18174.74 -1014.22 -5.58
A-Lennon Amoxy 125mg SUS
I
I 1
[3
1 IB
I ID
_ 100.00 17400 23.32:1: 4.90 4058.36 0.23
(n-174) 4002.00 -56.36 -1.41
A-LennonAmoxy250mgSUS
I
I IG
B
I IQ
_ 99.87:1:32.04 15779 39.47:1: 12.32 6236.25 0.38
(n-158) 5996.02 -240.23 -4.01
A-LennonAmoxy500mg(n=268) II 23.59t51.10 I~ 74.45t1'9953.60I~ IiiL-==.J 156.93 ~ 19405.47 -548.13 ~
I Acucil S 125mg SUS (n=3) II 100.00 II 300 II 24.48 II 73.44 II 0.23 II 69.00 -4.44 II -6.43I
ADDendix G
MiflscheijfifPi!ce List
" c ,'w,' , , ~
Av't!1ge p~t:k!1ge Totllt Aver!1g~,;ost ! Totlll,;05tcostper Totaf9!1tcu1tl~d Effect+/-
_iicttJanHI .. . .. SltIill19
I size units unit cost
%
~ ~ ~ ~ ~
I Acucil SF 250mg SUS (n=11) II 100.00 II 1100 II 39.48 II 434.28 0.38 418.00 I -16.28 II -3.89 I
I Adco-Amoxycil125mgSUS(n=1341)II 102.46:f:18.16I 137400II 25.07:f:4.52II 33619.44 0.23 31602.00 -2017.441 -6.38
I Adco-Amoxycil250mg CAP (n=2664) 18.38:f: 7.60 489551 30.27:f: 12.81 I 80628.60 1.58 77348.90 -3279.70 -4.24
I Adco-Amoxycil250mg SUS (n=1070) 103.98:f: 21.57 111260 40.98:f: 8.63 43847.83 0.38 42278.80 -1569.03 -3.71
I Adco-Amoxycil500mg CAP (n=2068) 16.79:f: 5.30 34728 51.21 :f:17.81 105909.771 3.07 106614.96 705.19 0.66
I Amocillin 125mg SUS (n=296) 101.18 :f:13.91 29950 24.84 :f:3.40 7352.39 0.23 I 6888.50 -463.89 -6.73
I Amocillin 250mg CAP (n=202) 16.53:f: 2.78 3340 27.92:f: 5.24 5640.03 1.58/ 5277.20 I -362.83 -6.88
I Amocillin 250mg SUS (n=16) 100.00 1600 39.00:f: 0.97 624.00 0.38 608.00 I -16.00 -2.63
I Amocillin500mgCAP(n=348) 17.51:f:5.64 6095 54.15:f:18.31 18841.07 3.07 18711.65 -129.42 -0.69
I Amoxycillin-Hexal (n=1275)* 17.55:f: 8.05 22374 62.67:f: 27.44 79910.22
I Betamox250mg CAP (n=6164) 18.46:f:7.86 6164 30.66:f:12.53 189005.06 1.58 9739.12 -179265.94 -1840.68
I Betamox500mgCAP(n=6161) I 17.58:f:5.61I 1082811 53.63:f:17.54 I 330411.71 3.07 332422.67 2010.96 0.60
I BetamoxS125mgSUS(n=1872) I 101.10:f:13.40 189255 24.71:f:3.22 46263.21 I 0.23 43528.65 -2734.56 -6.28
I BetamoxSF250mgSUS(n=1613) 100.70:f:16.92 162435 39.39:f:6.46 63538.43I 0.381 61725.30 I -1813.13 I -2.94
I C-Mox250mgCAP(n=9) 15.00 135 25.24:f:1.08 227.19 1.58 213.30 -13.89 -6.51
I'Pcamox 250mg CAP (n=147) 19.24:f: 8.22 2828 29.01 :f: 14.34 4264.61 1.58 4468.24 203.63 4.56
I Maxcil A 250mg CAP (n=3025) 17.72:f:8.00 53606 29.02:f: 11.99 87798.61 1.58 84697.48 -3101.13 -3.66
I MaxcilAF 500mgCAP(n=2055) 16.86:f:6.09 34652 51.34:f:19.46 105503.98 3.07 106381.64 877.66 0.83
I Maxcil P 125mg SUS (n=1469) 100.82:f: 9.00 148100 24.62:f: 2.34 36168.76 0.23 34063.00 -2105.76 -6.18
I Maxcil PF 250mg SUS (n=1362) 109.00:f: 54.98 148463 42.69:f: 21.15 58142.07 0.38 56415.94 -1726.13 -3.06
ADDendix G
, ..MiilsifhemffPfjci List
.__ .w, "V , "', "
~~ ~_t TOtal_.C1r1stjjerrr~.a/otJjjjiei! ettect+t-
Productname Sa.'?i~g
. size unit %
~ ~ ~ ~
w.vn ~
I Moxan 250mg CAP (n=2483) II 17.00:t 5.1811 42217 28.01 :t 8.9411 69551.3611 1.58 66702.8611 -2848.50 -4.27
I Moxan 500mg CAP (n=7584) I 16.77:t 5.44 127166 51.70:t 15.04 392062.20 II 3.07 390399.621 -1662.58 -0.43
I Moxan S 125mg SUS (n=1476) 101.69:t 12.91 150100 24.44:t 3.64 36069.40 I 0.23 34523.00 -1546.40 -4.48
I Moxan SF 250mg SUS(n=1569) 106.05:t27.05 166400 41.12:t11.09 64499.27 0.38 63232.00 -1267.27 -2.00
I Moxypen 125mg SUS (n=4340) 101.95:t 15.12 442460 24.51 :t 4.10 106390.08 0.23 101765.80 -4624.28 -4.54
1 Moxypen250mg CAP (n=9213) 18.13:t8.74 167064 1 29.50:t13.42 271742.61 1.58 263961.12 -7781.49 -2.95
I Moxypen 250mg SUS (n=3796) 103.95:t 23.75 3946051 39.91:t 10.10 1151483.07 0.38 1 149949.90 -1533.17 -1.02
I Moxypen 500mg CAP (n=7351) 17.04:t 6.38 125238 51.95:t 20.6511381902.22 3.071 384480.66 I 2578.44 0.67
1 Penmox 250mg CAP (n=8) 31.88:t 23.29 255 62.37 :t 37.02 II 498.96 1.58 402.90 I -96.06 -23.84
I Penmox 500mg CAP (n=19) 20.21 :t 6.42 384 50.66:t 28.4311 962.58 3.07 1178.88 216.30 18.35
I Penmox P 125mg SUS (n=3) I 100.00 300 24.65 II 73.95 0.23 69.00 -4.95 -7.17
I Promoxil 250mg CAP (n=918) I 20.54:t9.49 18858 31.69:t14.25 II 29092.43 1.58 29795.64 703.21 2.36
I PromoxilS 125mgSUS(n=20) 100.00 2000 I 24.2811 485.53 0.23 460.00 -25.53 I -5.55
I Promoxil SF 250mg SUS (n=21) 100.00 I 2100 38.541 809.321 0.381 798.00 I -11.3211 -1.421
1 Ranmoxy 250mg CAP (n=2539) 18.42 46763 29.93:t 14.28 75993.42 1.58 73885.541 -2107.8811 -2.851
I Ranmoxy 500mg CAP (n=4447) 16.89:t 6.38 75089 53.39:t 20.03 237443.85 3.07 230523.23 -6920.62 -3.00 I
I Rolab-Amoxil 250mg CAP (n=1107) 20.49 :t 9.23 22687 30.39 :t 13.77 33639.69 1.58 35845.46 2205.77 6.15 I
I Saltermox250mgCAP(n=3) 15.00 45 25.50 76.50 1.58 71.10 -5.40 -7.591
I Saltermox 500mg CAP (n=14) 7.79:t 5.54 249 57.00:t 18.90 798.03 3.07 764.43 -33.60 -4.40 I
I SaltermoxS 125mgSUS(n=6) 100.00 600 24.48 146.88 0.23 138.00 -8.88 -6.43 I
ADDendix G
MedscnemePficeUst
0." ' w.>.
Average package Total Average cost Total cost Cost per .Tofal calcula.tea 'Effect +/_ .
Product name Saving
size units unit cost %
~ ~ ~ ~ ~
I Saltermox SF 250mg SUS (n=9) I 100.00 I 900 I 39.77:1:0.2211 357.9611 0.3811 342.00 II -15.9611 -4.67
I Spectramox250mg CAP (n=82) 16.59:1:3.64 1360 25.80:1:7.3311 2115.7511 1.5811 2148.80 II 33.0511 1.54
I SpectramoxS 125mgSUS(n=114) 101.75:1:17.51 11600 24.94:1:4.37 2843.38II 0.23 II 2668.00II -175.38 II -6.57
I Spectramox SF 250mg SUS (n=58) 100.00 5800 39.48 2289.84 0.38 2204.00 -85.84 -3.89
I Xeracil250mg CAP (n=5) 20.00 100 26.63 133.15 1.58 158.00 24.85 15.73
I Zoxil250mg CAP (n=6166) 17.09:1: 6.24 105353 27.88:1: 9.85 171933.47 1.58 166457.74 -5475.73 -3.29
I Zoxil500mgCAP(n=4966) 16.34:1:4.66 81121 51.72:1:14.86 256821.18 3.07 249041.47 -7779.71 -3.12
I Zoxil S 125mg SUS (n=4424) 101.57:1:15.24 449358 24.35:1:3.87 107735.81 0.23 103352.34 -4383.47 -4.24
I ZoxilSF250mgSUS(n=3232) 100.95:I:11.87 326270 38.55:I:4.77 124579.82 0.38 123982.60 -597.22 -0.48
I
\
I
I
I
I
* Not listed on Medscheme@ Price List.
Aooendix G
Medscheme Price Ust
Averagepackage Total Averagecost Totalcost Costpei Totarcalculated. i Effect +{_
Productname ' Saving
size units unit cost, %
(R) (R) (R) (R) (R)
Amocillin125mgSUS(n=83) II 106.02:t23.94 II 8800 II 30.28:t11.69 II 2513.63 0.231 2024.00II -489.6311 -24.191
Amocillin 250mg CAP (n=161) II 18.73:t 6.8411 301511 32.64:t 13.5211 5254.69 1.73 5215.9511 -38.7411 -0.741
Amocillin 250mg SUS (n=7) I 100.00 II 700 II 39.4811 276.36 0.38 266.00 II -10.36 -3.891
Amocillin500mgCAP(n=71) 18.28:t5.30 I 12981 57.56:t17.82 4086.63 3.07 3984.8611 -101.77 -2.55
Amoxycillin-Hexal(n=980)* 17.44:t 8.57 17090 62.50:t 29.13 61248.36 II
Betamox250mgCAP(n=4471) 19.46:t9.26 87014 32.74:t14.73 146381.081 1.73 150534.2211 4153.14 2.76
Betamox 500mg CAP (n=4237) 18.53:t 17.63 78499 54.97:t 47.15 232893.97 3.07 240991.93 II 8097.96 3.36
Betamox S 125mg SUS (n=1278) 103.48:t 20.02 132250 25.24:t 4.93 32253.38 -6.04
Betamox SF 250mg SUS (n=1007) 102.98:t 25.76 103703 39.79:t 10.15 40070.01 -1.68
C-Mox250mg CAP (n=4) 26.25:t7.50 105 7.18:t13.28 28.72 1.73 181.65 152.93 84.19
C-Mox 500mg CAP (n=3) 21.00 63 68.23 204.69 3.07 193.41 -11.28 -5.83
Ipcamox 250mg CAP (n=16) I 21.88 :t 15.04 350 I 36.14 :t 23.62 I 578.29 I 4.49
MaxcilA 250mgCAP(n=3587) 17.79:t9.64 I 63824 31.11:t 16.14 111581.92 1.73 110415.52 -1166.40 -1.06
Maxcil AF 500mg CAP (n=3132) 16.67 :t 5.28 I 52202 51.19:t 17.35 160337.38 3.07 I 160260.14 I -77.241 -0.05
Maxcil P 125mg SUS (n=1987) 101.21 :t 10.93 201100 24.26:t 2.76 48209.98 0.23 46253.00 -1956.98 -4.23
Maxcil PF 250mg SUS (n=1549) 106.47:t 31.67 164915 40.78:t 12.57 63161.51 0.38 62667.70 -493.81 -0.79
Moxan 250mg CAP (n=2065) 16.94:t 5.58 34984 30.31 :t 10.05 62581.18 1.73 60522.32 -2058.86 -3.40
Moxan 500mg CAP (n=6162) 16.80:t 5.68 103524 52.73:t 16.08 324921.82 3.07 317818.68 -7103.14 -2.23
Moxan S 125mg SUS (n=1290) 101.74:t 13.02 131250 24.92:t 3.29 32150.71 0.23 30187.50 -1963.21 -6.50
Moxan SF 250mg SUS (n=1294) 104.48:t 22.14 135200 40.90:t 8.86 52922.66 0.38 51376.00 -1546.66 -3.01
ADDendixG
Table 4G: Amoxvcillin/clavulanic acid. Mav 2002 to Au
Product name
Average pac/fage
size
Average cost
(R)
r~ I
AugmenlinO.6g~Al(n=17)' 154H'2.1'1L3 6::'~ BDI IDb
I Augmentin 1.2gVIAL (n=35)* 1.00 3511 87.31 :I:0.0811 3055.71 II II II 1
Augmentin1000BDTAB
G
D I I
D I
10.59:1:2.58 254311 221.33:1:55.28 5314348.65
(n=24011 )*
Augmentin 375mg TAB (n=2104) 15.98:1:3.21 33627 139.99:1:43.83 294548.98 6.87 231017.49 -63531.49 -27.50 I
Augmentin 625mg TAB (n=680) 15.89:1:3.60 10808 210.89:1:66.15 143406.93 11.33 122454.64 -20952.29 -17.11 1
Augmentin COMB PACK (n=3)* 1.00 3 145.64 436.92 I
Augmentin S 156mg SUS (n=1011) 106.03:1:26.94 107200 51.26:1:36.45 51821.62 0.59 63248.00 11426.38 I 18.071
Augmentin SF 312mg SUS (n=996) 104.09:1:20.57 103675 140.91 :I:38.41 140346.19 1.16 120263.00 -20083.19 II -16.70 I
'""1
Adco-Amoclav 375mg CAP
G
6C3 1 w i
= 15.64:1: 3.07 50659 109.01:1: 22.22 353088.45 6.87
(n 3239) 348027.33 -5061.12 -1.45
I Adco-Amoclav Forte SUS (n=157) 103.18:1:17.62 16200 120.20:1:20.56 18871.52 1.16 18792.00 -79.52 -0.42
I Adco-Amoclav S SUS (n=123) 102.44:1:15.49 12600 60.90:1:8.98 7490.21 0.59 7434.00 -56.21 -0.76
I Augmaxil375mg TAB (n=39660) 15.67:1:3.61 621576 109.13:1:25.89 4328043.11 6.87 4270227.12 -57815.99 -1.35
I Augmaxil 625mg TAB (n=12850) 15.68:1:3.42 201524 179.54:1:40.23 2307110.05 11.33 2283266.92 -23843.13 -1.04
I Augmaxil S 156mg SUS (n=8518) 102.47:1:17.45 872835 61.60:1:10.42 524671.82 0.59 514972.65 I -9699.17 -1.88
I Augmaxil SF 312mg SUS (n=10926) 102.36:1:16.33 1118375 119.64:1:19.27 1307133.75 1.16 1297315.00 II -9818.75 -0.76
ADDendix G
Product name
Ave'1fge package
size
Total
units
Average cost II Total cost
Saving %
.. ,", . J l8J ,I .{RJ. II. (~J
I Bio-Amoksiklav 375mg TAB (n=901) II 15.48:f: 2.36 1394911 98.90:f: 22.841 89109.8511 6.8711 95829.6311 6719.78 I 7.01 I
I Bio-Amoksiklav625mgTAB(n=316) II 16.52:f:3.16 5220 II 178.80:f:37.481 56501.5411 11.331 59142.60 2641.06 4.471
I Bio-Amoksiklav S SUS (n=318) II 100.94:f: 9.68 32100 II 60.07:f: 5.84 I 19103.19 I 0.59 18939.00 -164.19 -0.87 I
I Bio-AmoksiklavSFSUS(n=451) I 104.88:f:24.46 47300 I 37.07:f:64.41 16718.85 1.16 54868.00 38149.15 69.53
I Clamentin 375mg TAB (n=14051) 15.63:f:2.96 I 219661 109.00:f:20.85 1531526.31 6.87 1509071.07 -22455.24 -1.49
I Clamentin S 125mg SUS (n=3520) 101.61 :f: 13.06 I 357660 61.60:f: 7.97 216828.56 0.59 211019.40 -5809.16 -2.75
I Clamentin SF 250mg SUS (n=4138) 102.19:f: 15.45 422875 119.57:f: 19.16 494796.02 1.16 490535.00 -4261.02 -0.87
I Clamentin 0.6g IV (n=8)* 1.00 8 41.21 329.68
I Clamentin 1.2g IV (n=3)* 1.00 3 75.38 226.14
I Clavumox 375mg TAB (n=12404) 15.73:f:3.61 195140 109.76:f:25.20 1361473.22 6.87 1340611.80 -20861.42 -1.56
Ic,avumoxs156mgsus(n=3494) 102.56:f:16.70 358345 61.31:f:10.99 214217.91 0.59 211423.551 -2794.361 -1.32
Ic,avumoxsF312mgsus(n=4927) 102.11:f:15.63 503105 119.37:f:18.41 588120.571 1.161 583601.801 -4518.771 -0.77
I Moxyclav 375mg TAB (n=1353) 15.37:f: 1.92 I 20802 1107.21:f: 13.63 145054.70 I 6.871 142909.74 -2144.96 -1.50
I Moxyclav S 125mg SUS (n=151) 103.97:f: 19.60 I 15700 I 62.49:f: 12.01 9436.42 0.59 9263.00 -173.42 -1.87
I Moxyclav SF 250mg SUS (n=200) I 102.00:f: 14.04 20400 119.24:f: 16.32 23847.02 1.16 23664.00 -183.02 -0.77
I Ranclav 375mg TAB (n=10421) II 15.77:f:3.15 164330 107.52:f:21.67 1120479.85 6.87 1128947.10 8467.25 0.75
I Ranclav625mgTAB(n=5116) II 15.75:f:3.16 80597 174.35:f:34.97 891959.75 11.33 913164.01 21204.26 2.32
I RanclavS125mgSUS(n=1853) II 102.70:f:18.10 190300 59.61:f:11.16 I 110452.09 0.59 112277.00 1824.91 1.63
I RanclavSF250mgSUS(n=2588)* II 102.85:f:17.93 266187 113.87:f:19.75 II 294685.06
I Rolab-Amoclav375mgTAB II 16.14:f:3.75 122107 111.15:f:29.12II 841096.33 6.87 838875.09 -2221.24 -0.26
ADDendix G
firoduct name
Total
.unlts
I (n=7567) II II II II II II II II I
I Rolab-Amoclav S SUS (n=1461) II 103.29:t 18.9511 150900 II 61.61:t 11.41 II 90006.5711 0.5911 89031.00 II -975.5711 -1.10 I
I Rolab-Amoclav SF SUS (n=1579)" 102.89:t 19.1811 162460 11120.23:t 22.91" 189850.2211 1.1611 188453.60 II -1396.6211 -0.741
* Not listed on Medscheme@ Price List.
ADDendix G
Table 5G: Amoxvcillin/clavulanic acid. SeDtember 2002 to December 2002.
1~.==()n~i~~1produ~tS~,""___I~ >,",;7'7']1=;". 21[;" w~w, n:';T:-][" . .~I
Augmentl"0.6gVIAL("=13)' 2O.77<12.221C3 86:;:::BDI IDD
I Augmentin 1.2g VIAL (n=12)* 1.33:t 1.15 16 II 112.18:t 86.10 II 1346.11 II I
Augmentin 1000 BDTAB
[3
DD
10.57:t 2.55 185695 221.54:t 54.85 3891115.76
(n=17564)*
I Augmentin 375mg TAB (n=1396) 16.15:t4.10 22545 138.87:t47.69 193856.58 6.87 154884.15 -38972.43 -25.161
I Augmentin 625mg TAB (n=484) 16.10:t3.48 7793 209.61 :t67.01 101450.86 11.33 88294.69 -13156.17 -14.90 I
I AugmentinS 156mgSUS(n=813) 104.31:t 20.31 84800 52.41:t 32.64 I 42607.24 0.59 50032.00 7424.76 14.84 I
I Augmentin SF 312mg SUS (n=680) II 104.71:t21.19II 71200 I 138.25:t32.99I 94012.20 I 1.16 82592.00 -11420.20 -13.831
r:. '.!'~"!~~~J!cts .,".11 .. ".. . ,JI~i;JI . . , ==J["" , - .
Adro-Amoclav375mg CAP 1[:3
B
I I
c::JQ
= 15.75:t 3.81 45838 109.21 :t 27.78 317798.96 6.87
(n 2910) 314907.06 -2891.90 -0.92
Adco-Amoclav 625mg CAP
[:3 8
1 I
c::JQ
_ 15.48:t2.15 22742 177.77:t25.48 261150.57 11.33
(n-1469) 257666.86 -3483.71 -1.35
I Adco-Amoclav ForteSUS (n=593) 101.69:t12.89 60300 119.36:t15.21 II 70778.89 1.16 69948.00 -830.89 -1.191
I Adco-Amoclav S SUS (n=499) 104.21 :t 22.90 52000 62.61 :t 14.1611 31244.45 0.59 30680.00 -564.45 -1.84 I
I Augmaxil 375mg TAB (n=16252) 15.64:t3.10 254241 109.04:t22.79 II 1772090.46 6.87 1746635.67 -25454.79 -1.461
I Augmaxil625mg TAB (n=5117) 15.56:t 2.67 79622 177.56 :t 36.07 II 908574.15 11.33 902117.26 -6456.89 -0.72 I
I AugmaxilS156mgSUS(n=4191) 101.48:t13.53 425296 62.10:t9.38 II 260263.16 0.59 250924.64 -9338.52 -3.721
Average package
size
Average cost
Saving
%
ADDendix G
Product name
%
I Augmaxil SF 312mg SUS (n=4964) I 101.83:t14.99 II 50550811 121.22:t21.59 II 601713.4811 1.161 586389.2811 -15324.20 II -2.611
Bio-Amoksiklav375mgTAB 15.5H3.071~ ,08.7..2,.681"5962.,311 6.87 [r---Ili("=1086) L =-:.:J 114358.02 ~~
I Bio-Amoksiklav625mgTAB(n=605) 16.10:t3.00 II 974311 161.71 :t60.68 II 97835.561 11.33 110388.19 12552.63 11.37
I Bio-Amoksiklav S SUS (n=130) 102.31 :t 15.0711 13300 I 61.51 :t 9.27 7996.05 0.59 7847.00 -149.05 -1.90
I Bio-Amoksiklav SF SUS (n=445) 101.91 :t 15.44 I 45350 39.64 ::!:59.80 17638.52 1.16 52606.00 34967.48 66.47
I Clamentin 375mg TAB (n=10828) 15.62:t2.90 169085 108.89:t20.47 1179057.97 6.87 1161613.95 -17444.02 -1.50
I Clamentin 1.2g IV (n=2)* 3.00 6 222.02 444.04
I ClamentinS 125mgSUS(n=2664) I 101.33:t12.85 269930 61.58:t7.98 164047.83 0.59 159258.70 -4789.131 -3.01
I Clamentin SF 250mg SUS (n=3350) 101.60:t 13.22 340370 119.14:t 15.53 399127.35 1.16 394829.20 -4298.15 -1.09
I Clavumox375mgTAB(n=9646) 15.74:!:3.40 151842 109.05:t 24.24 1051850.60 6.87 1043154.54 -8696.06 -0.83
I Clavumox S 156mg SUS (n=3300) 101.96:t 15.89 336477 61.63:t 10.05 203374.93 0.59 198521.43 -4853.50 -2.44
I ClavumoxSF312mgSUS(n=3866) 103.46:t19.73 399975 121.06:t25.53I 468000.00 I 1.161 463971.00 -4029.00 -0.87
I Moxyclav375mg TAB (n=993) 15.50:t2.33 I 153881 107.18:t17.07 106430.11 6.87 105715.56 I -714.55 -0.68
I Moxyclav S 125mg SUS (n=136) I 100.74:t 8.571 13700 58.26:t 13.56 7923.66 0.59 8083.00 I 159.34 1.97
I MoxyclavSF250mgSUS(n=165) 104.24:t20.22 17200 122.52:t24.08 20215.53 1.16 19952.00 -263.53 -1.32
I Ranclav 375mg TAB (n=10727) 15.65:t 3.36 167928 106.63:t 23.07 1143785.14 6.87 1153665.36 9880.22 0.86
I Ranclav625mgTAB(n=6259) 15.61:t2.76 97711 172.98:t30.63 1082670.21 11.33 1107065.63 24395.42 2.20
I RanclavS125mgSUS(n=1992) 103.06:t17.23 205300 59.51:t10.12 118540.91 0.59 121127.00 2586.09 2.14
I Ranclav SF 250mg SUS (n=2635) 102.11 :t 14.66 269050 112.86:t 16.64 297389.19 1.16 312098.00 14708.81 4.71
ADDendix G
(R) (R)
%
Roiab-Amoclav375mgTAB I IG 8
1 II Ic::JQ
= 16.01 :i: 3.84 139456 110.25 :i:29.04 960420.78 6.87
(n 8711) 958062.72 -2358.06 -0.25
I Rolab-AmociavS SUS (n=1411) II 102.34:i:15.12 II 144400 II 61.10:i:1o.0411 86205.2711 0.5911 85196.00 II -1009.2711 -1.181
I Rolab-Amoclav SF SUS (n=1533) II 103.08:i: 17.4911 15802311 120.75:i: 21.3811 185105.0711 1.1611 183306.6811 -1798.3911 -0.981
* Not listed on Medscheme@ Price List.
ADDendixG
Table 6G: Amoxvcillin/clavulanic acid. Janua
(R) (R)
(R)
cost
8
Saving
I Effect +/.
%
L-= .. ~n.'piOdUC...llJ'~iL -~-:-iiji.'~::j~...~. II. II !
I Augmentin 0.6g VIAL (n=56)* 1.88:t 1.65 10511 90.81 :t 72.7311 5085.5211 II II II I,
Augmentin1.2gVIAl(n=7). 4.86H.81 D 38:2B~ c:::JDI IDD
I Augmentin1000 BDTAB(n=22654)* 10.46:t 2.38 236981 II 228.57:t 52.93115177915.05
I Augmentin 625mg TAB (n=420) 15.85:t 3.56 665711 180.61:t 51.8811 75857.76 11.00 73227.00 -2630.76 -3.59
1 AugmentinCOMBPACK(n=2)* 1.00 211 159.8911 319.78
I Augm.n~:'5B~ ~u~(~OO) i~« 101:9~;~~j I: B1100~II,~:BH11.671'::~~~",~ 0.57i' ~~5:50~.-1~.OO< 4.43
Adco-Amoclav375mgCAP(n=3239) 15.66:t3.18 50726 107.25:t23.55 347387.15 6.7311 341385.9811 -6001.171 -1.761
Adco-Amoclav625mgCAP(n=751) 15.25:t1.71 11456 169.70:t22.23 127447.28 11.00 II 126016.00I -1431.28 -1.14 I
Adco-AmoclavFORT SUS (n=966) 101.14:t 11.99 97700 114.16:t 13.33 110281.07 1.10 107470.00 -2811.07 -2.621
Adco-AmoclavS SUS (n=696) 103.45:t19.02 72001 60.62:t12.14 42190.96 0.57 41040.57 -1150.39 -2.80 I
Augmaxil375mgTAB(n=11637) 15.66:t2.96 182208 107.57:t20.87 1251830.92 6.73 1226259.84 25571.08 -2.091
Augmaxil625mg TAB(n=5140) 15.61 :t3.06 80230 173.53:t35.98 891919.08 11.00 882530.00 -9389.08 -1.061
AugmaxilS 156mg SUS (n=3791) 102.42:t 16.94 388265 59.66:t 10.08 226185.94 0.57 221311.05 -4874.89 -2.20 I
AugmaxilSF 312mg SUS (n=4578) 101.99:!:14.57 466910 114.32:t 17.23 523340.96 1.10 513601.00 -9739.96 -1.90 I
Product name
Average package
size
Total
Average cost
Totalcost
Cost per
unit
units
(R)
ADDendix G
Product name
Average package
size
Total
units
Average cost
Totalcost
~:"""'<"O'
I ~~Costper
unit
1ifiijSCFiifiie7:J;;ceUSi~
Tota/eli"il d 1-
cost Effect.+/-
Saving
... .." ~.. J (If) n (If) ... U.~ (R) Il.L... ..fR!
15.64"2.611~ '08.3'"'8.561248672.7311 8.73 llir--l~ 241701.22 ~~
Bio-Amoksiklav825mgTAB IG
a l I
c::JQ
_ 16.40:f:3.35 26190 177.28:f:40.52 283120.43 11.00
(n-1597) 288090.00 4969.57 1.73
I Bio-AmoksiklavS SUS (n=349) 103.30:f:20.67 36050 II 60.96:f: 12.3911 21274.4311 0.57 20548.50 II -725.93 -3.531
I Bio-AmoksiklavSF SUS (n=555) 110.27:f:30.24 6120011 115.61:f:46.98 II 64164.5811 1.10 67320.00 II 3155.42 4.691
1 Clamentin 375mg TAB (n=11943) 15.68 :f:3.20 187281 11107.43:f: 22.45111283043.2711 6.73 1260401.1311 22642.14 -1.80 1
I ClamentinO.6gIV(n=3)* 3.00 911 118.1911 354.57/1 II I
Clamentin 1.2g IV(n=7)' 5.00 D 34:~::c::JD IDD
ClamentinS 125mgSUS(n=3357) 102.41::I:15.35 343800 60.22::1:9.70 202148.39 0.57 195966.00 -6182.3911 -3.15 I
Clamentin SF 250mg SUS (n=4108) 101.18:f:12.49 415640 113.48:f:15.80 466177.62 1.10 457204.00 -8973.621 -1.961
Clavumox375mg TAB(n=15101) 15.67:f:3.11 236666 106.78:f:21.76 1612524.95 6.73 1592762.18 19762.7'7 -1.241
ClavumoxS156mgSUS(n=4613) 102.59:f:18.11 473234 58.97::1:10.46 272011.59 0.57 269743.38 -2268.21 -0.841
ClavumoxSF 312mg SUS (n=4141) 102.52:f:15.97 424550 113.63:f:17.88 470542.53 1.10 467005.00 -3537.53 -0.761
Moxyclav375mg TAB(n=5594) 15.75::1:3.08 88084 106.98:f:22.09 598470.62 6.73 592805.32 -5665.30 -0.961
MoxyclavS 125mgSUS (n=392) 100.77:f:8.73 39500 57.73:f:5.18 22629.81 0.57 22515.00 -114.81 -0.51 I
MoxyclavSF 250mg SUS (n=633) 102.53:f:17.83 64900 113.48:f:19.60 71835.96 1.10 71390.00 -445.96 -0.621
Ranclav 375mg TAB(n=15435) 15.54:f:2.56 239788 105.98:f:18.47 1635727.19 6.73 1613773.24 21953.95 -1.361
Ranclav625mgTAB(n=9783) 15.62:f:2.83 152850 172.72:f:32.98 1689761.81 11.00 1681350.00 -8411.81 -0.50 I
%
Bio-Amoksiklav 375mg TAB
(n=2296)
ADDendix G
lflJU _ (8) J. ~. "
I Ranclav S 125mg SUS (n=3415) 103.56:t 19.2911 353660 II 58.77:t 14.9511 200708.41 II 0.57 201586.20 877.7911 0.44 I
I Ranclav SF SUS (n=4698) 102.26:t15.4611 480410 II 111.74:t22.87 II 524931.6811 1.10 528451.00 3519.3211 0.671
Rolab-Amociav375mg TAB 15.83< 3.591~ 108.38 <27.61 1161686.171 6.73 ~II(n=10907) ~ 1161995.07 ~L:1ill
I Rolab-Amoclav S SUS (n=866) 102.89:t 16.75 II 89100 II 59.77:t 12.3611 51758.16 II 0.57 50787.00 -971.16 II -1.91 I
I Rolab-Amoclav SF SUS (n=720) 102.64:t 16.0411 73900 II 115.81:t 18.7311 83381.7311 1.10 81290.00 -2091.7311 -2.571
* Not listed on Medscheme@ Price List
Average package
size
Average cost
Totalcost
ADDendixG
Table 7G: Amoxvcillin/flucloxacillin. Mav 2002 to Auaust 2002.
Product name
Average package size II Total units" Average cost It Total cost
(R) (R)
Aooendix G
Table 8G: Amoxvcillin/flucloxacillin. Seotember 2002 to December 2002.
Product name
Average package size U Total units II Average cost H Total cost
(R) (R)
ADDendixG
Table 9G: Amoxvcillin/flucloxacilln. Janua
Product name
Average package size II Total units II Average cost
I~ ~~~~griial proifucts~.o" ~]I*:'i!'~"=aI;i!fI '. ,!liEU ,. ., Jr ~.~Jlr a=,. U ' ,]1 ~
I Suprapen500mgCAP(n=238) II 16.67:1:3.5611 39681193.74:1:27.4911 22311.2911 5.20 II 20633.60 II -1677.6911 -8.131
I Suprapen S 250mg SUS (n=82) II 108.5411 8900 II 92.37:1: 24.84 II 7573.9711 0.8211 7298.00 II -275.9711 -3.781
~,~~ ' (3iij~~c. ~rc>~~.~! " nii ~" ~** .' 'U,~~;~. J I ';111 [,' 'U'c lIii!'lIm. *: r 11 '
I Flumox500mg CAP (n=274)* 16.05:1:4.54 4398 84.20:1:26.05 23070.68
I Macropen 500mg CAP(n=6126) 16.73:1:7.02 102465 87.63:1:36.76 536795.23 5.20 532818.00 -3977.23 -0.75
I Macropen S 250mg SUS (n=2371) 103.36:1:18.93 245075 85.95:1:15.72 203778.54 0.82 200961.50 -2817.04 -1.40
I Megapen 500mg CAP (n=3207) 16.90:1: 5.55 54206 89.34:1: 28.39 286500.71 5.20 281871.20 -4629.51 -1.64
I Megapen S 125mg SUS (n=754) 104.67:1:25.27 78924 86.51:1:20.85 65227.60 0.82 64717.68 -509.92 -0.79
* Not listed on Medscheme@ Price List.
ADDendix G
Table 10G:AmDicillin. Mav2002 to Auaust 2002.
Product name
Avel'ilge pCfclcage~;~eI1IT~~'linit$1I Average cost. Total cost ilrCostpifilnlt
(R)
",",~~~ml~ .,7 , . ;,.,.AI oJ q~ iI
1:. .Ofjg/hal prodUctS U' ~~. ='a U==-!"!~gt. . Uj:;i(III~~j;.I::U . ~ . . U hi
I II II II 1111 II 11>..11 .1
Ampimax250mg CAP (n=3) II 15.00 45 16.19 48.57 1.00 45.00 II -3.57 -7.93
Ampipen125mgSUS(n=3) II 100.00 300 18.48 55.44 0.17 51.00 -4.44 -8.71
Ampipen250mg CAP (n=71) II 37.54:t20.09 266539.66:t28.14 2815.60 1.00 2665.00 -150.60 -5.65
Ampipen500mgCAP(n=11) II 21.36:t5.95 23538.94:t12.79 428.30 1.80 423.00 -5.301 -1.25
Ampi-Rol250mg CAP(n=184)* II 31.84:t 20.71 5858 31.77:t 19.97 5845.04
Ampi-RoI500mgCAP(n=282)* II 22.11:t8.14 6234 40.78:t14.53 11501.14 I
Be-AmpiciI125mgSUS(n=50) II 100.00 5000 16.96:t0.12 848.01 0.17 850.00 1.99 0.23
Be-AmpiciI250mgCAP(n=247) 25.60:t10.03 6323 21.52:t8.02 5315.14 1.00 6323.001007.86 15.94
Penrite S 250mg SUS (n=2) 100.00 I 200 I 40.471 80.941 0.22 I 44.00 -36.94 -83.95
Petercillin125mg SUS (n=128) 110.94:t 31.33 14200 19.88:t 5.55 2544.13 0.17 2414.00 -130.131 -5.39
Petercillin250mg CAP(n=384) 26.09:t 12.55 10020 25.10:t 12.76 9638.51 1.00 10020.00 381.49 3.81
Petercillin250mg SUS (n=153) 100.00 15300 22.85:t 0.16 3495.36 0.22 3366.00 I -129.36 -3.84
Petercillin500mg CAP (n=723) 24.00:t8.74 17354 41.00:t14.31 29640.58 1.80 31237.201596.62 5.11
Ranamp 500mg INJ (n=4) 1.75:t 0.50 7 30.52:t 8.72 122.08
Spectracil125mgSUS(n=10) 100.00 1000 18.72:t0.75 187.18 0.17 170.00 -17.18 -10.11
Spectracil 250mg CAP (n=6) 20.00 120 20.52 123.12 1.00 120.00 -3.12 -2.60
Spectracil250mg SUS (n=12) 100.00 1200 23.48 281.76 0.22 264.00 -17.76 -6.73
.Not listed on Medscheme Price List.
ADDendix G
Average package size Average cost
(R)
(R)
~'= :.'.11
I II II II II II II II II I
_ . .:~eri'fJ~p!~~t!ctS~'-~H~..-, -:TI"iJl[=:rll." .~.,J[' '~I
Ampipen 250mg SUS (n=3) II 200.00 II 600 II 69.52 208.56 0.32 192.00 II -16.56 -8.63
Ampipen250mgCAP(n=43) 26.28:f:9.00 II 1130 16.42:f:10.49 705.85 1.00 1130.00 424.15 37.54
Ampipen500mgCAP(n=7) 28.57:f:10.69 20060.74:f:23.73 425.16 2.10 420.00 -5.16 -1.23
Ampi-Rol 250mg CAP (n=96)* 26.74:f: 11.83 2567 28.28:f: 11.69 I 2714.87
Ampi-Rol500mg CAP (n=167)* 20.90:f: 4.74 3490 40.89:f: 8.60 6829.17 I
Be-Ampicil125mg SUS (n=19) 131.58:f: 74.93 2500 22.54:f: 12.19 428.26 0.17 425.00 -3.26 -0.77
Be-Ampicil250mg CAP (n=91) 25.64:f: 9.71 2333 23.46:f: 8.16 2135.20 1.00 I 2333.00 197.80 8.48
I Petercillin 125mg SUS (n=109) 111.01 :f: 29.15 12100 20.50:f: 5.95 2234.24 0.17 2057.00 I -177.24 -8.62
I Petercillin 250mg CAP (n=313) 29.03:f: 14.50 9085 28.76:f: 14.39 9002.62 1.00 9085.00 82.38 0.91
I Petercillin 250mg SUS (n=86) 97.21 :f:14.76 8360 11.30:f:11.19 971.94 0.32 2675.20 1703.26 63.67
I Petercillin 500mg CAP (n=580) 23.06:f: 8.74 13374 39.44:f: 14.21 22877.26 2.10 28085.40 5208.14 18.54
I Ranamp500mgINJ(n=3)* 2.00 6 34.88 104.64
I Spectracil 250mg CAP (n=6) 53.50 :f:29.03 321 52.88 :f:27.62 317.28 1.00 321.00 3.72 1.16
I Spectracil125mg SUS (n=2) 200.00 400 37.22 74.441 0.17 68.00 -6.44 -9.47
* Not listed on Medscheme@Price List.
ADDendix G
Table 12G: AmDicillin.
Product name
Average package size 'II Totalunits II Average cost Total cost
(R) (R)
L'iH LL=~=lth' ,If ,~, "n:\jJ!~~I_I=L'=~l~r . ;~" :1
I . ..' ... .' . .11..i.i ..' i.. 11. i.i.i i .11 i.' II . ...II'i i . . ..i.i.iI1i..i.i:.,/.///:II II. . ;1
~." ~~!~iiJt:pr~i!iif;~h =.]_1 ...IL>.~.,~..<JI ..,]li=~=~~==,jLU;.~f.iijlij~~:liI010iI1t' . ,U.~.~._.]
I Ampipen250mg CAP (n=48) 26.90:i: 10.13 1291 14.93:i: 10.77 716.80 1.01 1303.91 587.11 II 45.03
I Ampipen500mg CAP (n=3) 20.00 60 36.49 109.47 2.01 120.60 11.13 II 9.23
I AmpipenF 250mg SUS (n=1) 100.00 100 34.12 34.12 0.33 33.00 -1.1211 -3.39
I Ampicillin500mg INJ (n=2)* 10.00 20 195.82 391.64 II
I Ampi-Rol 250mg CAP (n=109)* 30.08 :i:18.37 3279 26.60 :i:19.62 2899.24 I
I Ampi-Rol500mg CAP(n=247)* I 20.23:i: 2.931 49971 40.54:i: 6.28 I 10012.63 I
I Be-Ampicil125mgSUS (n=34) 100.00 3400 18.24:i:0.79 620.17 0.17 578.00 -42.17 -7.30
Be-Ampicil250mgCAP(n=144) 29.35:i:14.99 4227 27.95:i:13.74 4024.10 1.011 4269.27 245.17 5.74
Petercillin125mg SUS (n=84) 113.10:i:33.94 9500 20.36:i:6.51 1710.00 0.17 1615.00 I -95.00 I -5.88
Petercillin 250mg CAP (n=342) 29.92:i: 15.41 10232 3.62:i: 8.25 379.93 1.01 10334.32 9954.39 96.32
Petercillin 250mg SUS (n=105) 98.50:i: 10.82 10343 29.89:i: 14.44 10223.71 0.33 3413.19 -6810.52 -199.54
Petercillin 500mg CAP (n=779) 23.70:i: 10.20 18461 40.37:i: 16.64 31448.30 2.01 37106.61 5658.31 15.25
Spectracil125mg SUS (n=5) 100.00 500 17.48 87.40 0.17 85.00 -2.40 -2.82
Spectracil 250mg CAP (n=9) 53.33 :i:20.00 480 26.26 :i:38.79 236.34 1.01 484.80 248.46 51.25
Spectracil250mg SUS (n=16) 100.00 1600 34.48 551.68 0.33 528.00 -23.68 -4.48
* Not listed on Medscheme@Price List.
ADDendix G
Table 13G:AmDicillin/cloxaciliin. Mav 2002 to Auaust 2002.
Product name
Average package size U Total units II Average cost
(R)
ADDendix G
Table14G: AmDicillin/cloxacillin. SeDtember 2002 to December 2002.
Medschiiiie Price List
prOd
.
uct n n Av""'1/8 pack.ga size II Totalunits 1
.
1 Averagecost To..l ,"c- p;" unh~-t;;;;;r_iil r.;;;:;;;:J
...
. .
..
0
(R) (R) (R) (R) L::::I'Saving %
.'~"":t!~~~~rjiiifdtictS"M'ir"'~ ~jrl!~';\J];;~?'id~ ~ 1[.= It ..~ n'u,,~,~, . "~I"7. ]
Ampiclox 500mg CAP (n=300) II 21.37:J:7.9411 6410 11127.98:J: 51.9811 38207.5711 4.7311 30319.30 II -7888.2711 -26.021
Ampiclox S 250mg SUS (n=95) II 103.16:J: 17.5811 9800 II 69.11:J: 16.10 II 6565.0511 0.60 II 5880.00 II -685.0511 -11.651
Ampiclox 500mg VIAL (n=3)* II 5.00 II 15 II 133.8211 401.4611 II II II I
t.w...~~ Gene!!:I?~!:~c~ .. 11"'= ..n II II H 'IIIC';' 'T'rn::" . ':;=~. U U ~J
IApen 500mg CAP (n=1140) II 21.49:J:7.31 24503 104.37:J:34.33 118978.77 4.73 115899.19 -3079.58 -2.661
I Apen S 250mg SUS (n=269) II 102.08:J:20.99 27460 62.34:J:12.98 16769.34 0.60 16476.00 -293.34 -1.781
I Cloxam 500mg CAP (n=742) II 22.39:J:9.76 16616 103.32:J:43.35 76665.69 4.73 78593.68 1927.99 2.451
I Megamox 500mg CAP (n=569)* II 20.91 :J:7.47 11897 97.57:J:33.04 55519.81 I
I MegamoxS 250mgSUS(n=272)*II 108.05:J:35.24 29389 61.10:J:20.33 16618.37 I
* Not listed on Medscheme@ Price List.
Aooendix G
Table 15G: Amoicillin/cloxacillin. Janua
Product name
Average package size HTotal units 11 Average cost II Total cost
Medscheme Price Ust
,.,
iotafCi1i:uliifeCi cast
Sa
(R) II' ."...(~L~. .1
I Ampiclox500mgVIAL(n=7)* 11.86:1:10.16 I 8311351.15:1:296.3311 2458.04 II II II I
I AmpicloxS 250mg SUS (n=145) 110.34:1:30.56 I 16000 II 67.88:1:18.2311 9842.68 0.60 II 9600.00 II -242.6811 -2.531
r"'-Ge;jencpiOClucts== [=-..== ~~~=][=:'=f: I- ~ ... n- J
I Apen 500mg CAP (n=1545) 21.43:1: 6.34 3311611 94.36:1: 27.09 145785.49 4.30 142398.80 -3386.69 -2.381
I ApenS 250mgSUS(n=525) 104.00:1:19.61 54600 II 62.93:1:12.02 33038.08 0.60 32760.00 -278.08 -0.851
I Cloxam500mg CAP (n=961) 22.10:1:7.62 2123411 96.86:1:33.53 93082.64 4.30 91306.20 -1776.44 -1.951
I Megamox500mg CAP(n=851)* 20.41 :1:5.55 1736211 90.10:1:23.08 76674.44 I
I MegamoxS250mg SUS (n=313)* 106.39:1:24.50 33300 II 55.12:1:27.94 17251.06 I
* Not listed on Medschem~ Price List.
(R) (R)
ADDendixG
Table 16G: Benzathine Denicillin. Mav 2002 to Auaust 2002.
Product name II Averagepackage size II Total units IIAveragecost Totalcost Cost per unit ota ca cu ate cost
8
.
.
.
...
.
...
'
R
" .' Effect +/- ...1Saving %
(R) \' I (R) (R) i i
.. . - .~~m'H..lD . II .
Irlglna/~l"()~tICtS'--1~ ",."..., '11 '1[,,' .. 11"'F::=]1!0T'FliS1}.]1~.'I;!tli;11J
I UltracillinLA2.4 (n=1)* II 1.0011 .. . ... II, II II ,I
I ~ =~ 13eneric~~Oducts nil' '" , H ., " . :' .:,~: II II I
I~n~hine P~~2.4MU(n=4).11 ,-- ,-, ,:001111' . .-l' II '1
* Not listed on Medschem~ Price List.
Table 17G: Benzathine Denicillin. SeDtember 2002 to December 2002.
MecJscIJemi'PnceIist
~, " '"
Average package size IITotal units HAverage cost Total cost
I
i Cost per unit Totalcalculatedcost
8..
.
. .
..
.
...
.
Effect +/- i I Saving %
(R) (R) (R) (R)
r . Onglnal Pl"()cJu~~, II ~1L .,.11' , . " " niL ,II ' ,. ':..:' ItL",.I."".".ill.~._,__1I1
I UltracillinLA2.4(n=15)*II 1.00 II 1511 19.1911 287.8511 II, _ II ...,...11, ,_,I
I ,(;enencprodiicts Ir:" "~=._=Ir==. 1_/==::===11_ .i.:.I[ :===::~=:=I[===~[ ~ ..]
I II II II II II II II II I
Product name
* Not listed on Medschem~ Price List.
ADDendixG
Table 18G: Benzathine Denicillin. Januarv 2003. to ADrii2003.
1
1
I
Average package size U Total units II Average cost
~
'
[
Totalcost Cost per unit "tota ca cu ate cost
8
,' "
' '
R
tl '
R
tl · Effect +/- iI Saving %
I' >I I' >I (R) (R)! '
~~~~oil~~iiarproiiiic~~l II I '" 2~1[',""'.'~:]~':,,}1},:1,=~ ' 11- ' " ,~I ':='If I
UltacillinLA2.4 (n=8)* I 1.00 II 81 19.1911 153.5211 II II II I
~ x:~enerlc!ioiiiicts' '~'I : == II I '~ L' ,', ',l:j'il Lx I ~"'",. , ,_"v " r{:;;j!1~}~~:11~I I
BenzathinePen2.4MU(n=8)* I 3.25:t 4.1711 261 47.89:t 54.5311 383.1211 II II II I
* Not listed on Medscheme@ Price List.
Productname
ADDendixG
* Not listed on Medscheme@ Price List.
Table 20G: BenzvlDenicillin. SeDtember 2002 to December 2002.
Product name
Average pac/fage si~e Total units n Ave.rage cost
(R)
Totalcost
(R)
Cost per unit
(R)
'av,
AfiiiJscheme
(R)
I Originalproducts II II.'- '~_::1~1;(i:~\!!!]1"1;~t.' - 1~;111(0.;\;!.\;!\]~;;!II.'"II~ I
' " , v_ _, _ ' , :""'.."'_, ,:''''''''',__,..'«_.'''':."." ~ ,"-"'=o;.,_~"'" ~. ".v
INovopen1.0MUCAR(n=2)*II 1.75:1:0.35II 4 II 25.37:1:3.24II 50.74II II I II I
I Novopen5.0MUCAR(n=1)*II 1.00II 1 II 28.1411 28.1411 II I II I
['!3~erlcPrOductS !It. . ': ==:'::'J[~: _'F_ U,_."U _ ~H __.JIIL,:':':':::: ::]11,1
I II II II II II II I II I
* Not listed on Medscheme@Price List.
- - - - -- - - - - ---
B Nled..heme PrIceLIst ..Prod"'" neme : Averagepeclrage.Ize i r.tal units Ave.age.... r.tel.... Costperunit "" i:a'cuTIif8iliiiiSff----'] - , .
, .. (R) (R) . Effect +/-. Saving %
,.. (R) (R)'
I," Origin!,!rduc'-U ." -.' -. 11'-- I ::ii:!:II:!:).t(lj r===-==] r/;)7:j:j;';j',:'=;1 [=.. ".. .. " J ' .... r'- 1
I Novopen1.0OMUCAR(n=10)*II 1.60:1: 0.9711 1611 21.90:1: 13.3611 218.98 II II II II I
1_==Seiieiic"",ats U=.=_." _ ""JI JL- .jl n.-- JI -, - . Jt - --.=]11,' , ."; ""
I Benzylpenicillin1MU(n=2)* II 5.00 II 10 II 66.29 II 132.58 II II II II I
I Benzylpenicillin5MU(n=1)* II 1.00 II 1 II 23.51 II 23.51 II II II II I
ADDendix G
Table 21G: Benzylpenicillin. January 2003 to April 2003.
Ave II TotaIUnlts
.
.
.
I; A~gecom
I
Tota/cost
. > I (R) >. (R)
I .- . >. 11' U ' W...lr ~.- ~I :=. U . I I
I Novopen 1.0 MU CAR (n=1)* II 7.00 II 711 96.6811 96.6811 II II I I
I Novopen 5.0 MU CAR (n=3)* II 1.00 II 311 28.1411 84.4211 II II I I
I .~~~erlcproducts~-JL. ~_u. 1L u.U. JI-~.-~-._II . ]1 ..~n.:~]1 . I ;y;'~~;'1
I Benzylpenicillin 1MU (n=1)* II 2.00 II 211 27.6911 27.6911 II II I I
I Benzylpenicillin 5MU (n=1)* II 1.00 II 1 II 23.51 II 23.51 II II II I I
* Not listed on Medscheme@ Price List.
Product name
MedschemePifceUst
'Total ca/cu/atea cost.
+/-
~
,\
(R)
ADDendixG
Table 22G: Benzyl rocaine. May 2002 to Auaust 2002.
L" (~~, J .~R)_".Un .., ...~~
[ .tJ~giiialPrOdUC~::.:: . U . ~ .. .lL.::'" ..11---11 11 '_' . II II __
I Penilente LA2.4MU (n=67)* 1.61 :t 0.9711 10811 25.39:t 15.30 II 1700.83 II II II
I Penilente LA 1.2 INJ (n=33)* 1.24 :t 0.44 " 41 II 13.91:t 4.87 II 458.93 II II II
I PenilenteFORT1.2MU(n=3)* 1.00 " 311 11.1911 33.57 " "II
I Penilente FORT 6.0MU (n=3)* I 2.00" 6 II 50.41" 151.23I II ""
~ "GeriencpiOdiiii~__ Jr:.. .~_ -IL... ..'1 n' -.' U}jili~ILiE" :11 .Ir.'
I II II II II II" II II
(R)
Effect +/-
Saving %
1
I
I
Product name
Average package size
Totalunits
Average cost
Totalcost
Cosrper unit
edsiinemet:'nci'[Jst
'Totalcalculated cost
* Not listed on Medschem~ Price List.
Table 23G: Benzyl SeDtember 2002 to December 2002.
MidscnimeP,lceDsf
Productname IIAveragepack
..
ag
..
e
.
s
..
Ize
11 Tot
.
CI
.
Jun/ts
..
1I Avel3g8cos, Totalcost Cost"., unH Tofalc.lcula/ed cost r;;;;:;:;]
"
.
. .
.
(R) . (R) (R) (R) L:::.:JISaving %
L "_Ol'lglnaIProdu:~_._~.jl . __,_~~_~:j~'..-','__ ~il'.'-II"--7iT-lr ~--"r - Ii ~ '=---I~-: 1[*7:-"1
I Penilente LA2.4MU (n=52)* II 1.23:t0.73 II 6411 19.40:t11.62 II 1008.60 II II II II I
I Penilente LA 1.21NJ (n=19)* II 1.47:t 1.1711 2811 16.53:t 13.2411 314.0411 II II II I
I Penilente FORT 1.2MU (n=2)* II 4.00:t 2.83 II 8 II 44.80:t 31.69 II 89.59 II II II" I
f' ~enencPrOd~c~__lr~= . H Ii .Jr..' H..t
I II II" II "II "II I
* Not listed on Medschem~ Price List.
ADDendix G
G:B J 2003 to ADrii 2003
* Not listed on Medscheme@ Price List.
- - - -
__ ...' __________'...__ _____Janua
-
.. ,.... Medscheme Price Lis' . . .... .
'"""_>_'_"-''''0_'-X
Product name
Averagepackagesize'
Totalunits
Averagecos'
Totalcas'
"Costperunit'
TotarciTculateacos'
r+/I
(R) (R)
(R) (R)
Saving %
I. nliJalprodu ..II
.V.A
.IL JL . ... n
. .
.Up IJ'r' .' "'la!)W,i'1';,a,.liili1,n . ..,-'-1 [ ---Jl
I PenilenteLA2.4MU(n=60)* II 1.68:t 0.93 II 101 II 28.05:t 15.47 II 1682.73 II II II II I
I Penilente LA 1.21NJ (n=25)* II 1.04:t 0.20 II 2611 12.18:t2.20 II 304.5611 II II II I
I Penilente FORT 1.2MU (n=2)* II 1.00 II 211 12.31 II 24.6211 II II II I
1.1.:',=Generic"rod..=.. JL,... ..__..",:,...,'",_II,,,......,JIL....._ ,:,1 .II ,=: II J[ II
' If:'-' I
I II II II II II II II II I
ADDendix G
2002 to Auaust 2002.
~verage pack~ge
size
I Cedor125mgSUS(n=47) 78.19:t16.17 II 367511 150.29:t69.4311 7063.7511 1.3711 5034.7511 -2029.00 II -40.30 I
Ceclor25OmgCAP (n=51) 17.65I10.881~ 165.46t I 9459.341~1 Ir--Ir--I~ 100.24 ~ 7317.00~~
I Ceclor250mg SUS (n=30) 75.00 II 2250 II 177.90:t 32.00 II 5337.0811 2.2411 5040.00 II -297.0811 -5.89 I
Ceclor50OmgCAP(n=20) 17.50t6.181~ 478.5H~~I Ir--Ir--I
~ 199.62~~ 4364.50~~
I CedorBD187mgSUS(n=83) 50.00 4150 11102.25:t11.10 II 8487.1511 1.9411 8051.00 -436.1511 -5.421
I CeclorBD Forte 375mg SUS(n=36) 52.08:t7.01 187511 196.37:t35.0411 7069.30 II 3.1411 5887.50 -1181.80 II -20.071
I Cedor CD 375mg TAB (n=85) 10.44:t 2.15 88711 156.45:t 36.9711 13298.28 II 13.80 II 12240.60 -1057.6811 -8.64 I
C3
296.91:t
aC3 1
[::Jc:J
Ceclor CD 500mg TAB(n=25) 10.20:t 1.00 255 7422.68 12.47
127.37 3179.85 -4242.83 -133.43
I Cloracef MR375mg TAB(n=75) 10.21 :t 1.0711 76611 144.28:t 24.30 II 10821.20II 13.80 II 10570.80 -250.40II -2.371
le'~ 'n~~'p;;f:~Ili11fl1.i,'LI
1 Adco-Cefaclor125P SUS (n=438) 76.78:t 14.25 3362811 105.83:t 19.9911 46355.1411 1.37 46070.3611 -284.7811 -0.621
I Adco-Cefaclor250mg CAP (n=686) 16.20:t4.77 1111111 133.78:t38.93 II 91773.5211 8.13 90332.4311 -1441.0911 -1.60 I
I Adco-Cefaclor 250PSUS (n=372) 75.32:t 5.00 28020 II 168.57:t 12.36 II 62706.51II 2.24 62764.80 II 58.2911 0.09 I
Adco-CefaclorBD 187mg SUS
G
BC3 Ic:JQ
_ 51.13:t7.72 56750 100.02:t16.12 111026.72 1.94
(n-1110) 110095.00 -931.72 -0.85
I Adco-CefaclorBD375mg SUS (n=775) 49.68:t 8.67 38500 II 156.75:t 26.71 11121478.04 II 3.14 II 120890.00 II -588.0411 -0.49 I
ADDendix G
Average cost
Adco-Cefaclor BD TAB ("=2320)* 10.17 :t 1.60 23603 I 140.83 :t 22.32 II 326727.71 II II
Cee 125mg SUS ("=129) 101.36:t 16.03 13075 107.08:t 29.40 II 13812.99 II 1.37 17912.7511 4099.76 22.89
Cee250mgSUS("=121) 100.29:t25.59 12135 184.02:t45.38 22266.26II 2.24 27182.40 4916.14 18.09
Cee 500mg TAB ("=175) 15.63:t 4.32 2735 191.58:t 53.54 33526.9211 12.47 34105.45 578.53 1.70
Cloraeef 250mg CAP ("=32) 13.59:t 5.42 435 120.64:t 43.56 3860.59 II 8.13 I 3536.55 -324.04 -9.16
CloraeefBD187mgSUS("=17) 58.82:t19.65 1000 87.53:t41.86 1488.00 II 1.94 1940.00 I 452.00 23.30
Cloraeef BD 375mg SUS ("=24) 50.00 1200 161.29:t 12.25 3870.8411 3.14 3768.00 I -102.84 -2.73
CloraeefP125mgSUS("=3) 75.00 225 104.48 313.4411 1.37 308.25 -5.19 -1.68
Cloraeef PF 250mg SUS ("=9) 83.33:t 12.50 750 190.30:t 32.22 1712.70 II 2.24 1680.00 -32.70 -1.95
Lilly-Cefaelor 125P ("=91) 77.47:t 13.47 I 7050 107.06:t 18.97 9742.07 1.37 9658.50 -83.57 -0.87
Lilly-Cefaelor 250P ("=56) 73.79:t 24.05 4132 166.94:t 52.57 9348.88 2.24 9255.68 -93.20 -1.01
Lilly-CefaelorBD187mgSUS("=204) 51.23:t7.75 10450 I 99.98:t15.67 20395.31 1.94 20273.00 -122.31 I -0.60
Lilly-Cefaelor BD 375mg SUS ("=179) 49.43:t 5.75 8795 155.08:t 17.17 27759.14 3.14 27616.30 -142.84 -0.52
Lilly-Cefaclor CAP ("=109) 16.96:t 4.17 1740 126.39:t 34.69 13776.02 8.13 14146.20 370.18 2.62
Lilly-Cefaelor CD 375mg ("=402) 10.45:t 1.98 4202 144.32:t 27.31 58017.43 13.80 57987.60 -29.83 -0.05
Rolab-Cefaclor250mgCAP("=268) 15.85:t3.88 4249 125.53:t31.99 33642.19 8.13 34544.37 902.18 2.611
Rolab-Cefaelor500mg CAP ("=166) 15.40:t3.75 2557 194.42:t51.13 32274.06 12.47 31885.79 -388.27 -1.221
Rolab-CefaelorBD 187mg SUS
G a I
c:JQ
_ 53.96:t 13.41 9875 105.98:t 26.32 19393.87 1.94
("-183) 19157.50 -236.37 -1.23
I Rolab-Cefaelor BD 375mg SUS 45.04:t 13.24 5090 11142.78:t 39.8211 16134.3511 3.1411 15982.60 II -151.7511 -0.951
ADDendix G
Average package
s/~e
Avera~e cost
Saving
(R)
I (n=113) I II II II II II II II I
I Rolab-Cefaclor CD 375mg TAB (n=223) 10.19:1: 1.3511 227211 140.69:1: 19.19 II 31374.51 II 13.80 II 31353.60 II -20.91 II -0.07 I
Rolab-CefadorCD 500mgTAB(n=20)" 12.50"4."1[3 ~8~:74:1 8779.351DI IDD
Rolab-CefadorPAED125mgSUS IG 6[3 1 Ic:JD
= 76.92:1:11.93 6000106.68:1:16.75 8321.04 1.37
(n 78) 8220.00 -101.04 -1.23
Rolab-CefaclorPAED 250mg SUS IG 6 Ic:JQ
= 78.37:1: 14.88 4075 176.17:1: 33.51 9160.65 2.24
(n 52) 9128.00 -32.65 -0.36
I Vercef 125mg SUS (n=9) 75.00 675 94.49:1:0.01 850.38 1.37 924.75 74.37 8.041
Ivercef187mgSUS(n=303) 50.31:1:6.72 15245 86.18:1:14.27 26112.29 1.94 29575.30 3463.01 11.711
I Vercef250mg CAP (n=308) 16.47:1:4.69 5074 123.06:1:34.40 37901.29 8.13 41251.62 3350.33 8.121
I Vercef 250mgSUS(n=9) 51.67:1:35.00 465 106.98:1:69.76 962.79 2.25 1046.25 83.46 7.981
I Vercef375mgSUS(n=228) 49.47:1:4.57 11280 142.05:1:12.41 32387.43 3.14 35419.20 3031.77 8.561
I Vercef 500mg CAP(n=329) 14.70:1:2.82 4835 167.59:1:64.05 55138.17 12.47 60292.45 5154.28 8.55 I
I VercefMR 375mg TAB(n=835) 10.99:1:2.82 9176 138.61 :1:36.55 115737.60 13.80 126628.80 10891.20 8.60 I
* Not listed on Medscheme@Price List.
Accendix G
Table 26G: Cefaclor. Se
Product qa",e
Average pacJrage
size
Average cost II Total cost
L"rl~ .. (R) ]I. (~J .11 ... .1
I ~ "Ji,,%wLt22.2;ch,II'. JJ ~.w~Ill,~..SL~<.J J
I Ceclor 125mg SUS (n=52) II 76.44:t 5.8911 3975 118.58:t 24.98 6166.38 II 1.37 5445.75 -720.63 -13.23 I
I Ceclor 250mg CAP (n=55) 15.76:t 2.3211 867 158.33:t 66.86 8708.14 I 8.13 7048.71 -1659.43 -23.54 I
Iceclor250mgSUS(n=13) 75.0011 975 190.11:t29.63 2471.47 2.24 2184.00 -287.47 -13.161
I Ceclor 500mg CAP (n=18) 14.44:t 1.62 260 275.61 :t 77.09 4960.93 12.47 3242.20 -1718.73 -53.01 I
I CeclorBD187mgSUS(n=34) 54.41:t14.40 1850 107.08:t32.87 3640.81 1.94 3589.00 -51.81 -1.441
1 Ceclor BD Forte 375mg SUS (n=22) 56.82:t 17.56 1250 188.21 :t 62.74 4140.53 3.14 3925.00 -215.53 -5.491
I Ceclor CD 375mg TAB (n=46) 10.65:t 2.50 490 154.58:t 34.97 7110.86 13.80 6762.00 -348.86 -5.16 I
L3
356.32:t
aC3 Qc:J
CeclorCD 500mg TAB (n=10) 11.40:t3.27 114 3563.19 12.47
190.40 1421.58 -2141.61 -150.65
I Adco-Cef~~I~r125P (n=314) . . 76.43:t 9.04 24000 II 106.59:t 12.3611 33470.3611 1.37 32880.00 II -590.36 -1.80 I
I Adco-Cefaclor 250mg CAP (n=353) 17.31 :t 7.88 6112 II 135.05:t 66.7511 47671.62 II 8.13 49690.56 II 2018.94 4.061
I Adco-Cefaclor 250P (n=198) 76.59:t 11.81 1516511 173.78:t 27.0711 34407.8711 2.24 33969.60 II -438.27 -1.291
I Adco-CefaclorBD187SUS(n=660) 50.95:t7.16 3362511 101.46:t14.35 II 66964.4811 1.94 65232.50 II -1731.98 -2.661
1 Adco-Cefaclor BD 375mg TAB 49.07:t 12.56 21540 II 154.73:t 38.70 II 67927.60 II 13.80 297252.00 11229324.40 77.151
ADDendix G
Average package
sIze
Average cost
Totalcost
%
lBJ_
1 '11 Vi" ,;1 '>I II' I
I (n=439) II I II I
Adco-Cefaclor BD TAB (n=1263)* 10.20:1:1.45 12884 143.33:1:20.83 181028.81 II I
Cec 125mg SUS (n=105) 99.29:1:4.18 10425 109.98:1:2.86 11547.5911 1.371 14282.25 2734.66 19.15
Cec250mgSUS(n=113) 98.45:1:7.68 11125 178.72:1:24.47 20195.22 2.24 24920.00 I 4724.78 18.96
Cloracef250mgCAP(n=5) 15.00 7511 123.49:1:0.01 617.43 8.13 609.75 -7.68 -1.26
CloracefBD187mgSUS(n=5) I 50.00 25011106.75:1:11.30 533.73 1.94 485.00 -48.731 -10.05
Cloracef BD 375mg SUS (n=18) 50.00 900 130.55:1:59.48 2349.84 3.14 2826.00 I 476.16 16.85
Cloracef PF 250mg SUS (n=3) 75.00 I 225 169.50 I 508.50 I 2.24 504.00 I -4.50 -0.89
Lilly-Cefaclor 125P SUS (n=84) 78.57:1:17.42 6600 109.37:1:24.20 9187.38 I 1.37 9042.00 -145.38 -1.61
Lilly-Cefaclor 250P SUS (n=54) 75.93:1:10.82 4100 170.99:1:23.95 9233.50 2.24 I 9184.00 -49.50 -0.54
Lilly-CefaclorBD187mgSUS(n=162) 53.70:1:13.14 8700105.39:1:25.85 17073.08 1.94 16878.00 -195.08 -1.16
Lilly-CefaclorBD 375SUS (n=111) I 49.10:1:5.49 5450 155.07:1:16.00 17213.12 3.14 17113.00 -100.12 -0.59
Lilly-Cefaclor CAP (n=90) 16.76 :I:4.95 1508 139.64 :I:40.64 12512.54 8.13 12260.04 -252.50 -2.06 I
Lilly-Cefaclor CD 375mg TAB (n=218) 10.19:1:1.76 2222 139.93:1:25.63 30504.66 I 13.80 30663.60 158.94 0.52 I
Rolab-Cefaclor 250mg CAP (n=139) 15.21:1:1.34 211411 127.16:1:13.80 I 17674.73 8.13 17186.82 -487.91 -2.841
Rolab-Cefaclor 500mg CAP (n=33) 16.82:1:5.42 55511 183.04:1:75.79 II 6040.24 12.47 6920.85 880.61 12.72 I
Rolab-CefaclorBD187mgSUS 50.3H4.32 ~I 92.34<30.2611'2374.00 I 1.94 II~(n=134) ~ 13095.00 ~~
I Rolab-CefaclorBD375mgSUS 49.65:1:3.7611 561011156.48:1:11.3311 17682.17 3.14 17615.40 II -66.7711 -0.381
ADDendix G
Average package
I (n=113) II II II II II II I
Rolab-CefaclorCD375mgTAB ]
[3
8 1 1
c:Jc:J
= 10.49 :f:2.11 1658 145.44 :f:36.35 22979.48 13.80
(n 158) 22880.40 -99.08 -0.43
I Rolab-CefaclorCD 500 TAB(n=27)* 10.56:f:1.60 II 28511 385.90:f: 60.47 II 10419.30 II II II I
Roiab-CefadorPAED125SUS 1
[3
[:3 1 Ic:JQ
= 83.93 :f:20.53 3525 119.32 :f:29.02 5011.35 1.37
(n 42) 4829.25 -182.10 -3.77
RoIab-CefaciorPAED250SUS IG a
]c:Jc:J
= 71.84:f:13.76 1365 165.16:f:30.17 3138.07 2.24
(n 19) 3057.60 -80.47 -2.63
Vercef 125mg SUS (n=6) 75.00 450 94.48:f:0.02 566.86 1.37 I 616.50 49.64 8.051
Vercef187mg SUS (n=218) 50.92:f:6.73 11100 87.99:f:11.65 19180.83 1.94 21534.00 2353.17 10.931
Vercef250mgCAP(n=316) 17.08:f:5.47 5397 128.14:f:40.08 40493.04 8.13 43877.61 3384.57 7.71 I
Vercef 250mg SUS (n=3) 75.00 225 153.48 460.44 2.24 504.00 43.56 8.64 I
Vercef 375mg SUS (n=122) 49.67:f: 12.31 6060 142.90:f: 34.63 17434.21 3.14 19028.40 1594.19 8.38 I
Vercef500mgCAP(n=180) 15.27:f:1.86 2748 186.06:f:41.62 33491.49 12.47 34267.56 776.07 2.261
VercefMR 375mg TAB(n=557) 11.70:f:3.58 6517 148.06:f:45.05 82469.19 13.80 89934.60 7465.41 8.30 I
* Not listed on Medscheme4!>Price List.
ADDendixG
Table 27G: Cefaclor. Janua
Average package
size
Total
Average cost
~_.' '. .. . ...L.EJ[ . -~ . 'I ".,,," o.n _ ~'..""'~
I Ceelor125mgSUS(n=42) 77.98:t8.19II 327511 111.08:t13.0511 4665.5611 1.3711 4486.7511 -178.8111 -3.991
Cedor250mgCAP(n=29) 17.0H11.'41~ 152.26<~~I 11111~ 108.21~~ 4024.35~~
I Ceclor250mgSUS(n=24) 75.00 1800 148.52:t56.69 3564.36 2.24 4032.00 467.6411 11.60 I
I Ceelor 500mg CAP (n=16) 18.19:t 6.40 291 162.70:t 84.65 2603.16 12.47 3628.77 1025.61 II 28.26 I
I Ceelor BD 187mg SUS (n=42) 53.57:t 13.03 2250 110.05:t 25.25 4621.95 1.94 4365.00 -256.9511 -5.891
I CeclorBDForte375mgSUS(n=18) 50.00 900 166.74:t7.59 3001.32 3.14 2826.00 -175.3211 -6.20 I
I Ceelor CD 375mg TAB (n=47) 11.34 :t 3.55 533 161.67 :t 48.45 7598.57 13.80 7355.40 -243.17 II -3.31 I
C3
247.24:t
aG c::Jc::J
10.00 150 3708.58 12.47
121.67 1870.50 -1838.08 -98.27
I CloraeefMR 375mg TAB (n=36) II 10.42:t1.40 I 37511 147.38:t21.40 II 5305.6811 13.80 I 5175.00 I -130.6811 -2.531
. . ,}.'iI2}~ZJ~:Ulj L~~~~][;5"~ II 'I[ 0' ,. ~I I
Adeo-Cefaelor125P(n=271) 78.87:t15.77 21375 110.70:t24.08 30000.08 1.37 29283.75 -716.33 -2.451
Adeo-Cefaclor 250mg CAP (n=463) 17.25:t 7.99 7985 132.32:t 68.80 61262.67 8.13 64918.05 3655.38 5.631
Adeo-Cefaelor250P(n=135) 76.48:t9.54 10325 173.84:t22.73 23468.22 2.24 23128.00 -340.22 -1.471
Adeo-CefaclorBD187SUS(n=653) 51.11:t7.18 33375 98.74:t15.29 64475.43 1.94 64747.50 272.07 0.421
Adeo-Cefaelor BDTAB (n=1215)* 10.24:t1.49 12444 144.15:t23.43 175144.66 I
Cee 125mg SUS (n=149) 101.85:t 16.97 15175 113.05:t 24.71 16844.78 1.37 20789.75 3944.97 18.981
Ceelor CD 500mg TAB (n=15)
Aooendix G
Medscheme Price Us~
(~) 91 (~JII (8) !II ,_~ ;l!!L"""".I...,",_.., ',' "".y, ' ,
I Cee 250mg SUS (n=115) 96.74::1: 10.22 II 11125 181.29::1:33.08 II 20847.85 2.24 24920.00 II 4072.15 16.34 I
I Cee 500mg TAB (n=275) 15.65:t 4.90 II 4303 192.58:t 59.69 I 52958.13 12.47 53658.41 II 700.28 1.31
I Cloraeef 250mg CAP (n=6) 15.00 II 90 123.49 740.94 8.13 731.70 II -9.24 -1.26
I Cloraeef 500mg CAP (n=3) 12.67::1:4.62 II 38 203.84:t 50.94 611.52 12.47 473.86 -137.66 -29.05
I CloraeefBD375mgSUS(n=3) 50.00 II 150 158.49 475.47 3.14 471.00 -4.47 -0.95
I Lilly-CefaelorP 125mgSUS(n=56) 73.14::1:9.74 4096 101.53:t12.47 5685.84 1.37 5611.52 -74.32 -1.32
I Lilly-Cefaclor P 250mg SUS (n=97) 75.00 7275 168.64:t 0.01 16357.66 2.24 16296.00 -61.66 -0.38
I Lilly-CefaelorBD 187mgSUS(n=202) 51.49::1:8.51 10400 101.04:t16.82 20409.23 1.94 20176.00 -233.23 -1.16
I Lilly-CefaelorBD375(n=148) 51.89:t 16.34 7680 163.70::1:50.87 24228.21 1.94 14899.20 -9329.01 -62.61
I Lilly-CefaelorCAP(n=117) 16.38:t4.33 1916 128.51::1:36.95 15035.61 8.13 15577.08 541.47 3.48
I Lilly-Cefaclor CD 375mg TAB (n=273) 10.38:t 3.25 2833 I 143.35:t 45.40 39134.62 13.80 39095.40 -39.22 -0.10
I Rolab-Cefaelor 250mg (n=110) 14.86:t 0.82 163511 123.42:t 7.32 13576.55 8.13 13292.55 -284.00 -2.14
I Rolab-Cefaelor500mg(n=76) 15.76:t3.77 119811 213.40::1:65.86 16218.16 12.47 14939.06 -1279.10 -8.56
Rolab-Cefaelor BD 187mg SUS
[3
1 BC3 c::JQ
_ 50.81 :t4.44 6300 90.14:t33.79 11177.75 1.94
(n-124) 12222.00 1044.25 8.54
Rolab-CefadorBD 375mg SUS 1
[3
6 1 II Ic:JQ
_ 49.50 :t 3.50 5000 151.53 :t 28.08 15304.44 3.14
(n-101) 15700.00 395.56 2.52
Rolab-Cefacior CD 375mg TAB IG 8G I Ic::JQ
= 10.21 :t 1.69 2735 135.59:t 37.62 36338.95 13.80
(n 268) 37743.00 1404.05 3.72
Rolab-CefaolorCD500(n=37)' 11.0BHg2ID ~;:~ 1'6'48.07IDI IDD
ADDendix G
Average package
Total
ulJits
Average cost HI Total cost
(R) ;II (11) JI (11). I
77.7H14.43Ir-;.;;;l109.12<24.3212946.331~1 11111~ L =-.J 2877.00~~
Rolab-CefadorPAED260m9SUS I G 6[3 1c:Jc:J
= 78.69:t 16.35 4800 177.96:t 36.86 10855.47 2.24
(n 61) 10752.00 -103.47 -0.96
I Vercet 187mg SUS (n=343) 53.21 :t 13.94 18250 91.92:t 23.83 31527.92 1.94 35405.00 3877.08 10.951
I Vercet 250mg CAP (n=205) 16.89:1:4.76 3462 126.76:1:35.31 25985.61 8.13 28146.06 2160.45 7.68 1
1 Vercet 375mg SUS (n=199) 47.59:1:9.55 9470 134.76:1:30.82 26817.77 3.14 29735.80 2918.03 9.81 I
I Vercet500mgCAP (n=337) 15.01:1:1.69 5060 187.14:t26.97 63065.50 12.47 63098.20 32.70 0.051
1 VercetMR 375mg TAB (n=833) 11.31 :1:3.32 9423 142.93:t41.66 119060.53 13.80 130037.40 10976.87 8.441
* Not listed on Medscheme@ Price List.
Rolab-Cetaclor PAED125mg SUS
(n=27)
ADDendix G
ADDendix G
Table 29G: Cefadroxil. Se
ADDendixG
Table 30G: Cefadroxil. Janua
Product name
Average package s/~e II Total units IL Average cost
ADDendixG
Table 31G: Cefazolin. Mav 2002 to Auaust 2002.
Product name
Average package size Average cost 11 Total cost
Table 32G: Cefazolin. SeDtember 2002 to December 2002.
* Not listed on Medscheme@ Price List.
ADDendixG
Table 33G: Cefazolin.
Product name
Average cost II'Total cost
(R) (R)
Effect +/-
ADDendix G
Table 34G: CefeDime.
Product name
Average package size
* Not listed on Medscheme@ Price List.
ADDendix G
Table 35G: Cefixime. Mav 2002 to Auaust 2002.
Product name
Averagepaclc~ge size Averagecost II Totalcost
* Not listed on Medscheme@ Price List.
Table 36G: Cefixime. SeDtember 2002 to December 2002.
Ploduct name
To~1cost
(fl)
* Not listed on Medscheme@ Price List.
ADDendix G
Table 37G: Cefixime. Janua
Product name
Average package size II Total units II Average cost
(R)
* Not listed on Medscheme@ Price List.
ADDendix G
Table 38G: Cefotaxime. Mav 2002 to Auaust 2002.
Product name
Average package size Average cost
(R)
Table 39G: Cefotaxime. SeDtember 2002 to December 2002.
1!roduct name
Ay,erage,package slz,e
ADDendix G
Averagecost Totalcost
(R) (R)
ADDendix G
Table 41G: Cefoxitin.
Proquct n..!fJe Average pac~age size Average cost
* Not listed on Medscheme@ Price List.
ADDendix G
Table 42G: CefDodoxime. Mav 2002 to Auaust 2002.
Product name
Averagepaclsagesize 11 Total units H Average cost ~E Total cost
(R)
* Not listed on Medscheme@ Price List.
Table 43G: CefDodoxime. SeDtember 2002 to December 2002.
Average package size
Average cost
* Not listed on Medscheme@ Price List.
Aooendix G
Table 44G: Cefoodoxime. Januarv 2003 to Aoril 2003.
Product name
Average package size ~t Total unIts 1l Average cost II Total c.ost
* Not listed on Medscheme@ Price List.
ADDendix G
Average package size H Total units If Average cost
* Not listed on Medscheme@ Price List.
Average package size II Total units II Average cost
* Not listed on Medscheme@ Price List.
Aooendix G
Table 47G: Ceforozil. Janua
Product name
Average package size! I Total units II Average cost
* Not listed on Medscheme@ Price List.
Aooendix G
Table 48G: Cefradine. Mav 2002 to Auaust 2002.
Product name
Average package size II Total units U Averagecost
Table 49G: Cefradine. Seotember 2002 to December 2002.
ADDendix G
Table 50G: Cefradine. Janua
Product name
Total units 'I. Average cost
ADDendix G
Table 51G: Ceftibuten. Mav 2002 to Auaust 2002.
Product name
Average package size Average cost
Table 52G: Ceftibuten. SeDtember 2002 to December 2002.
P~duct name
Average CO$t.
* Not listed on Medscheme@ Price List.
ADDendix G
Table 53G: Ceftibuten. Janua
Product name
Average package size IITotal u,.,its 11 Average cost
* Not listed on Medscheme@ Price List.
ADDendix G
Table 54G: Ceftriaxone. Mav 2002 to AUGust 2002.
Average package size Average cost II Total cost
(R) (R)
ADDendix G
Table 55G: Ceftriaxone. SeDtember 2002 to December 2002.
Product name
Average package size Average cost
ADDendixG
Table S6G: Ceftriaxone. Janua
Product name
Averagepackage size II Total units 11 Average cost
(R)
ADDendix G
Table 57G: Cefuroxime. May 2002 to August 2002.
Productrtame 11~Ayeragel1~Ql<~ge$i~e II AYer~gecO$t Totalcost
(R) (8)
11'3'~'7";'11 ""~'7" I:'!";'"' "II' "'"'' " '"
I Zinnat 125mg SUS (n=30661)* II 78.70:1: 31.2411 2412870 11140.94:1: 45.63 114321450.50 II II II II I
IZinnat125mgTAB(n=640)* II 11.82:1:5.9011 756211118.25:1:58.5711 75683.1811 II II II I
I Zinnat 250mg TAB (n=48639)* II 11.84:!: 4.49 II 576080 11195.96:1: 74.28 II 9531533.0911 II II II I
I Zinnat500mgTAB(n=2033)* II 10.43:!: 2.5511 21210 11305.66:!: 81.6911 621413.1211 II II II I
P 'I;I~I~I .~,11II]7~]~'.,~I,..., IL ..' jr~(~I"II!,:';i~! ' "I
I Zinacef 750mg INJ(n=3)* II 5.00 II 15 II 281.7711 845.31 II II II II I
* Not listed on Medscheme@ Price List.
Table 5SG: Cefuroxime. SeDtember 2002 to December 2002.
Product,name
Average package size
r.~ ~ ",.".l .. '~,~~I " , ,II w. n JI" ~~~ ,,1[ ,-II ,"',j
I Zinnat125mgSUS(n=19389)*II 77.67:1:30.96 150586211 140.29:1:45.46 II 2720162.7811 II II I
I Zinnat125mgTAB(n=394)* II 12.55:1:11.00 494611126.97:1:108.5211 50025.9711 II II I
I Zinnat 250mg TAB (n=25771)* II 11.82 :I:4.46 304657 II 196.77 :I:74.08 II 5071045.48 II II II I
I Zinnat500mg TAB(n=1088)* II 10.59:1: 2.52 I 11518 II 318.58:1: 80.36 II 346610.4511 II II I
r"-"!C1~~en~~~aucts It ,_ " , ,."., ']1.- :.,,~, ~r~~'~"."I~~t u II I~J[I~'~"l
I II II II II II II II II I
* Not listed on Medscheme@ Price List.
ADDendix G
ril2003.
total unIts II Average cost ~!; Total cost
Aooendix G
Table 60G: Ceohalexin. Mav 2002 to Auaust 2002.
Product name
.Average package size
Savin
1- c.w~cw::W;";--I~.. ..11 I~IY . ,,"'"'_. J1 .~~i'J9.111.alprOdiJct$..:..::=]1 -. ....'5:11 1~]jjijiiiiIi:ifj;jii__I:I!t;;;=I_I. . .
I Keflex 125mg SUS ("=26) II 115.38:t 54.35 II 3000 11158.24:t 174.12 II 4114.27 II 0.63 II 1890.00 -2224.27 -117.691
I Keflex 250mg CAP ("=32) II 19.94:t 5.09 II 63811 175.69:t 133.83 II 5622.22 II 3.15 II 2009.70 -3612.52 -179.751
I Keflex 250mg SUS ("=22) II 122.73:t 42.89 II 2700 11278.45:t 214.05 II 6125.7911 1.36 II 3672.00 -2453.79 -66.82 I
I Keflex 500mg TAB ("=166) II 17.95:t 5.48 II 2979 II 424.80:t 212.38 II 70516.30 II 5.75 II 17129.25 -53387.05 -311.671
I. .. .11 .. .n.:m~ n n ~J
I Betacef 125mg SUS ("=9) II 100.00 900 II 62.47:t 0.01 562.26 I 0.63 567.00 II 4.74 I 0.84
I Betacef250mgCAP("=49) II 21.71:t7.18 106411 62.55:t25.90 3064.91 3.15 3351.6011 286.69 8.55
I Betacef 500mg CAP ("=612) II 18.99:t 3.92 307711 104.30:t 19.82 16896.06 5.75 17692.75 796.69 4.50
I Cerexi" 500mg CAP ("=115)* II 18.16:t6.15 208811 107.06:t34.11 12311.98
I Fexi" 250 mg TAB ("=32) I 17.66:t2.54I 56511 73.31 :t13.66 2345.85 3.15 1779.75 -566.10 -31.81
I Fexi" 250mg SUS ("=45) 84.78:t 21.74 381511 127.79:t 30.01 5750.61 1.36 5188.40 -562.21 -10.84
I Fexi" 500mg TAB ("=15) 21.27:t 3.71 31911 142.04:t 25.75 I 2130.62 5.75 I 1834.25 -296.37 I -16.16
I Le"ocef125mgSUS("=349) 107.45:t26.30 37500 70.26:t 17.35 24521.85 0.63 23625.00 -896.85 -3.80
I Le"ocef250mgCAP("=1269) 21.41:t 7.25 27169 69.42:t22.46 88090.92 I 3.15 85582.35 -2508.57 -2.93
I Le"ocef250mgSUS("=259) 100.62:t16.95 26060 137.92:t22.73 35721.57I 1.36 35441.60 -279.97 -0.79
I Le"ocef500mgCAP("=925) 17.31:t8.78 16012 104.63:t49.05 96784.71 5.75 92069.00 -4715.71 -5.12
ILilly-Cephalexi" 125P SUS ("=2)* 100.00 200 144.47 288.94
I Lilly-Cephalexi" CAP ("=4)* 20.00 80 90.94:t 52.76 363.75 I
I Ra"ceph 125mg SUS ("=98) 95.66:t 13.44) 9375 61.98:t 6.94 6074.40 II 0.63 5906.25 -168.15 -2.85
ADDendix G
Product name
Average package size n Total units n Average cost H Total cost
I .1 (~) (~) JI (R) I (R) I
I Ranceph250mgCAP(n=412) II 22.75:1:8.94 II 9371 II 72.07:1:28.54 29692.69II 3.15 I 29518.65II -174.0411 -0.59 I
I Ranceph 250mg SUS (n=59) II 100.00 II 5900 II 120.34 7100.0911 1.361 8024.00 II 923.91 II 11.51 I
I Ranceph 500mg CAP (n=459) II 18.81:1:6.5911 863511 111.61 :1:36.41 51230.2811 5.751 49651.2511 -1579.0311 -3.181
* Not listed on Medscheme@ Price List.
ADDendixG
Table 61G: CeDhalexin. SeDtember 2002 to December 2002.
Medscheme Price Ljst~~~
Product name
Average package size
(IJ) ..< (R)
r n. 0 ,~.JF '0 ~w... If, 0, I
[ !!~g~~Jprod~~~.==~1Ui;iI'1:'~~1~;=~:J<U:~w. II[ . . . , 'II '~=J
I Keflex125mgSUS(n=33) II 109.09:f:29.19II 3600 II 111.99:f:73.68II 3695.5711 0.6311 2268.00 II -1427.5711 -62.941
I Keflex250mgCAP(n=31) II 24.13:f:6.51 II 748 II 217.50:f:168.46 II 6742.4311 3.1511 2356.20 II -4386.2311 -186.161
I Keflex250mgSUS(n=17) II 159.00:f:50.51 II 2703 II 456.05:f:253.19 II 7752.8211 1.3611 3676.0811 -4076.7411 -110.90 I
I Keflex500:9 TAB (n:116) II. 15.90 ~::..~.:.~911< 1844:11.;336.84:f: 220.50 II 39073.571Iyy5.~511 10603.00 11-28470.5711 -268.51 1
, . ~~tJ~i;!c.p~du(ft$.:,1~ . -- ::i~ r~ 11L' , "II ILLi.1~iLJ
I Betacef 125mg SUS (n=3) 100.00 II 300 62.4711 187.41 0.63 189.00 II 1.5911 0.84
I Betacef250mg CAP (n=1) 30.00 II 30 93.2311 93.23 3.15 94.50 II 1.2711 1.34
I Betacef 500mg CAP (n=23) 18.48:f:3.51 II 425 101.68:f: 16.581 2338.75 5.75 2443.751 105.00 1 4.30
I Cerexin 500mg CAP (n=67)* 18.94:f: 5.13 II 1269 112.92:f:28.72 7565.37
I Fexin250mgTAB(n=7) 29.29:f:13.361 205 107.93:f:24.55 755.49 3.15 645.75 -109.74 -16.99
I Fexin250mgSUS(n=28) I 81.43:f:27.72 2280 118.77:f:33.33 3325.55 1.36 3100.80 -224.75 -7.25
Fexin500mgTAB(n=8) I 17.00:f:5.66 136 136.37:f:48.74 I 1090.921 5.75 I 782.00 I -308.92 -39.50
Lenocef 125mg SUS (n=232) 111.64 :f:33.46 25900 73.89 :f:22.30 I 17143.63 0.63 I 16317.00 I -826.63 -5.07
Lenocef250mg CAP (n=727) 22.11 :f:8.36 16072 71.50:f:26.29 51981.08 3.15 50626.80 -1354.281 -2.68
Lenocef 250mg SUS (n=185) 96.65:f: 18.87 17880 132.83:f:24.97 24574.42 1.36 24316.80 -257.62 -1.06
Lenocef 500mg CAP (n=698) 16.54:f:7.61 11542 98.94:f: 41.63 69055.20 5.75 66366.50 -2688.70 -4.05
Lilly-Cephalexin CAP (n=6)* 20.00 120 64.48 386.88
Ranceph125mgSUS(n=107) 100.00 I 10700 I 64.14:f:0.11 6863.37 0.63 6741.00 -122.37 -1.82
Ranceph250mgCAP(n=343) 21.93:f:6.30 II 752311 65.38:f:20.96 22425.69 3.15 23697.45 1271.76 5.37
ADDendix G
Product name
Average Average cost U T()talcost
&J (R)
Aooendix G
Table 62G: Ceohalexin. Janua
'product name
Average package size HTotal units II: Average cost
I Keflex 125mg SUS(n=41) 127.20:t49.22II 5215 83.04:t31.87 II 3404.48 0.63 3285.45 -119.03 -3.621
I Keflex 250mg CAP (n=33) 20.94:t 13.7411 691 69.76:t 42.95 II 2302.05 3.15 2176.65 -125.40 -5.761
I Keflex250mgSUS(n=19) 100.0011 1900 123.17:t6.38II 2340.18 1.19 2261.00 -79.18 -3.501
I Keflex 500mg TAB (n=143) 14.59:t 7.5611 2087 208.23:t 226.62IL~~6~50 5.75 12000.25 -17776.25 -148.131
G'l,.,rfc P{qtlijc.~
rBeta~~f125mg SUS (n=3) " I 100.00 300 62.4711 187.41 II 0.63 189.00 II 1.5911 0.84
I Betacef 250mg CAP (n=15) 23.00:t 9.02 345 56.72:t 39.4411 850.7411 3.15 1086.75 236.01 II 21.72
I Betacef 500mg CAP (n=21) 19.71 :t 2.78 414 106.03:t 9.1811 2226.6911 5.75 2380.50 153.81 II 6.46
I Cerexin 500mg CAP (n=85)* 17.82:t 5.26 1515 107.12:t 28.5211 9105.1911
Fexin 250 mgTAB (n=11) I 13.00:t4.73 143 59.52:t20.14 II 654.70 II 3.151 450.45 -204.25 -45.34
Fexin 250mg SUS (n=18) 82.22:t20.45 1480 109.24:t25.38II 1966.2311 1.191 1761.20 -205.03 -11.64
Fexin 500mg TAB (n=14) 19.57:t 0.85 I 2741 116.34:t 0.30 I 1628.74 I 5.75 1575.50 -53.24 -3.38
Lenocef125mgSUS(n=130) 115.77:t42.70 15050 75.30:t27.65 9788.67 0.63 9481.50I -307.17 -3.24
Lenocef250mgCAP(n=1126) 21.78:t7.81 24520 69.92:t24.14 78732.00 3.15 77238.00 -1494.00I -1.93
Lenocef 250mg SUS (n=86) 109.30 :t 29.22 9400 134.88:t 35.22 11599.44 1.19 11186.00 -413.44 -3.70
Lenocef500mgCAP(n=1161) 16.19:t7.65 18795 97.62:t40.65 113340.78 5.75 108071.25 -5269.53 -4.88
Lilly-Cephalexin CAP (n=3)* 100.00 300 120.48 361.44
Ranceph125mgSUS(n=224) 105.80:t36.83 23700 67.70:t 23.77 15165.18 0.63 I 14931.00 -234.18 -1.57
Ranceph 250mg CAP (n=346) 21.93:t8.70 I 7587 69.39:t27.16 24010.50 3.1511 23899.05 -111.45 -0.47
ADDendix G
Product name
Average package size Average cost II Total cost
(RJ II (8J II: (8J
'I fij cc""'_il r.,...C>"''.:,~w',:,:,:,w""':'~'~"w II _"_"'''9''''''''''''-_'':'V.;.._~»...}t
I Ranceph250mgSUS(n=265) II 101.74:f:18.30 II 26960 II 122.52:f:21.97II 32466.8211 1.1911 32082.40 II -384.4211 -1.20 I
I Ranceph 500mg CAP (n=587) II 18.61 :f:6.1411 1092711 110.09:f: 33.5711 64624.61 II 5.7511 62830.2511 -1794.36 II -2.861
* Not listed on Medscheme@ Price List.
Aooendix G
Table 63G: Ceohradine. Mav 2002 to Auaust 2002.
Product name
Averagepackagesize n Total unit 11 Average cost
(R)
Table 64G: Ceohradine. Seotember 2002 to December 2002.
[ ~ OrIgfnalproducts= ~I fH~ - ~n ~ n -~~~:n < ~ ~If <= ~~ =< =~:~~I[q HI
... .. . ... ... ". ~~.. . .'. ..~ ~ H.. . , . .
Cefril125mgSUS(n=66)* II 106.06:t24.04 7000 II 115.75:t26.35 II 7639.45 II II I
Cefril250mg CAP (n=82)* II 23.50:t12.82 1927 II 215.33:t111.0911 17656.87 II II I
Cefril250mg SUS (n=13)* II 100.00 I 1300 II 176.13112289.65" "I
Cefril500mgCAP(n=216)* II 19.48:t 6.471 420711 321.49:t 108.4311 69442.5311 II II I
1~'!!e~~ilcp~aiiC~ =]C~~.'~::~~~~":,i.'?~>::~'<1~f._:===IL..~ =.. ,':-I[:::=J[' .==1
I Bactocef 500mg CAP (n=6)* II 25.00:t 5.48 II 150 II 260.55:t 61.4311 1563.27 II II II II I
* Not listed on MedschemeG3'>Price List.
ADDendix G
Table 65G: CeDhradine. Januarv 2003 to ADrii 2003.
Total units II Average cost
(R)
ADDendixG
Table 66G: Cloxacillin. Mav 2002 to Auaust 2002.
Product name
Average package size U Total units a Average cost
I . .Jr .IL;, m,;;,11;; . n .,.~':U. u . U. ... H l=J~;
I Orbenin250mgCAP(n=29) II 22.41:1:7.9811 650 II 76.67:1:31.7411 2223.50 II 3.0511 1982.50 II -241.00 II -12.16
IOrbenin500mCAP(n=60) II 21.57:1:4.5311 129411 117.52:1:37.2411 7051.00 II 4.90 II 6340.60 II -710.40 II -11.20
I Orbenin S 125mg SUS (n=107)* II 145.79:1: 67.6811 15600 II 94.79:1: 43.60 II 10142.4211 II II II
'~~i1~ts."j'J~l':,j:;;,:;jEI1:;'ri~~ . . . [2;L~.J ~02:j,,:L~..,t ~ . i~II ~ t::.jL"G",
Clocillin 250mg CAP (n=369)* 33.77:1:18.65 12462 102.21:I:53.57 37716.19
Clocillin 500mg CAP (n=447)* 27.53:1:17.36 12304 92.94:1:107.33 41544.16
Cloxin 250mgAMP (n=7)* 23.43:1:4.28 164 344.31 :1:68.54 2410.19
Cloxin250mgCAP(n=828) 32.76:1:25.55 27129 98.28:1:73.73 81377.11 3.05 94951.50 13574.39 14.30
Cloxin 500mg AMP (n=12)* 10.25:1:7.65 123 304.90:1:215.21 3658.81
Cloxin 500mg CAP (n=732) 25.58:1:14.60 18725 125.11 :I:67.68 91577.99 4.90 91752.50 174.51 0.19
* Not listed on Medscheme@Price List.
ADDendixG
Table 67G: Cloxacillin. SeDtember 2002 to December 2002.
Product name
Averagepackagesize UTotal units n Averagecost
[ .~mm>()nglitarpr()aiictS~'~~~]' ~>"m,,~~ .1 ~)i.:I!))r '11))i~[iiil!l~ ," ,ill "Jill, =~il Ie . 'I!
lorbenin250mgCAP(n=16)* II 25.31 :1:10.40 II 40511 83.20:1:47.10 II 1331.1711 3.0511 1235.25 -95.92 -7.771
lorbenin500mCAP(n=57)* II 24.37:1:9.9211 138911 132.93:1:59.1611 7577.2911 4.9511 6875.55 -701.74 -10.211
I Clocillin 250mg CAP (n=377)* 36.17:!: 25.69 13637 104.46:!: 82.30 39383.22 I
I Clocillin500mg CAP(n=229)* 28.90:t 37.80 6618 121.35:!:197.81 27789.01 I
I Cloxin250mgAMP(n=4)* 37.50:!:5.00 150 541.69:!:72.18 2166.76 I
I Cloxin 250mg CAP (n=773) 30.70:!: 18.65 23731 88.31 :!:60.68 68260.23 3.05 72379.55 4119.32 5.691
I Cloxin 500mg AMP (n=16)* 24.94 :!:9.09 399 726.64 :!:260.24 11626.19 I
I Cloxin 500mg CAP (n=868) 27.03:!: 17.55 23463 133.71 :!:87.85 116056.06 4.98 116845.74 789.68 0.681
*Not listed on Medscheme@Price List.
ADDendix G
Table 68G: Cloxacillin. Janua
Product name
Average package
size
Total
units
Average cost II Total cost
Costper"
unit cost Effect +1-
Saving
%
(~) II (ElJ
(El) (~)
I Clocillin250mg CAP (n=639)* 34.85:t22.98 II 22269 II 110.77:t 72.82 II 70781.87 II II I
I Clocillin500mgCAP (n=441)* 27.54:t18.8811 12147 II 135.26:t 98.4611 59648.09 II II I
CloxacillinFesenius500mg INJ 10 1 18 IDD
20.00 80 631.76:t0.02 2526.92
(n=4)*
I Cloxin250mg AMP (n=3)* 15.00II 45 II 248.08 II 744.24 II II I
I Cloxin250mg CAP (n=1081) 34.10:t28.22II 3685911 110.27:t89.19II119204.05 3.03 172282.771153078.7211 30.811
Cloxin500mg AMP(n=14). 2100<419 1[3 6',:~~ aD IDD
I Cloxin500mgCAP(n=1174) 24.97:t12.33 II 2931711 126.76:t61.79 II 148813.31 II 5.05 148050.8511 -762.4611 -0.511
*NotlistedonMedscheme@ PriceList.
ADDendixG
Table 69G: Flucloxacillin. Mav 2002 to Auaust 2002.
Product name
Average package size ]1 Total units 11 Average cost
Table 70G: Flucloxacillin. SeDtember 2002 to December 2002.
Average package size,
Average cost
ADDendix G
Table 71G: Flucloxacillin.
Product name
Average package size 1 I Total units 1 I Average cost
(R)
ADDendix G
Table 72G: ImiDenem/ciiastatin. Janua
* Not listed on Medscheme@ Price List.
ADDendix G
Table 73G: Loracarbef. Mav 2002 to Auaust 2002.
A~P!O__II~~llll"'-11iI!W-'
. (R)
L ~ _ .~... ILd.. . 1". 1 . . .
f .. Orlglnalpr7!'lucts. 'U' "'~~""~~11.h .h '11 Ir ' '~II ..~. 'I
" ' , ~ ,'-, '~__='~~' '__""""""""'.".~,.,.,., ,_,_,_,___,_,_,_,_,',_,_,_,_,_,_,_,_,_,_,_,_,_, 'Yo_''''',''".' ,,',i,i._,"':- -:'::"'"":-:,:'/",,,,_,,":...:.:.,::..,/::-:,',:.i"CO',:""-"",:"",,,'CO_"'" .,',::, -i'i:"- .., -- . ,:','::'::',__/ ,.,.,., ,..,..,.,./i_."':: / ,.. - .. ,-.,":",..:',..,...:.:.:-.,_,__,'::>'::,":.:.'
I Lorabid 200mg CAP (n=4995)* II 10.50:t 2.3311 52467 II 254.86:t 56.48 111273040.67 II II II II I
I Lorabid PAED 100 SUS (n=3571)* II 52.05:t 10.0211 185870 11156.63:t 30.20 II 559318.7911 II II II I
I Lorabid PAED 200 SUS (n=3192)* II 52.00:t 10.43 II 165980 II 253.03:t 51.56 II 807663.95 II II II II I
[_.~'" Gene~.~~~~~,~.".. II ".,,,. ." .,.,~ ~I:~' '~.., II' ~,..~ '~Ir~:' ~"::'. n~'~- ~,. "
I II II II II II II II II I
* Not listed on Medscheme@ Price List.
Table 74G: Loracarbef. SeDtember 2002 to December 2002.
Average package size ~I.Total units
* Not listed on Medscheme@ Price List.
ADDendix G
Table 75G: Loracarbef. Janua
Average package size Average cost
* Not listed on Medscheme@ Price List.
ADDendix G
Table 79G: MeroDenem. Janua
Product name
Aye~gepackage $i~e
* Not listed on Medscheme@ Price List.
ADDendix G
Table 80G: Penicillin VK. Mav 2002 to Auaust 2002.
Average package size Average cost
(R)
(R)
11~<i<ff\, ", ',~"," "I__ri1i!!~rr~1)~.~:;U&,'C ' '~)JUili!:sU!~ ' "I~' '~.;2';" [2 I ,. 'j
I I II II II II II I I I
1:~-'~"-~en'l1c;p~~~cl$.\ r. ~~i__ .::. I['~:~'.I]L: ,.i:. t'~.'.--:'I[~'_w .
I Betapen 125mg SUS (n=38) 147.37 :t68.72 5600 27.71:t 12.85 1052.89 0.19 1064.00 11.11 1.041
I Betapen250mgTAB(n=499) 57.67:t 39.01 28775 27.02:t 18.76 13480.54 0.67 19279.25 5798.71 30.08 I
linen VK 125mg SUS (n=10) 100.00 1000 20.49 204.87 0.19 190.00 -14.87 -7.83 I
I LenV.K. 250mg TAB (n=1282) 65.98:t41.47 84585 36.88:t22.14 47275.79 0.67 56671.95 9396.16 16.581
I Len VK 125mg SUS (n=218) 158.49:t 108.33 34550 27.11 :t 20.71 5910.76 0.19 6564.50 653.74 9.961
I Novo VK 250mg TAB (n=847) II 51.34 :t 34.58 43484 35.15:t 23.37 29770.19 0.67 29134.28 -635.91 -2.18 I
* Not listed on Medseheme@ Priee List.
ADDendix G
Table 81G: Penicillin VK. SeDtember 2002 to December 2002.
Product name
Averagepackage size U Total units 11Average cost
(R)
Betapen 125mg SUS (n=42) 123.81 :f:43.11 5200 23.23:f: 8.19 975.82 0.18 936.00 -39.82 -4.25 I
Betapen 250mg TAB (n=386) 57.74:f: 40.77 22286 27.05:f: 19.40 10440.97 0.67 14931.62 4490.65 30.071
Inci! VK 125mg SUS (n=3) 100.00 300 19.48 58.44 0.18 54.00 -4.44 -8.221
Len V.K. 250mg TAB (n=1015) 63.99:f: 50.28 64952 35.47:f: 27.08 36001.59 0.67 43517.84 7516.25 17.271
Len VK 125mg SUS (n=178) I 158.26:f: 98.25 28170 29.98:f: 18.14 5335.61 0.18 5070.60 -265.01 -5.23 I
Novo VK 250mg TAB (n=841) I 49.97:f: 32.12 42026 35.55:f: 22.21 29896.65 0.67 28157.42 -1739.23 -6.181
* Not listed on Medscheme@ Price List.
ADDendix G
Table 82G: Penicillin VK. Janua
Product name
Averagepack,age s/7,~IIITotal units !IIIAY~r..g~c()St
I A-LennonPhenox Pen TAB(n=18) II 41.56:!:37.16 II 74811 31.38:!:28.0611 564.8811 0.71 II 531.0811 -33.811 -6.361
r= ' '=~7i..ifii.!~jJrOduct,r~m..m' '11'/' "'~."'=J':=I_[==:i=i ~ . . ~:;~' " ". ~'H I
I Betapen125mgSUS(n=55) I 153.82:!:99.99 8460 1 29.67:!:18.77 1631.87 0.18 1522.80 -109.07 -7.16
I Betapen250mgTAB(n=485) 50.01 :!:32.83 24255 25.62:1:15.82 12424.66 0.71 17221.05 4796.39 27.85
I'nci' VK 125mg SUS (n=15) 100.00 1500 12.29:1: 10.32 184.39 0.18 270.00 85.61 31.71
I LenV.K.250mgTAB(n=1101) 61.76:1:39.89 68001 32.50:1:19.751135787.00 0.71 48280.71 12493.71 25.88
I Len VK 125mg SUS (n=224) 180.54:1: 130.33 40440 33.46:1: 23.42 II 7496.08 0.18 7279.20 -216.88 -2.98
I Novo VK 250mg TAB (n=919) 47.94:1: 31.86 44057 35.76:1: 22.5711 32859.94 0.71 II 31280.47 -1579.47 -5.05
I Rolab Pen VK 250mg TAB (n=7) 37.14:1:21.38 260 7.88:1:3.4211 55.18 0.7411 192.40 137.22 71.32
* Not listed on Medscheme@ Price List.
ADDendix G
Table 83G: PiDeraciliin. Mav 2002 to Auaust 2002.
Meclsciieine ~PriceT.Jst
ProductfJame
Averagepackage size II Total units Ii Average cost 11Total cost
(R)
* Not listed on Medscheme@ Price List.
Table 84G: PiDeraciliin. SeDtember 2002 to December 2002.
Average cost U Total cost
(R)
* Not listed on Medscheme@ Price List.
ADDendix G
Table 85G: Procaine Penicillin. Mav 2002 to Auaust 2002.
Product name
Averagepackagesize II Total units 11 Average cost
(R)
Table 86G: Procaine Penicillin.
ADDendix G
Table 87G: Procaine Penicillin. Janua
Average package size JI Total units H Average cost
(R)
* Not listed on Medscheme@ Price List.
ADDendix H
Table 1H:Antibiotics listed on the MPL. May2002 to August 2002.
200,
ACUCIL250MGCAP
{31 26.001126.001126.001126.0011
ACUCIL S 125/5ML SUS
IBI 23.001123.001123.001123.0011
ACUCIL SF 250/5ML SUS
'BI 38.001138.001138.001138.001GI
!ADCO-AMOCLAV FORTE SUS
,BOOI116.0011116.00IGI
ADCO-AMOCLAV S SUS
111001001 59.001159.0011
IADCO-AMOCLAV375MG TAB
{31103.0011103.0011103.0011103.0011 103.0011
ADCO-AMOCLAV 625MG TAB
{31170.0011170.0011170.0011170.0011 170.0011
IADCO-AMOXYCILLIN 125/5ML SUS
IBI 23.0011 23.0011 23.0011 23.0011
ADCO-AMOXYCILLIN 250/5ML sus
101 38.001138.001138.0011 38.001GI
ADCO-AMOXYCILLIN 250MG CAP
'GI 26.001126.001126.001126.0011
IADCO-AMOXYCILLIN500MGCAP
IGI 46.001146.001146.0011 46.0011
ADCO-CEFACLOR 125/5ML sus
{1103.0011103.0011103.0011103.0011 103.0011
IADCO-CEFACLOR250/5ML sus
1[31168.0011168.0011168.0011168.0011 168.0011
ADCO-CEFACLOR250MGCAP
'GI122.0011122.0011122.0011122.0011 122.0011
ADCO-CEFACLORBD 187MG/5MLsus
{I 97.0011 97.0011 97.0011 97.0011
IADCO-CEFACLORBD375MGTAB
IGI 138.0011138.0011138.0011138.0011 138.0011
IADCO-CEFACLORBD375MG/5MLsus
'GI157.0011157.0011157.0011157.0011 157.0011
ALAMOXYCILLIN
'GOODODI
lA-LENNONAMOXYCILLIN CAP
'GI 26.001126.001126.001126.0011
lA-LENNONAMOXYCILLIN125MG/5MLsus
'BI 23.001123.001123.0011 23.0011
A-LENNONAMOXYCILLIN250MG/5MLsus
'BI 38.001138.001138.0011 38.001GI
A-LENNONPHENOXYMETHTAB
'BI 67.001167.001167.001167.001GI
lA-LENNON PHENOXYMETHYLPEN sus
'000DODI
IAMOCILLIN250MG CAP
'GI 26.001126.001126.001126.0011
IAMOCILLIN250MG/5MLsus
'BI 38.0011 38.0011 38.0011 38.001GI
,AMOCILLIN500MG CAP
IGI 46.001146.001146.001146.0011
Pioductname
II"I. ;....;!!I 18Y......r:;:
,2_U""'-:.':';:,,:I';.,""-j.'_':I', ---""""",,-:'1t
"' ".:-;-;.,-4
AMOCILLINSUSP125MG/5MLsus
101 23.001123.001123.0011 23.0011
0.231
AMOXIL250MGCAP
II 26.001126.001126.001126.001GI
1.731
IAMOXIL500MGCAP
II 46.001146.001146.001146.00IGI
3.071
AMOXILS 125/5MLsus
101 23.001123.001123.0011 23.0011
0.231
IAMOXILSF250/5MLsus
'GI 38.001138.001138.0011 38.001GI
0.381
AMPICLOX500MGCAP
{I 99.001199.001199.0011 99.0011
4.951
IAMPICLOXS 250MGsus
1110011 60.001160.001160.0011 60.0011
0.601
IAMPIMAX250MGCAP
'I 20.001120.001120.001120.0011
1.001
AMPIPEN125/5MLsus
'110011 17.001117.0011
0.171
IAMPIPEN250/5MLsus
'GI 22.001122.001122.001122.00IGI
0.221
AMPIPEN250MGCAP
II 20.001120.001120.001120.0011
1.001
AMPIPEN500MGCAP
'I 36.001136.001136.001136.00IGI
1.801
APEN 500MG CAP
II 99.001199.001199.001199.0011
4.951
,APENS 250MGsus
101 60.001160.001160.0011 60.0011
0.601
IASPEN-CEPHALEXIN125MG/5MLsus
101 63.001163.001163.0011 63.0011
0.631
ASPEN-CEPHALEXIN250MGCAP
'I 63.001163.001163.001163.0011
3.151
IASPEN-CEPHALEXIN250MG/5ML sus
'GI136.0011136.0011136.0011136.0011 136.0011
1.361
AUGMAXCIL S sus
1110011 59.0011 59.0011 59.0011 59.0011
0.591
'AUGMAXCIL SF sus
1110011 116.0011116.0011116.0011116.001GI
1.161
IAUGMAXCIL375MG TAB
'1103.0011103.0011103.0011103.0011 103.0011
6.871
IAUGMAXCIL625MG TAB
'1170.0011170.0011170.0011170.0011 170.0011 11.331
AUGMENTIN 375MG TAB
'1103.0011103.0011103.0011103.0011 103.0011
6.871
IAUGMENTIN625 MG TAB
'1170.0011170.0011170.0011170.0011 170.0011
11.331
IAUGMENTINS 156/5ML sus
101 59.001159.001159.0011 59.0011 0.591
AUGMENTIN SF 312MG/5ML sus
'GI116.0011116.0011116.0011116.00IGI
1.161
BE-AMPICIL 125/5ML sus
'0117.001117.001GI
0.171
BE-AMPICIL250MGCAP
II 20.001120.001120.001120.0011
1.001
BETACEF 125MG/5ML sus
1110011 63.0011 63.0011 63.0011 63.0011
0.631
ADDendix H
MPL Price (Retaillncl VA71
Productname
J[J l\r[][lg;]ri;;;......'.';jl
91y
..__....... [BJ
..2Q02.2002.. '.i ..' 'er,ul1lti
BETACEF250MGCAP
II 63.001163.001163.001163.0011
3.151
BETACEF500MGCAP
'1115.0011115.0011115.0011115.0011
5.751
BETAMOX250MGCAP
{I 26.001126.001126.001126.001GI
1.731
BETAMOX500MGCAP
II 46.001146.001146.001146.0011
3.071
BETAMOXS 125/5MLSUS
'I 23.001123.001123.001123.0011
0.231
BETAMOXSF 250/5MLSUS
{I 38.001138.001138.001138.0011
0.381
BETAPEN125/5MLSUS
1119.001119.0011
0.191
BETAPEN 250MG TAB
'GI 67.001167.001167.001167.001GI
0.671
BIO-AMOKSIKLAVS SUS
II 59.001159.001159.001159.0011
0.591
BIO-AMOKSIKLAVSF SUS
'GI116.0011116.0011116.0011116.0011
1.161
BIO-AMOKSIKLAV625MGTAB
IGI170.0011170.0011170.0011170.0011 170.0011
11.331
BIO-AMOKSIKLAV375MGTAB
11103.0011103.0011103.0011103.0011 103.0011
6.871
CEC 125MG/5MLSUS
{31103.0011103.0011103.0011103.0011 103.0011
1.371
CEC 250MG/5MLSUS
IGI 168.0011168.0011168.0011168.0011 168.0011
2.241
CEC 500MGTAB
'GI187.0011187.0011187.0011187.0011 187.0011
12.471
CECLOR125P 125MG/5MLSUS
IGI 103.0011103.0011103.0011103.0011 103.0011
1.371
CECLOR250MG CAP
'1122.0011122.0011122.0011122.0011 122.0011
8.131
CECLOR250P 250MG/5MLSUS
IGI168.0011168.0011168.0011168.0011 168.0011
2.241
CECLOR500MGCAP
IGI187.0011187.0011187.0011187.0011 187.0011
12.471
CECLORBD 187/5MLSUS
{I 97.0011 97.0011 97.0011 97.0011
1.941
CECLORBD FORTE375/5MLSUS
IGI157.0011157.0011157.0011157.0011 157.0011
3.141
CECLORCD 375MGTAB
{31138.0011138.0011138.0011138.0011 138.0011
13.801
CECLORCD 500MGTAB
11187.0011187.0011187.0011187.0011 187.0011 12.471
CEFADROX500MGCAP
IGI 106.0011106.0011106.0011106.0011 106.0011
10.601
CEFADROXSUSP 500MGIMLSUS
{1121.0011121.0011121.0011121.00IGI 2.021
CIPADUR500MGCAP
IGI106.0011106.0011106.0011106.0011 106.0011
10.601
CLAMENTIN375MGTAB
IGI 103.0011103.0011103.0011103.0011 103.0011 6.871
CLAMENTINS SUS
II 59.001159.001159.001159.0011 0.591
ADDendix H
Product name
1[:][aIJ Frle\::rJlJlji;1»
,) "'2 02"\ >2002. \ ,2002< .." 2\" erunitl
CLAMENTINSF SUS
IBI 116.0011116.0011116.0011116.0011 116.0011
1.161
CLAVUMOXS sus
101 59.001159.0011 59.0011 59.001GI
0.591
CLAVUMOXSF 312MGsus
'01116.0011116.0011116.0011116.0011
1.161
CLAVUMOXTAB
'1103.0011103.0011103.0011103.0011 103.0011
6.871
CLORACEF250MGCAP
'1122.0011122.0011122.0011122.0011 122.0011
8.131
CLORACEF500MGCAP
'1187.0011187.0011187.0011187.0011 187.0011
12.471
CLORACEFBD187sus
{31 97.001197.001197.001197.0011
1.941
CLORACEFBDSUS
{1157.0011157.0011157.0011157.0011 157.0011
3.141
CLORACEFMRTAB
{31138.0011138.0011138.0011138.0011 138.0011
13.801
CLORACEFP 125 sus
{31103.0011103.0011103.0011103.0011 103.0011
1.371
CLORACEFPF 250MG/5MLSUS
IGI168.0011168.0011168.0011168.0011 168.0011
2.241
CLOXAM 500MG CAP
'GI 99.001199.001199.0011 99.0011
4.951
CLOXIN250MGCAP
IGI 61.001161.001GI
3.051
CLOXIN 500MG CAP
'GI 98.001198.001198.001198.0011
4.901
CLP ALLIANCECEPHALEXIN
'GDDDDDI
I
C-MOX S 125/5ML sus
101 23.001123.001123.0011 23.0011
0.231
C-MOX250MGCAP
II 26.001126.001126.001126.001GI
1.731
C-MOXS 250/5MLsus
101 38.001138.001138.001138.0011
0.381
C-MOX500MGCAP
II 46.001146.001146.001146.0011
3.071
CPL ALLIANCECEPHALEXIN
'GDDDDDI
I
CPL ALLIANCECEPHALEXIN DRY SYRUP
'BDDDDDI
I
DACEF500 MGCAP
{1106.0011106.0011106.0011106.0011 106.0011
10.601
DACEF500MG/5MLsus
{1121.0011121.0011121.0011121.00IGI
2.021
DYNA-AMOXYCILLIN 125/5ML sus
'BI 23.001123.001123.0011 23.0011
0.231
EXCILLIN125 MGsus
'0GI17.001117.00IGGI
0.171
FEXIN250MGTAB
'GI 63.001163.001163.001163.0011
3.151
FEXIN250MG/5MLsus
1110011136.0011136.0011136.0011136.0011136.0011
1.361
FEXIN500MGTAB
'GI115.0011115.0011115.0011115.0011
5.751
Prodiictname
'1'......1J ....!'."tlt"11 rJiine
:002 .
FLOXAPEN 250MG CAP
'1100.0011100.001110000011100.0011 10000011
50001
INCIL VK 125/5ml SUS
'G119.001119.0011
0.191
IPCAMOX250MGCAP
1131 26.001126.001126.0011 26.001GI
1.731
KEFLEX125MG/5MLSUS
IGI 63.001163.001163.001163.001GI
0.631
KEFLEX250MGCAP
II 6300011630001163.001163.001GI
30151
KEFLEX 250MG/5ML SUS
'GI136.0011136.0011136.001113600011 136.0011
1.361
KEFLEX 500MG TAB
'11150001111500011115.0011115.0011
5.751
LEN VK 100 125/5ML SUS
1110011 19.001119.0011
0.191
LEN VK 250MG TAB
'GI 67.0011670001167.0011 6700011
00671
LENACLOR 125 P SUS
IGI 103.0011103.0011103.0011103.0011 103.0011
1.371
LENACLOR 250 P SUS
'GI168.0011168.0011168.0011168.0011 168.0011
2.241
LENACLOR BD 187 SUS
{I 97.001197.0011970001197.0011
10941
LENACLOR BD FORTE SUS
'GI15700011157.0011157.001115700011 157.0011
3.141
LENACLOR CAP
1131122.0011122.0011122.001112200011 12200011
8.131
LENACLOR CAP
1131187.001118700011187.001118700011 187.0011
12.471
LENACLOR CD 500MG TAB
1131187.0011187.0011187.0011187.0011 18700011
12.471
LENACLOR CD TAB
1[31138.0011138.0011138.001113800011 138.0011
13.801
LENOCEF 125MG/5ML SUS
'GI 63.0011 630001163.0011 63.001GI
0.631
LENOCEF 250MG CAP
'I 63.001163.0011630001163.001GI
3.151
LENOCEF250MG/5MLSUS
'GI136.0011136.0011136.0011 136.0011 136.0011
1.361
LENOCEF 500MG CAP
'111500011115.0011115.0011115.0011
5.751
LlLLY-CEFACLOR125MG/5MLSUS
IGI103.0011103.0011103.0011 103.0011 103.0011
1.371
LILLY -CEFACLOR 250MG CAP
113112200011122.0011122.001112200011 122.0011
80131
LILLY -CEFACLOR 250MG/5ML SUS
'GI168.0011168.00111680001116800011 16800011
20241
LlLLY-CEFACLOR BD 375MG/5ML SUS
'GI157.0011157.0011157.0011157.0011 157.0011
3.141
LlLLY-CEFACLOR BD 187MG/5ML SUS
'GI 97.0011 97.0011 97.0011 97000101
10941
LlLLY-CEFACLOR CD 375MG TAB
1[31138.001113800011138.0011138.0011 138.0011
13.801
MACROPEN 500MG CAP
1131 7800011 78.0011 78.0011 78.001GI
5.201
ADDendix H
ProdiictnalTte
U'......Ii j ................ rrMalT"llj"ilrii!llj"illY' I")fci
. ZOO.
MACROPEN S 2S0MG SUS
i[1 82.001182.001182.0011 82.0011
0.821
MAXCILA 2S0MGCAP
{I 26.001126.001126.001126.0011
1.731
MAXCIL AF SOOMGCAP
IGI 46.001146.001146.0011 46.00IGI
3.071
MAXCIL P 12S/SMLSUS
IGI 23.001123.001123.001123.0011
0.231
MAXCIL PF 2S0/SMLSUS
{I 38.001138.001138.001138.0011
0.381
MEGAMOX2S0MGCAP
IDDDDDI
I
MEGAMOXS 12SMG/SMLsus
101 60.001160.001160.0011 60.0011
0.601
MEGAPEN SOOMGCAP
IGI 78.001178.001178.001178.0011
S.201
MEGAPENS 12SMG/SMLsus
101 82.001182.001182.0011 82.0011
0.821
MOXAN2S0MGCAP
IGI 26.001126.001126.001126.0011
1.731
MOXAN SOOMGCAP
IGI 46.001146.001146.001146.00IGI
3.071
MOXANS 12S/SMLsus
IGI 23.001123.001123.001123.0011
0.231
MOXAN SF 2S0/SMLsus
101 38.0011 38.0011 38.0011 38.001GI
0.381
MOXYCLAV 37SMGTAB
IGI 103.0011103.0011103.0011103.0011 103.0011
6.871
MOXYCLAV S sus
101 S9.0011S9.0011S9.0011s9.0011
0.S91
MOXYCLAV SF sus
101116.0011116.0011116.0011116.0011 116.0011
1.161
MOXYPEN 12S/SMLsus
IGI 23.001123.001123.0011 23.0011
0.231
MOXYPEN 2S0/SMLsus
101 38.0011 38.0011 38.0011 38.001GI
0.381
MOXYPEN 2S0MG CAP
'GI 26.001126.001126.0011 26.001GI
1.731
MOXYPEN SOOMGCAP
IGI 46.001146.001146.0011 46.00IGI
3.071
NOVOVK2S0MGTAB
101 67.001167.001167.0011 67.0011
0.671
ORBENIN 2S0MG CAP
II 61.001161.001161.0011
3.0SI
ORBENIN SOOMG CAP
II 98.001198.001198.001198.001GI
4.901
PENMOX2S0MGCAP
IGI 26.001126.001126.0011 26.0011
1.731
PENMOX SOOMGCAP
IGI 46.001146.001146.001146.00IGI
3.071
PENMOXP 12S/SMLsus
IGI 23.001123.001123.0011 23.0011
0.231
PENMOXPF2S0/SMLsus
'GI 38.001138.001138.0011 38.001GI
0.381
PENRITE S 12S/SMLsus
'0117.001117.0011
0.171
Productriame
I[]
MY.'.' ..!>::fI!Yi IfIg>..' <'; .<q'ct
· :....:..............................[lUB(tQzl[]l]DQo!JtCinitjt
PENRITE 250 S 250/5ML SUS
1110011 2200011 22000112200011 22000lGI
00221
PENRITE 500MG CAP
'I 36000113600011360001136000[1
10801
PETERCILLIN 125/5ML SUS
11100lGI 17000111700011
00171
PETERCILLIN 250/5ML SUS
IGI 220001122000112200011220001GI
00221
PETERCILLIN 250MG CAP
II 2000011200001120000112000011
10001
PETERCILLIN 500MG CAP
'I 3600011360001136000113600011
10801
PROMOXIL 250MG CAP
1[31 2600011 26000112600011 2600011
10731
PROMOXIL S 125MG/5ML SUS
1110011 2300011 23000112300011 2300011
00231
PROMOXIL SF 250MG/5ML SUS
IGI 3800011380001138000113800011
00381
RANCEPH 250MG CAP
'I 6300011630001163000116300011
30151
RANCEPH 500MG CAP
{3111500011115000111150001111500011
50751
RANCEPH 125MG/5ML SUS
'GI 6300011630001163000116300011
00631
RANCEPH 250MG/5ML SUS
,1100111360001113600011136000111360001113600011
10361
RANCLAV 375MG TAB
1[3110300011103000111030001110300011 10300011
60871
RANCLAV 625MG TAB
{3117000011170000111700001117000011 17000011
110331
RANCLAV FORTE SUS
{DDDDDI
I
RANCLAV SUS
'GI 5900011590001159000115900011
00591
RANMOXY 250MG CAP
{31 2600011260001126000112600011
10731
RANMOXY 500MG CAP
'GI 4600011460001146000114600011
30071
ROLAB-AMOCLAV S SUS
'GI 5900011590001159000115900011 00591
ROLAB-AMOCLAV SF SUS
'GI11600011116000111160001111600011
10161
ROLAB-AMOCLAV 375MG TAB
1[3110300011103000111030001110300011 10300011
60871
ROLAB-AMOXYCILLIN 250MG CAP
'GI 2600011260001126000112600011
10731
ROLAB-AMOXYCILLIN/FL 500 MG CAP
IGI 78000117800011780001178000lGI
5.201
ROLAB-AMPICILLIN250MGCAP
'I 2000011200001120000112000011
10001
ROLAB-AMPICILLIN500MGCAP
'I 3600011360001136000113600011
10801
ROLAB-CEFACLOR 250MG CAP
'GI 122000111220001112200011 12200011 12200011
80131
ROLAB-CEFACLOR 500MG CAP
'G118700011187000111870001118700011 18700011
12.471
ADDendix H
Prodiictname
I[]m
»ii iNty ..JqliJU'(¥>FAqij';i ....:). .........Q
i..t...............;li2JJt.'2QQU ..2QQ2..1nQfkuRiiJ
ROLAB-CEFACLOR BO 187MG sus
'GI 9700011 97.0011 97.0011 97.0011
1.941
ROLAB-CEFACLOR BO 375MG sus
'GI 157.001115700011157.0011 157.0011 15700011
3.141
ROLAB-CEFACLOR CO TAB
1[31138.0011138.0011138.0011138.0011 138.0011
13.801
ROLAB-CEFACLOR PAEO 125MG sus
,GI103.0011103.001110300011103.0011 103.0011
10371
ROLAB-CEFACLOR PAEO 250MG sus
'GI 168.0011168.0011168.0011 168.0011 16800011
20241
ROLAB-CEPHALEXIN 500MG CAP
'1115.00111150001111500011115.0011
5.751
ROLAB-CLOXACILLIN 250MG CAP
II 61.001161.001GI 30051
ROLAB-CLOXACILLIN 500MG CAP
II 98.001198.001198.00119800011
4.901
ROLAB-FLUCLOXACILLIN 250MG CAP
'110000011100.0011100.001110000011 10000011
5.001
SALTERMOX 250MG CAP
'GI 26.00112600011260001126.0011
1.731
SALTERMOX 500MG CAP
IGI 460001146.001146.001146.0011
3.071
SALTERMOX S 125/5ML sus
'GI 23.001123.001123.0011 23.0011
0.231
SALTERMOX SF 250/5ML.:sus
'GI 38.0011 38000113800011 38000lGI
0.381
SPECTRACIL 125/5ML sus
'GGI17.001117.00IGGI 0.171
SPECTRACIL 250/5ML sus
'GI 22.0011 22.0011 2200011 2200011
0.221
SPECTRACIL250MGCAP
'I 20,001120.001120000112000011
1.001
SPECTRAMOXC 250MGCAP
'GI 26.001126.001126.001126.0011
1.731
SPECTRAMOX S 125/5ML sus
IGI 2300011 23.0011 23.0011 23.0011
0.231
SPECTRAMOX SF 250/5ML sus
1110011 3800011 38.0011 38.0011 38000lGI 0.381
SUPRAPEN 500MG CAP
'GI 78.001178.001178.001178.0011
5.20\
SUPRAPEN S 250MG sus
'GI 82.0011 820001182.0011 82.0011
00821
VERCEF 125MG/5ML sus
,GI103.0011103.0011103.0011103.0011 103.0011 1.371
VERCEF 187MG/5ML sus
'GI 970001197.001197000119700011 1.941
VERCEF 250MG CAP
'GI12200011122.0011122.001112200011 122.0011 8.131
VERCEF 250MG/5ML sus
'GI168.0011168.0011168.0011168.0011 16800011 2.241
VERCEF 375MG/5ML sus
'GI157.0011157.0011157.0011157.0011 15700011 3.141
iVERCEF 500MG CAP
'GI 187.0011187.0011187.0011187.0011 187.0011 12.471
VERCEF MR 375MG TAB
1[3113800011138,0011138.0011138.0011 138.0011 13.801
ADDendix H
Product name
rpL
'ize
1 M~~JLJ~~eJU~/Y jl~AU9-jr==J~Cost ~' ',' 2.002 ., " 2 02 002. 2002.' ~ ;,,,,,,,unit,(BJ
[31 260001126000112600011260001~1 10731
[31 260001126000112600011260001~1 10731
[31 460001146000114600011460001~1 30071
01 230001123000112300011230001~1 00231
110011 3800011 38000113800011 38000lGI 00381
MPL Price (Betail incl VA7J
XERACIL 250MG CAP
ZOXIL 250MG CAP
ZOXIL 500MG CAP
ZOXIL S 125MG/5ML SUS
ZOXILSF 250MG/5MLSUS
ADDendixH
Table 2H: Antibiotics listed on the MPL. September 2002 to December 2002.
"C~CC1
§]
"""""""" .. ......
: .' ' MPLPrice(Retailincl VA1J
; MPL ". . m .. ' ~,. .,." ... .. ". ,..
1 Size ... 1 S~pt Oct. '.. .1. . Nov. .: Dec.. ." ."Co . .....
inOO~~@Jl200~E+-~
IGI 23.001GI 23.001GGI 0.231
]GI 38.001GGGI 38.00110.381
]GI 116.0011116.0011116.001~1116.0011 1.161
]GI 59.001GI 59.oo1GGI 0.591
]01 103.0011103.0011103.0011103.0011103.0011 6.871
]01 170.0011170.0011170.0011170.0011170.0011 11.331
]GI 23.001GI 23.001GI 23.00110.231
]GI 38.001GI 38.00IG~1 0.381
101 26.001~1 26.001126.001126.0011 1.731
101 46.0011 46:0011 46.0011 46.0011 46.0011 3.071
101 103.0011103.0011103.0011103.0011103.0011 1.371
101 168.0011168.0011168.0011168.0011168.0011 2.241
101 122.0011122.0011122.0011122.0011122.0011 8.131
]01 97.001GGGGI 1.941
101 138.0011138.0011138.0011138.0011138.0011 13.801
101 157.0011157.0011157.0011157.0011157.0011 3.141
101 46.00IGGGI 46.00113.071
]01 26.001~1 26.001126.001GI 1.731
]GI 23.001~GGGI 0.231
IGI 38.00IGGG~1 0.381
]GI 67.001GI 67.001GGI 0.671
IGI IDD~GI 0.181
101 26.001~1 26.001GI 26.00111.731
]GI 38.001GI 38.00IG~1 0.381
101 46.00IGI 46.00IGI 46.00113.071
IGI 23.001GI 23.001123.oo1GI 0.231
]01 26.001~1 26.001GI 26.00111.731
Product name
[ACUCIL S 125/5ML SUS
[ACUCIL SF 250/5ML SUS
[ADCO-AMOCLAV FORTE SUS
[ADCO-AMOCLAV S SUS
[ADCO-AMOCLAV375MG TAB
[ADCO-AMOCLAV625MG TAB
[ADCO-AMOXYCILLIN125/5ML SUS
[ADCO-AMOXYCILLIN250/5ML SUS
[ADCO-AMOXYCILLIN250MG CAP
[ADCO-AMOXYCILLIN500MG CAP
[ADCO-CEFACLOR 125/5ML SUS
[ADCO-CEFACLOR 250/5ML SUS
[ADCO-CEFACLOR 250MG CAP
[
ADCO-CEFACLOR BD 187MG/5ML
SUS
[ADCO-CEFACLOR BD 375MG TAB
IADCO-CEFACLOR BD 375MG/5ML
SUS
lA-LENNON AMOXYCILLIN500MG
CAP
[A-LENNON AMOXYCILLINCAP
lA-LENNON AMOXYCILLIN125MG
SUS
lA-LENNON AMOXYCILLIN250MG
SUS
[A-LENNON PHENOXYMETH TAB
[
A-LENNON PHENOXYMETHYLPEN
SUS
[AMOCILLIN 250MG CAP
[AMOCILLIN 250MG/5ML SUS
[AMOCILLIN 500MG CAP
[AMOCILLIN SUSP 125MG/5ML SUS
[AMOXIL 250 250MG CAP
ADDendixH
Product name
[AMOXIL 500MG CAP
[AMOXIL S 125/5ML SUS
[AMOXIL SF 250/5ML SUS
[AMPICLOX 500MG CAP
[AMPICLOX S 100ML 250MG SUS
[AMPIMAX 250 250MG CAP
[AMPIPEN 100ML 125/5ML SUS
[AMPIPEN 250/5ML SUS
[AMPIPEN 250MG CAP
[AMPIPEN 500MG CAP
[APEN 500MG CAP
[APEN S 250MG SUS
[
ASPEN-CEPHALEXIN 125MG/5ML
SUS
[ASPEN-CEPHALEXIN 250 MG CAP
[
ASPEN-CEPHALEXIN 250MG/5ML
SUS
[AUGMAXCIL S SUS
[AUGMAXCIL SF SUS
[AUGMAXCIL 375MG TAB
[AUGMAXCIL 625MG TAB
[AUGMENTIN 375MG TAB
[AUGMENTIN 625 MG TAB
[AUGMENTIN S 156/5ML SUS
[AUGMENTIN SF 312MG/5ML SUS
[BE-AMPICIL 125/5ML SUS
[BE-AMPICIL 250MG CAP
[BETACEF 125MG/5ML SUS
[BETACEF 250 MG CAP
[BETACEF 500MG CAP
[BETAMOX 250MG CAP
MPL
Size
]D[
][3[
][3[
]O[
][3[
]O[
][3[
][3[
]O[
]O[
]O[
][3[
][3[
]Ot
][3[
1[3[
1[3[
ID[
]D[
]D[
]D[
1[3[
1[3[
]G[
]O[
1[3[
IO[
]O[
ID[
MPL Price (Retail incl VAT)
, , ",~~,-
~@J
..."..." i
~
'... ..
@]a
.
~
Cost
Sept Oct... Nov. .. Dec. " ·
2002.:. 2002 . ..20~2 ..' 2002 Average per unit
460001GI 460001GI 4600011 30071
23000lGI 23000lGI 2300011 00231
38000lGGGGI 00381
99000lGI OOooolGI 9405011 40731
60000lGI 60000lGI 6000011 00601
20000lGI 20000lGI 2000011 10001
17000lGI 1700011 17000lGI 00171
32000]GI 32000lGGI 00321
20000]GI 20000lGGI 10001
42000]~1 42000lGGI 20101
99000]GI 0000011OOooolGI 40731
60000]GI 600001G~1 00601
63000]G~~GI 00631
63000lGI 630ool~GI 30151
136000]11360001~~113600011 10361
59000]GI 5900011 59000lGI 00591
116000]~1 116000111160001111600011 1.161
103000]1 103.0011 10300011 10300011 10300011 60871
170000]1 17000011 17000011 17000011 17000011 110331
103000]1 10300011 103000iGI 10300011 60871
170000]1 17000011 17000011 1700001117000011 110331
59000lGI 59000iGGI 00591
11600011 116.0011 11600011 1160001111600011 1.161
17000lGI 1700011 17.00IGI 00171
20000lGI 20000lGI 2000011 10001
63000lGI 630001G~1 00631
63000]GI 63000lGI 6300011 30151
1150001~1 115000lGI11500011 50751
26000]GI 2600011 2600011 2600011 10731
Product name
[BETAMOX 500MG CAP
[BETAMOX S 125/5ML SUS
[BETAMOX SF 250/5ML SUS
[BETAPEN 125/5ML SUS
[BETAPEN 250MG TAB
[BIO-AMOKSIKLAV S SUS
[BIO-AMOKSIKLAV SF SUS
[BIO-AMOKSIKLAV 625MG TAB
[BIO-AMOKSIKLAV 375MG TAB
!CEC 125125MG/5ML SUS
!CEC 250MG/5ML SUS
[CEC 500MG TAB
[CECLOR P 125MG/5ML SUS
[CECLOR 250MG CAP
!CECLOR P 250MG/5ML SUS
[CECLOR 500MG CAP
[CECLOR BD 187/5ML SUS
[CECLOR BD FORTE 375/5ML SUS
!CECLOR CD 375MG TAB
[CECLOR CD 500MG TAB
[CEFADROX 500MG CAP
[CEFADROX SUSP 500MGIML SUS
[CIPADUR 500MG CAP
[CLAMENTIN 375MG TAB
[CLAMENTIN S SUS
[CLAMENTIN SF SUS
!CLAVUMOX S SUS
!CLAVUMOX SF 312MG SUS
!CLAVUMOX 375MG TAB
Appendix H
§]
..-....................
'. MPL Price (Retail ;ncl VAT)
MPL '.. Cd _. ." '.. ....
..' ,... ',' , .. Cost
Size. Sept. ..'. Oct ... Nov... Dec..' ...,. . .
.._ @] ~J@]=~2Ib~I~,t
]01 46.00IGI 46.00IGI 46.00113.071
]GI 23.001~1 23.00IG~1 0.231
]GI 38.001GGGGI 0.381
]GI 19.00IGGG~1 0.181
]GI 67.001GGGI 67.00110.671
]GI 59.001GI 59.001159.001Gr 0.591
]GI 116.0011116.0011116.0011116.0011116.0011 1.161
]01 170.0011170.0011170.0011170.0011170.0011 11.331
]01 103.0011103.001GI 103.0011103.0011 6.871
]01 103.0011103.0011103.0011103.0011103.0011 1.371
101 168.0011168.0011168.001~1 168.0011 2.241
]01 187.0011187.0011187.0011187.0011187.0011 12.471
]01 103.0011103.0011103.001~1103.0011 1.371
101 122.0011122.0011122.0011122.0011122.0011 8.131
]01 168.0011168.0011168.001GI 168.0011 2.241
]01 187.0011187.0011187.0011187.0011187.0011 12.471
]01 97.001GI 97.001197.001GI 1.941
101 157.0011157.0011157.0011151.0011157.0011 3.141
1131 138.0011138.0011138.0011138.0011138.0011 13.801
]01 187.0011187.0011187.0011187.0011187.0011 12.471
]131 106.0011106.0011106.0011106.0011106.0011 10.601
]01 121.0011121.0011121.0011121.0011121.0011 2.021
]131 106.0011106.0011106.0011106.0011106.0011 10.601
101 103.0011103.0011103.0011103.0011103.0011 6.871
]GI 59.001GI 59.001GI 59.00110.591
IGI 116.0011116.0011116.00IGI116.0011 1.161
IGI 59.001GI 59.001GI 59.00110.591
]GI 116.0011116.0011116.0011116.0011116.0011 1.161
101 103.0011103.0011103.0011103.0011103.0011 6.871
ADDendix H
I MP/.r=cMp;;.;;A?c; ......... .I
Productname
' Sa.:ninOct 1 : II. jr1
: 2002" 2002... 2002 . 2002 'R'
, . _,. _.._. ',' . " . ',c" _.,....,.,: .,.-.,........,.".".,..",.,."".,.,__. .._........................ 'n",.V' .... "., .
ICLORACEF 2S0MG CAP 101 122.0011 122.0011 122.0011 122.0011 122.0011
8.131
ICLORACEF SOOMGCAP 101 187.0011 187.0011 187.0011 187.0011 187.0011
12.471
ICLORACEF BD 187MG SUS 101 97.001GI 97.001GGI
1.941
ICLORACEF BD 37SMG SUS 101 1S7.0011 1S7.0011
1S7.0011 1S7.0011 1S7.0011
3.141
ICLORACEFMRTAB 101 138.0011 138.0011 138.0011 138.0011 138.0011 13.801
ICLORACEF P 12SMGSUS 101 103.0011 103.0011 103.0011 103.0011 103.0011
1.371
ICLORACEF PF 2S0MG/SMLSUS 101 168.0011 168.0011 168.0011 168.0011 168.0011
2.241
ICLOXAM SOOMGCAP 101 99.001GI 96.001196.00IGI
4.731
ICLOX,N2S0MGCAP 101 61.001GI 61.001GGI 3.0sl
ICLOX,N SOOMGCAP 101 98.0011 101.0011101.001GI 4.981
ICLPALLIANCECEPHALEXIN 101 63.ool1 63.001163.0011
3.1SI
IC-MOX 12S S 12S/SML SUS IGI 23.0011 23.001123.0011
0.231
IC-MOX 2S0MG CAP 101 26.0011 26.001126.0011 26.0011
1.731
IC-MOX S 2S0/SMLSUS IGI 38.001GI 38.001GGI
0.381
IC-MOX SOOMGCAP 101 46.00IGI 46.001146.0011 46.0011 3.071
ICPLALLIANCECEPHALEXIN 101 11s.0011 11s.0011 11s.00IGI11s.0011 s.7sl
ICPLALLIANCECEPHALEXINDRY
IGI 63.00IGGG1 0.631
SYRUP
IDACEF SOOMG CAP
101 106.0011 106.0011 106.0011106.0011 106.0011 10.601
IDACEF SOOMG/SMLSUS 101 121.0011 121.0011 121.0011 121.0011121.0011 2.021
IDYNA-AMoXYCILLIN12S/SMLsus IGI 23.0011 23.001123.0011 23.0011 0.231
IEXCILLIN12SMGsus IGI 17.001GI
17.001GGI
0.171
IFEXIN 2S0MGTAB
101 63.oo1GI 63.ooIG1 3.1sl
IFEXIN 2S0MG/SMLsus IGI 136.0011 136.0011
136.0011 136.0011 136.0011
1.361
IFEXIN SOOMGTAB
101 11s.0011 11s.0011 11s.0011 11s.0011 11s.0011
s.7sl
IFLOXAPEN 2S0 2S0MG CAP
101 100.0011 100.0011 100.0011 112.0011 103.0011 s.1sl
I'NCIL VK100m112S/SmlSUS
IGI 19.001GI18.001GGI 0.181
I,PCAMOX 2S0MG CAP 101 26.0011 26.001126.0011 26.0011
1.731
IKEFLEX12SMG/SMLsus IGI
63.0011 63.00IG1 0.631
I KEFLEX 2S0MG CAP
101 63.001GGGI 63.0011
3.1sl
ADDendix H
@]
I~ .. . MPLPrice
.
(R~;'
.
:/
.
'
.
i
..
n
.
'C
.
Iv,
...
.:4
.
TJ ."
MPL II' . .. . . '.
Product name .. . i . ... : ." .~ i . Cost
: Sa
..
.
.
1 [
.
!
.
:~
.
t rOct ]
.
'
.
f
',
No~'. II
..
' .D
..
8C
. ]I~
..
~ per unn
..' .. ...: 20()2 2002 _: ... 2002 .~~~.. .. (RJ
IKEFLEX250MG/5MLSUS IGI 136.0011 136.0011 136.0011 136.0011136.0011 1.361
IKEFLEX500MGTAB 101 115.001~1 115.001~1 115.00115.751
ILENVK100125/5MLSUS IGI 19.001GI 18.001GGI 0.181
!LENVK250MGTAB IGI 67.001GI 67.001GGI 0.671
ILENACLOR125MGP SUS 101 103.0011103.0011103.0011103.0011103.0011 1.371
ILENACLOR250MGPSUS 101 168.0011168.0011168.0011168.0011168.0011 2.241
ILENACLORBO187MGSUS 101 97.001GI 97.001197.oo1GI 1.941
ILENACLORBOFORTESUS 101 157.0011 157.0011 157.0011 157.0011157.0011 3.141
ILENACLORCAP 101 122.0011 122.0011 122.0011 122.0011122.0011 8.131
ILENACLORCAP 101 187.0011 187.0011 187.0011 187.0011187.0011 12.471
ILENACLORCO500MGTAB 101 187.0011 187.0011 187.0011 187.0011187.0011 12.471
ILENACLORCOTAB 101 138.0011 138.0011 138.0011 138.0011138.0011 13.801
ILENOCEF125MG/5MLSUS IGI 63.001GI 63.001163.001~1 0.631
ILENOCEF250MGCAP 101 63.001GI 63.0011 63.0011 63.0011 3.151
ILENOCEF250MG/5MLSUS IGI 136.0011 136.0011 136.0011 136.0011136.0011 1.361
ILENOCEF500MGCAP 101 115.0011 115.0011 115.0011 115.0011115.0011 5.751
ILiLLY-CEFACLOR125MG/5MLSUS 101 103.0011103.0011103.0011103.0011103.0011 1.371
ILiLLY-CEFACLOR250MGCAP 101 122.0011122.0011122.0011122.0011122.0011 8.131
ILiLLY-CEFACLOR250MG/5MLSUS 101 168.0011168.0011168.0011168.0011168.00112.241
I~I~~Y-CEFACLORBO375MG/5ML 101 157.0011157.0011157.0011157.0011157.00113.141
I~'~~Y-CEFACLORBO 187MG/5ML 101 97.001GGGGI 1.941
ILiLLY-CEFACLORCO375MGTAB 101 138.0011 138.0011 138.0011 138.0011138.0011 13.801
IMACROPEN500MGCAP 101 78.001GI 78.001GI 78.0011 5.201
IMACROPENS250MGSUS IGI 82.001~1 82.001GI 82.0011 0.821
IMAXC'LA250MGCAP 101 26.001GI 26.001GI 26.0011 1.731
IMAXCILAF500MGCAP 101 46.001~1 46.0011 46.0011 46.0011 3.071
IMAXCILP125/5MLSUS IGI 23.001GI 23.oo1GI 23.0011 0.231
IMAXC,LPF250/5MLSUSIGI 38.001GI 38.001GGI 0.381
IMEGAMOX250MGCAP101 99.001GI 96.00IGGI 4.731
Appendix H
EJ
" .' ... t,rPLprice(Retailincl VATJ
MPL . ... ... ~. . - ,
Product name I.. Size i .., . . ..."'... . "'. ., "'Cost
; Sept. Oct.., Nov. Dec.., , .
:m![.;][J]1 ~-[':]~--II per~nd
IMEGAMOX S 125MG/5ML SUS IGI 60000lGI 60000lGGI 00601
IMEGAPEN500MGCAP 101 78000lGGGGI 50201
IMEGAPENS 125MG/5MLSUS IGI 82.001GI 82.001GGI 00821
IMOXAN250MGCAP 101 26.001GI 26000lGI 26.0011 10731
IMOXAN500MGCAP 101 46.00IGI 46.00IGI 46.0011 30071
IMOXANS125/5MLSUS IGI 23.001~1 23000lGGI 00231
IMOXANSF250/5MLSUS IGI 380001~1 380001138.001GI 00381
1MOXYCLAV 375MG TAB 101 103.0011 103.0011 103.0011 1030001110300011 6.871
IMOXYCLAVSSUS IGI 59.001GI 59.001GI 5900011 00591
I MOXYCLAV SF SUS IGI 116.0011116.0011116.001G111600011 10161
IMOXYPEN125/5MLSUS IGI 23.001~1 23.001123.001GI 00231
IMOXYPEN250/5MLSUS IGI 380001~1 38.001138000lGI 00381
IMOXYPEN250MGCAP 101 26.oo1GI 26.001126.001GI 1.731
IMOXYPEN500MGCAP 101 460001GI 46.001146.001146.0011 3.071
INOVOVK250MGTAB IGI 67.00IGI 670001G~1 00671
IORBENIN250MGCAP 101 61.oo1GI 61000lGGI 30051
IORBENIN500MGCAP 101 980001~1 1010001~~1 4.981
IPENMOX250MGCAP 101 26.00IGI 260001126000112600011 10731
IPENMOX500MGCAP 101 460001GI 460001146.0011 46.0011 3.071
IPENMOXP125/5MLSUS IGI 230001~1 230001123000112300011 00231
IPENMOXPF250/5MLSUSIGI 38000lGI 38000lGGI 0.381
IPENRITES125/5MLSUSIGI 17.00IGI 17.001GGI 00171
IPENRITES250/5MLSUS IGI 32.001~1 32.0011 32.oo1GI 00321
IPENRITE500MGCAP 101 42.001GI 420001142.001142.0011 20101
IPETERCILLIN125/5MLSUS IGI 17000lGI 17.001117000lGI 00171
IPETERCILLlN250/5MLSUS IGI 320001~1 32.001GGI 0.321
IPETERCILLlN250MGCAP 101 20000IGI 20000lGI 200001110001
IPETERCILLIN500MGCAP 101 42000lGI 420001142000114200011 20101
IPROMOXIL250MGCAP 101 26000lGGGI 2600011 10731
ADDendix H
, .
@]
... ;11 MPLPriCfl(R~~~I/nclvA.T) .. ...........................
Productname . M~L . i . - j . . ... . '.. : . .~'...".Co~
Size .. Sept.; Oct.:: Nov Dec. .. .
. .1 2002II200d 2OO2J~2 Ir-=1per;:~
IPROMOXIL S 125MG/5ML SUS IGI 230001~1 230001G~1 00231
IpROMOX,LSF250MG/5MLSUS IGI 38000lGI 38000lGGI 00381
IRANCEPH250MGCAP101 63000lGGGGI 30151
IRANCEPH500MGCAP 101 1150001~1 1150001~111500011 50751
IRANCEPH125MG/5MLSUSIGI 63000lGI 63000lGGI 00631
IRANCEPH250MG/5MLSUS IGI 1360001113600011136000111360001113600011 10361
IRANCLAV375MGTAB 101 1030001110300011103000111030001110300011 60871
IRANCLAV625MGTAB 101 1700001117000011170000111700001117000011 110331
!RANCLAVFORTESUS IGI 1160001111600011116000111160001111600011 1.161
IRANCLAVSUS IGI 59000lGI 59000lGGI 00591
IRANMOXY250250MGCAP101 260001~1 26000lGI 260001110731
IRANMOXY500500MGCAP 101 460001GI 460001146000114600011 30071
IROLAB-AMOCLAVSSUSIGI 59000lGI 59000lGGI 00591
1ROLAB-AMOCLAVSFSUS IGI 1160001111600011116000111160001111600011 1.161
1ROLAB-AMOCLAVTAB 101 1030001110300011103000111030001110300011 60871
IROLAB-AMOXYCILLIN 250MG CAP 101 26000lGI 260001126000112600011 10731
I~~~B-AMOXYCILLIN/FL500MG 101 78000lGGGGI 50201
1ROLAB-AMPICILLIN 250MG CAP 101 200001~1 200001G~1 10001
1ROLAB-AMPICILLIN500MGCAP 101 42000lGI 42000iGI 420001120101
I ROLAB-CEFACLOR250MGCAP 101 122000111220001112200011122000111220001180131
IROLAB-CEFACLOR 500MG CAP 101 187000111870001118700011187000111870001112.471
1ROLAB-CEFACLOR BD 187MG SUS 101 97000iGI 97000lGI 970001110941
1ROLAB-CEFACLOR BD 375MG SUS 101 157000111570001115700011157000111570001130141
IROLAB-CEFACLOR CD TAB 101 13800011 13800011 13800011 1380001113800011 130801
I~~~B-CEFACLOR PAED 125MG 101 1030001110300011103000111030001110300011 10371
I~~~B-CEFACLOR PAED 250MG 101 1680001116800011168000111680001116800011 20241
I ROLAB-CEPHALEXIN 500MG CAP 101 1150001111500011115000lGI11500011 50751
IROLAB-CLOXACILLIN250MGCAP 101 61000lGI 610001161000lGI 30051
IROLAB-CLOXACILLIN500MGCAP 101 98000lGI 10100011101000lGI 40981
ADDendixH
Product name
[
ROLAB-FLUCLOXACILLIN 2S0MG
CAP
[SAL TERMOX 2S0MG CAP
[SAL TERMOX SOOMG CAP
[SALTERMOX S 12S/SML SUS
[SAL TERMOX SF 2S0/SML SUS
[SPECTRACIL 12S/SML SUS
[SPECTRACIL 2S0/SML SUS
[SPECTRACIL 2S0MG CAP
[SPECTRAMOX C 2S0MG CAP
[SPECTRAMOX S 12S/SML SUS
[SPECTRAMOX SF 2S0/SML SUS
[SUPRAPEN SOOMGCAP
ISUPRAPEN S 2S0MG SUS
IVERCEF 12SMG/SML SUS
[VERCEF 187MG/SML SUS
[VERCEF 2S0MG CAP
[VERCEF 2S0MG/SML SUS
[VERCEF 37SMG/SML SUS
IVERCEF SOOMG CAP
IVERCEF MR 37SMG TAB
[XERACIL 2S0MG CAP
[ZOXIL 2S0MG CAP
[ZOXIL SOOMG CAP
IZOXIL S 12SMG/SML SUS
[ZOXIL SF 2S0MG/SML SUS
..
~
.....
MPL .l . MPL Price (~~t;Ji~!~c:!VAT) _
S
.
f
..
'Z
..
e
'
...
1 Sept -11 OcL I
I
Nov. I
I
... Dec. 11 Averag,
2002 I 2002 ~ 2002 I 2002
]01 100,0011100.001~~1103,ooll
101 26,oolGI 26.001GI 26.0011
101 46.00IGG~1 46.001[
1[31 23,oolGI 23,OoIGG[
][31 38,oolGI 38,OolGGI
][31 17.001GI 17,OoIGG[
1[31 32,OolGI 32,001132,001132,ool[
]01 20,oolGI 20,oo1GG[
101 26,ool~1 26,ooiGI 26,Ool[
]GI 23,oolGI 23,001123.001GI
][31 38,ooiGI 38,oolGI 38,001[
]01 78,oolGI 78,001178.00IG[
][31 82,ooiGI 82,001182.001182,ool[
101 103.0011103,0011103.0011103,0011103,Ool[
1[31 97,ooiGI 97,oolGI 97,ool[
101 122,0011122,0011122,0011122,0011122,Ool[
101 168,0011168,0011168.0011168.0011168,Ool[
][31 1S7,ooIl 1S7,ooIl 1S7,ooIl 1S7.00111S7,ooIl
]01 187,0011187.0011187,0011187.0011187.0011
101 138,0011138,0011138,0011138.0011138,0011
101 26,oolGI 26.001GI 26.0011
101 26,oolGI 26.001126,001126,0011
101 46.00IGI 46.00IGI 46,0011
1[31 23.001GI 23,001123.00IG[
1[31 38.001GI 38,001138,001138.ool[
. Cost
per unit
&..-.
S.1S]
1.73]
3.07]
0.23]
0.38]
0.17]
0.32]
1.00]
1.731
0,23]
0.381
S.20]
0.82]
1,37]
1,941
8.13]
2.24]
3,14]
12.47]
13.80]
1,73]
1.73]
3.071
0,231
0,38\
ADDendixH
Table 3H: Antibiotics listed on the MPL. January 2003 to April 2003.
Product name
.rL;JI......... . .............. ...................L Pri.eil inc VA?:.................... ................................
DBBBBI. Costper
. . "v. " . .. ..... an.200Feb.23 Mar-2oo3 Apr-2003 .. verage unit(RJ
IACUC,L 2S0MG CAP 10DDDDDI
1
IACUCIL S 12S/SMLSUS IGGG1 23.0011
0.231
!ACUCIL SF 2S0/SMLSUS 1C3G1 38.0011
0.381
IADCO-AMOCLAV 37SMGTAB 101 101.0011 101.0011101.0011101.0011
6.731
IADCO-AMOCLAV62SMGTAB 101 16S.001116S.001116S.001116S.001116S.0011
11.001
IADCO-AMOCLAVFORTESUS 1C31 110.0011 110.0011 110.0011110.0011 1.101
IADCO-AMOCLAVS SUS IC3GI S7.0011 S7.0011 0.S71
IADCO-AMOXYC,LLlN 12S/SMLSUS IC3GG1 23.0011 0.231
IADCO-AMOXYC,LLlN 2S0/SMLSUS II 38.00IG1 0.381
IADCO-AMOXYC,LLlN2S0MGCAP 10GI 24.00IG1 23.75111.581
IADCO-AMOXYCILLINSOOMGCAP 101 46.001146.00IG1 46.0011 3.071
IADCO-CEFACLOR 125/SMLSUS 101 103.0011 103.0011 103.0011103.0011103.0011 1.371
IADCO-CEFACLOR 250/5ML SUS 101 168.0011 168.0011 168.0011168.0011168.0011 2.241
IADCO-CEFACLOR 2S0MG CAP 101 122.0011122.0011122.0011122.0011122.0011 8.131
IO-CEFACLOR BD 187MG/5ML IDGGGGI 97.0011 1.941
!ADCO-CEFACLOR BD 375MG TAB 101 138.0011138.0011 138.0011 138.0011 138.0011 13.801
ADCO-CEFACLORBDFOR
01 157.0011 157.0011 157.0011157.0011157.0011 3.141
375MG/5MLSUS
lA-LENNONAMOXYCILLIN 101 46.00IG1 46.0011 3.071
lA-LENNONAMOXYCILLIN125MG
IC3GGGGI 23.00110.231
SUS
lA-LENNONAMOXYCILLIN250MG
IGGGGGI 38.0011 0.381
SUS
lA-LENNONAMOXYCILLINCAP
10GG1 23.75111.581
liNNON PHENOXYMETHYLPENIGGGGGI 70.5011 0.711
INNON PHENOXYMETHYLPEN IGGGGGI
0.181
IAMOC'LLIN250MGCAP
10G1 23.7511 1.581
IAMOCILLIN250MG/5MLSUS
1C3G1 38.00110.381
fMOCILLIN 500MGCAP
101 46.0011 3.071
A endix H
JMPL.Sizei
I. . ..iJIJan~20031 Il=e6~200
IAMOCILLIN SUSP 12SMG/SMLSUS I~~~~~I 2300011
IAMOXIL2S0MGCAP10~~G~1 2307SI1
IAMOXILSOOMGCAP10GG~~1 4600011
IAMOXILS12S/SMLSUS I~~~~~I 2300011
IAMOXILSF2S0/SMLSUS I~GG~~I 3800011
IAMPICLOXSOOMGCAP IO~G~~1 8600011
IAMPICLOXS2S0MGSUSI~~~~~I 6000011
IAMPIMAX2S0MGCAP IO~~~~1 2002SI1
IAMPIPEN12S/SMLSUS I~~~G~~I
IAMPIPEN2S0/SMLSUSI~~~~~~I
IAMPIPEN2S0MGCAPIO~~~~1 2002SI1
IAMPIPENSOOMGCAP IO~~G~1 40.2SI[
IAPENSOOMGCAP IO~G~~1 86.0011
IAPENS2S0MGSUS I~~~~~I 6000011
~~~EN-CEPHALEXIN12SMG/SMLGGGGGI 63.0011
IASPEN-CEPHALEXIN2S0 MG CAP lOG I 630001G~1 63.0011
~~~EN-CEPHALEXIN2S0MG/SMLGGGGI 119.001111900011
IAUGMAXCIL37SMGTAB 10~~~~1101.0011
IAUGMAXCIL62SMGTAB 101 16S.001116S.001116S.001116S0001116S.0011
IAUGMAXCILSSUS I~GG~~~I
/AUGMAXCILSFSUS 1~~~GGI110.0011
IAUGMENTIN37SMGTAB 10~~1 10100011101.0011101.0011
IAUGMENTIN62SMGTAB 101 16S.001116S.001116S.001116S.001116S.0011
IAUGMENTIN S 156/SMLSUS I~GG~~I 57.0011
IAUGMENTIN SF 312MG/5ML SUS I~~I 110000lGGI11O.0011
IBE-AMPICIL125/SMLSUS I~~~G~~I
IBE-AMPICIL2S0MG CAP IO~~~~1 20.2S11
IBETACEF12SMG/5MLSUS IGG~GGI 63.0011
Product name
0023]
1058]
3.071
0.231
0.38]
4.301
00601
1.01]
0.17]
0.331
10011
2.011
4.301
0060]
0.63]
301S1
1.191
6.731
11000]
0.571
1.101
60731
11000]
0.S71
1.10]
00171
1.01]
0.631
ADDendixH
Product name
[BETACEF 250 MG CAP
[BETACEF 500MG CAP
[BETAMOX 250MG CAP
[BETAMOX 500MG CAP
[BETAMOX S 125/5ML SUS
[BETAMOX SF 250/5ML SUS
[BETAPEN 125/5ML SUS
[BETAPEN 250MG TAB
[BIO-AMOKSIKLAV625MG TAB
[BIO-AMOKSIKLAV 375MG TAB
[BIO-AMOKSIKLAV S SUS
[BIO-AMOKSIKLAV SF SUS
[CEC 125MG/5ML SUS
[CEC 50MG/5ML SUS
[CEC 500MG TAB
[CECLOR 125P 125MG/5ML SUS
[CECLOR 250MG CAP
[CECLOR P 250MG/5ML SUS
[CECLOR 500MG CAP
[CECLOR BD 187/5ML SUS
[CECLOR BD FORTE 375/5ML SUS
[CECLOR CD 375MG TAB
[CECLOR CD 500MG TAB
[CEFADROX 500MG CAP
[CEFADROX SUSP 500MGIML SUS
[CIPADUR 500MGCAP
[CLAMENTIN 375MG TAB
[CLAMENTIN S 125MG SUS
MPLPrice (Retai'incl VAT)
iMPLSize,r .. .' ..'»'"'W~ . .,
. . .' .r~~:2~~~II~~2~~F!',r-2~]~ve~gel
]D~~~~I 63.001[
]D~~G~1115.001[
]OGG~GI 23.751 [
]O~G~~I 46.001 [
]~~~GG~[
]~~~~~I 38.001[
]~~I 18.001~~~[
]~GGGGI 70.501[
]DI 165.0011165.0011165.0011165.0011165.001[
]D~~I 101.0011101.0011101.001[
]~GI 57.001~~1 57.001[
]~~I 110.001~~1110.001[
]01 103.0011103.0011103.0011103.0011103.001[
]01 168.0011168.0011168.0011168.0011168.001[
]01 187.0011187.0011187.0011187.0011187.001[
]01 103.001~1 103.0011103.0011103.001[
]01 122.0011122.0011122.0011122.0011122.001[
]01 168.0011168.0011168.0011168.0011168.001[
]01 187.0011187.0011187.0011187.0011187.001[
]O~G~~I 97.001[
]01 157.0011157.0011157.0011157.0011157.001[
]01 138.001~1 138.0011138.0011138.001[
]01 187.0011187.0011187.0011187.0011187.001[
]01 106.001~1 106.0011106.0011106.001[
]D~I 121.0011121.0011121.0011121.001[
]01 106.0011106.0011106.0011106.0011106.001[
]O~~I 101.0011101.0011101.001[
]~GG~~I 57.001[
Cost per
unit (R) 1
3.151
5.75]
1.581
3.071
0.23]
0.38]
0.18]
0.71]
11.001
6.731
0.57]
1.10]
1.37]
2.241
12.471
1.37]
8.13]
2.24]
12.47]
1.941
3.14]
13.801
12.471
10.60]
2.02]
10.60]
6.73]
0.571
A endix H
MPL Price (Retail incl VAT)
Productname I
.
!M
.
PL SiZ~!
B
1
,.
'.
.
. ...
B
.u ...
.
I!..~~~~~
.
.I=~-~u::::
,.
11:... u.~
..Jan. 2003 Feb. 200 Mar-2oo. Apr-2003 Averag .
'"" ~1~"",,,,,,,,,,,,"~~d~ ,.~I' . _ . _ . U_ ¥ . _".' .'..' ,_.. _ V~
ICLAMENTINSF2S0MGSUSI~~~I 110000111100001111000011
ICLAVUMOX37SMGTAB10~~1 101000111010001110100011
ICLAVUMOXSSUS I~GGGGI S700011
ICLAVUMOXSF312MGSUSI~~~I 110000111100001111000011
ICLORACEF2S0MGCAP 101 1220001112200011122000111220001112200011
ICLORACEFSOOMGCAP 101 187000lGI 187000111870001118700011
ICLORACEFBDSUS 101 1S7000111S7000111S7000111S7000111S700011
ICLORACEFBD187SUS 10GG~~1 9700011
ICLORACEFMRTAB 101 1380001113800011138000111380001113800011
ICLORACEFP 12SSUS 101 1030001110300011103000111030001110300011
ICLORACEFPF 2S0MG/SMLSUS 101 1680001116800011168000111680001116800011
ICLOXAMSOOMGCAP ID~~~~I 8600011
ICLOX,N2S0MGCAP I~I 3030001130300011303000113030001130300011
ICLOX,NSOOMGCAPID~I 1010001~~110100011
ICLPALLIANCECEPHALEXIN ID~~~~I 6300011
/C-MOXS12S/SMLSUS I~~~~~I 2300011
IC-MOX2S0MGCAP 10~~G~1 2307sII
IC-MOXS2S0/SMLSUS I~~~~~I 3800011
IC-MOXSOOMGCAP 10~~~~1 4600011
ICPLALLIANcECEPHALEXIN ID~~I 11soooll11sooo1111soooll
~~~~~LlANCECEPHALEXINDRY ~~~~GI 6300011
IDACEFSOOMGCAP 101 1060001110600011106000111060001110600011
IDACEFSooMG/SMLSUSID~~I 121000111210001112100011
IDYNA-AMOXYCILLIN12S/SMLSUS I~~I 230001~~1 2300011
IEXCILLIN12SMGSUS I~~~~~~I
IFEXIN2S0MGTAB ID~~~~I 6300011
IFEXIN2S0MG/SMLSUSI~GG~I 1190001111900011
IFEXINSOOMGTAB IDG~I 11so001111sooo1111soooll
Costper
unitlBl-3
1.10]
6073]
00S7]
1.10]
8013]
12.47]
3014]
1094]
130801
1037]
2024]
4030]
30031
Soosl
301s1
0023]
10S8]
0038]
3007]
S07S]
0063]
10060]
20021
00231
00171
301s1
10191
S07s1
A endix H
MPL Price (Retail incl VAT)
'MPLSize,r .. .. ~. .. .. ... .. . . .. ..
~.,,'~,.,~~:tJan. ~~BI~~:~(}()~lr~~:200~I~v;~~~
IFLOXAPEN250250MGCAP ID~I 112.0011112.0011112.0011112.0011
I,NC,LVK125/5m,susI~~~~~GI
I,PCAMOX250MGCAP10~GG~1 23.7511
IKEFLEX125MG/5MLsus I~~GGGI 63.0011
IKEFLEX250MGCAPID~I 63.001~GI 63.0011
IKEFLEX250MG/5MLSUSI~~GI 119.0011119.0011119.0011
IKEFLEX500MGTAB ID~~~1115.0011115.0011
ILENVK100125/5MLSUS I~~I 18,ool~~GI
ILENVK250MGTAB I~GGGGI 70.5011
ILENACLORCAP 101 122.0011122.0011122.0011122.0011122.0011
ILENACLORCAP 101 187.001~1 187.0011187.0011187.0011
ILENACLOR125Psus 101 103.0011103.0011103.0011103.0011103.0011
ILENACLOR250Psus 101 168.0011168,0011168,0011168.0011168,0011
ILENACLORBD187sus lOG I 97.001~~1 97.0011
ILENACLORBDFORTEsus 101 157.0011157.0011157,0011157.0011157,0011
ILENACLORCDTAB IDI 138.001~1 138.0011138.0011138.0011
ILENACLORCD500MGTAB 101 187.0011187,0011187.0011187,0011187.0011
ILENOCEF125MG/5MLsus I~~G~GI 63.0011
ILENOCEF250MGCAPID~GGGI 63.0011
ILENOCEF250MG/5MLSUSI~~G~I 119.0011119,0011
ILENOCEF500MGCAPID~~~1115.0011115,ooll
IULLY-CEFACLOR 125MG/5ML sus 101 103,0011 103.0011 103.0011103.0011103.0011
lULLY-CEFACLOR 250 MG CAP 101 122.0011122,0011122.0011122.0011122.0011
IULLY-CEFACLOR250MG/5ML sus 101 168.0011 168,0011 168.0011 168.0011 168.0011
~I~~Y-CEFACLORBD 187MG/5ML OGGGGI 97.0011
~~~L~G~;~~~~~RBDFO 01 157.001GI 157.0011157.0011157.0011
lULL Y-CEFACLOR CD 375MG TAB IDI 138.0011138.0011138.0011138.0011138.0011
IMACROPEN500MGCAP 10~~~~1 78.0011
Product name
ADDendix H
Product name
[MACROPEN S 250MG SUS
[MAXCIL A 250MG CAP
[MAXCIL AF 500MG CAP
[MAXCIL P 125/5ML SUS
[MAXCIL PF 250/5ML SUS
[MEGAMOX 250MG CAP
[MEGAMOX S 125MG/5ML SUS
[MEGAPEN 500MG CAP
[MEGAPEN S 125MG/5ML SUS
[MOXAN 250MG CAP
[MOXAN 500MG CAP
[MOXAN S 125/5ML SUS
[MOXAN SF 250/5ML SUS
[MOXYCLAV 375MG TAB
[MOXYCLAV S SUS
[MOXYCLAV SF SUS
[MOXYPEN 125/5ML SUS
[MOXYPEN 250/5ML SUS
[MOXYPEN 250MG CAP
IMOXYPEN 500MG CAP
INOVO VK 250MG TAB
[ORBENIN250MG CAP
[ORBENIN 500MG CAP
[PENMOX250MG CAP
[PENMOX 500MG CAP
[PENMOX P 125/5ML SUS
[PENMOX PF 250/5ML SUS
IpENR,TE S 125/5ML SUS
t~PL s;zJI~n_-~. m ...=~PL~~ce (~~~~' ;ncl VA))
DIJan. 2~D~I~;b. 2oo~IMar-2oo~l~pr-~~~~1~V~"~f!~
!~~~~~I 8200011
!O~~G~I 2307511
]OGG~~I 460001[
]~~~~~I 230001[
!~~~~~I 380001[
!D~~~~I 8600011
!~~~~~I 6000011
!O~~GGI 7800011
!~~~~~I 8200011
!OGGG~I 2307511
]OGG~~I 4600011
]~~I 230001~~1 230001[
]~~I 38.001~~1 380001[
!O~I 10100011101.0011101000111010001[
!~~G~~I 570001[
!~~~I 11000011110000111100001[
]~~~~~I 2300011
!~~I 380001~~1 38.0011
!OGI 240001G~1 2307511
!OGG~~I 460001[
]~~~GGI 700501[
!~I 3030001130300011303000113030001130300011
!D~~I 10100011 1010001110100011
]OGGG~I 230751 [
!OGG~~I 4600011
]~~~~~I 2300011
!~~~~~I 38.0011
!~G~GGGI
Cost
,unit
0.82]
1.58!
3007!
0023!
0038]
4.30]
0.60]
5020]
0082]
1.58]
3007!
0023!
0038!
6073!
0057!
1.10!
0023]
0038]
1058]
3007!
0071!
3.03!
5.05]
1058!
3007!
0.23]
0038]
0017]
A endix H
Productname
MPL,...P(j(;e.(R.f1.talllif(:/llll!)
,,' , 'u "
~~:~~~~~I~!~~:~~~~~~~~~~
IPENRITES2SO/SMLSUS I~~~~~I 33.0011
IPENRITESOOSOOMGCAP IO~~~~1 40.2sll
IPETERCILLIN12S/SMLSUS I~~~~~GI
IPETERCILLIN2SO/SMLSUS I~~~~~I 33.0011
IPETERCILLIN2SOMGCAP IO~~~~1 20.2sll
IPETERCILLINSOOMGCAP IO~~~~1 40.2sll
IPROMOXIL2SOMGCAP10~1 240001G~1 23.7S11
IPROMOXILS 12SMG/SMLSUS I~~I 23.001~~1 23.0011
!PROMOXILSF2SOMG/SMLSUS I~~I 380001~~~1
IRANCEPH12SMGSUS I~~I 630001~~1 63.0011
IRANCEPH2SOMGSUSI~~~I 11900011119.001111900011
IRANCEPH2SOMGCAP IO~1 630001~~1 6300011
IRANCEPHSOOMGCAP lOG I 11Soool~1 11Sooo1111s.0011
!RANCLAVSUS I~GI S7.00IG~1 S700011
IRANCLAV37SMGTAB10~1 1010001~1 101.0011101.0011
IRANCLAV62SMGTAB 101 16S.001116S0001116S.001116S.001116S00011
IRANCLAVFORTESUS1~~~~GI110oooll
IRANMOXY2SOMGCAP10~GG~1 2307SI1
IRANMOXYSOOMGCAP 10~1 46.001~~1 4600011
IROLABPENVK2SOMGTAB I~DI lOG I 7400011
IROLAB-AMOCLAVTAB10~1 1010001~1 101.001110100011
IROLAB-AMOCLAVSSUSI~GGG~~1
IROLAB-AMOCLAVSFSUS I~~~GI 1100001111000011
IROLAB-AMOXYCILLIN2SOMGCAP 10~1 240001G~1 2307sI1
I~~~B-AMOXYCILLIN/FLSOOMG 10GGGGI 78.0011
IROLAB-AMPICILLIN2SOMGCAP IOGI 200001~~1 20.2S11
IROLAB-AMPICILLINSOOMGCAP IO~1 42.001~~1 40.2S11
IROLAB-CEFACLOR250MGCAP 101 122.0011 12200011122.0011 1220001112200011
0033]
2.01]
0.17]
0.33]
1.01]
2001]
1.S8]
0.23]
0.38]
0.63]
1.19]
301S]
S.7S]
0.S7]
6.73]
11.00]
1.10]
10S8]
3007]
0.74]
6.73]
0.S7]
1.10]
1.S8]
S.20]
1.01]
2.01]
8013]
ADDendix H
'-'-,
1:..lf .... ..... ... . . MPLPrice(Reta/inCV? . ... .... m . . .....
Product name
I.. ................/Jra. oolleb. 2ool",ar-1131verar :::::
. . ,-,.
IROLAB-CEFACLOR500MGCAP 101 187.0011 187.0011 1870001118700011187.0011
120471
IB-CEFACLOR BDFO 375MG 101 157.001115700011157.0011157.001115700011
3.141
IB-CEFACLOR BD SU 187MG 10GGGGI 97.001110941
IROLAB-CEFACLOR CD 375MG 101 138.0011 138.0011 138.0011 1380001113800011
13.801
TAB
IROLAB-CEFACLORPAED125MG 101 103.0011 103.0011 1030001110300011103.0011 10371
SUS
IROLAB-CEFACLORPAED250MG 101 168.0011 168.0011 168.0011 168.001116800011 20241
SUS
IROLAB-CEPHALEX,N500MGCAP 1131 115000[1 115.00111150001150751
IROLAB-CLOXACILLIN250MGCAP II 303.0011303.0011303.0011303.0011303.0011 3.031
IROLAB-CLOXAC,LLlN500MG CAP IDI 10100011101.0011101.00115.051
IROLAB-FLUCLOXAC'LLIN250MG 101 112000lGI 11200011112.0011112.0011 5.601
CAP
ISALTERMOX250MGCAP 10G1 23.7511 10581
ISALTERMOX500MGCAP
101 4600011 30071
ISALTERMOXS 125/5MLSUS
II 230001100231
ISALTERMOXSF 250/5MLSUS II 3800011 38.001100381
ISPECTRACIL 125/5ML SUS II 0.171
ISPECTRACIL250/5MLSUS
II 33000110.331
ISPECTRAC,L 250MG CAP IDI 20.2511 1.011
ISPECTRAMOXC 250MGCAP
10G1 23.75111.581
ISPECTRAMOX S 125/5ML SUS
II 23.00110.231
ISPECTRAMOX SF 250/5ML SUS II 38.00110.381
ISUPRAPEN 500MG CAP 10GG1 7800011 50201
ISUPRAPENS 250MGSUS IGGI 82.0011 00821
IVERCEF125MG/5MLSUS 101 103.0011 103.0011 10300011103.001110300011 1.371
IVERCEF187MG/5MLSUS
10GGGI 97.0011 1.941
IVERCEF250MGCAP
101 122.0011 122.0011 12200011122.0011122.0011
80131
IVERCEF250MG/5MLSUS
101 168.0011 168.0011 168.0011 168.0011168.0011 2.241
IVERCEF375MG/5MLSUS
101 157.0011 157.0011 157.0011 157.0011157.0011 30141
IVERCEF500MGCAP
101 187.0011 187.0011 18700011187.0011187.0011 12.471
ADDendix H
Product name
13.80j
1.S8j
10S8j
3.07j
0.23j
0038j
[VERCEF MR 37SMG TAS
[XERACIL2S0MG CAP
IZOX'L 2S0MG CAP
[ZOXILSOOMGCAP
[ZOXILS 12SMG/SML SUS
[ZOXILSF 2S0MG/SML SUS
JRNN. IE
jD~1 138.0011138.0011138.0011138.0011
jDGG~~1 2307SI1
jDGG~~~1
jD~GG~1 46.0011
j~~~~~1 23.0011
j~GG~~1 38.0011
ADDendix I
The pharmacological classification of drugs according to the MIMS@ (Snyman, 2003: 9-11a).
1 CENTRAL NERVOUS SYSTEM
2 ANAESTHETICS
3 ANAGESICS
4 MUSCULO-SCETETAL AGENTS
5 AUTONOMIC
6 AUTACOIDS
7 CARDIO-VASCULAR AGENTS
8 BLOOD AND HAEMOPOEITIC
9 ALCOHOLISM
10 RESPIRATORY SYSTEM
11 EAR, NOSE AND THROAT
12 GASTRO-INTESTINAL TRACT
13 ANTHELMINTICS
14 DERMATOLOGICALS
15 OPHTHALMICS
16 URINARY SYSTEM
17 GENITAL SYSTEM
18 ANTIMICROBIALS
18.1 Beta-Iactams
18.1.1 Penicillins
18.1.2 Cephalosporins
18.1.3 Others
18.2 Erythromycin and other macrolides
18.3Aminoglycosides
18.4 Tetracyclines
18.5 Chloramphenicols
18.6 Sulphonamides and combinations
18.7 Quinolones
18.8 Mycobacteria
18.8.1 Tuberculostatics
18.8.2 Antileprotics
18.9 Other anti-bacterial agents
18.10 Antifungal agents
18.11 Antiprotozoal agents
18.12 Antiviral agents
19 ENDOCRINE SYSTEM
ADDendix I
20 VITAMINS, TONICS, MINERALS AND ElECTROl YTS
21 ANIMO-ACIDS
22 SPECIAL FOODS
23 CYTOSTATICS
24 IMMUNOLOGICAL
25 CHELATING AGENTS, ION EXCHANGE PREPARATIONS
26 BIOLOGICALS
27 ENZYMES
28 POISEN ANTIDOTES
29 OTHERS
30 MEDICAL CASES
ADDendix J
Table 1J: Classification of beta-Iactam antibiotics according to the MIMS@ (Snyman,
2003: 247-263).
[-!hpC/asS J-
. .Tradea'j
n .
.w..,
'ye(t1"r8!/?!!.i
'..<::]
Penicillins
A-Lennon Amoxycillin@ Amoxycillin trihydrate
Adco-Amoclav<ii>
Amoxycillinlclavulanic acid
Adco-Amoxycillin@ Amoxycillin trihydrate
Amocillin@
Amoxycillin sodium
Amoxicillin Hexal@
Amoxycillin trihydrate
Amoxil@
Amoxycillin trihydrate
Ampicillin-Fresenius Vials@) Ampicillin sodium
AmpicloX@ Ampicillin/cloxacillin
Ampipen@
Ampicillin
Apen @
Ampicillin/cloxacillin
Augmaxil@ Amoxycillinlclavulanic acid
Augmentin@ Amoxycillinlclavulanic acid
Be-Ampicil@
Ampicillin trihydrate
Benzatec@
Buffered benzylpenicillin sodium
Benzathine Penicillin-Fresenius
Benzathine penicillin
Vials@
Benzyl Penicillin-Fresenius Vials@ Benzyl penicillin sodium
I
BetamoX@
Amoxycillin trihydrate
Betapen@
Phenoxymethylpenicillin
Bio-Amoksiklav<ii>
Amoxycillinlclavulanic acid
I
Clamentin@
Amoxycillinlclavulanic acid
ClavumoX@
Amoxycillinlclavulanic acid
Cloxacillin-Fresenius Vials@) Cloxacillin sodium
Cloxam@
Ampicillin/cloxacillin
Cloxin@
Cloxacillin sodium
Floxapen@ Flucloxacillin sodium
Intramed Ampicillin & Cloxacillin@
Ampicillin/cloxacillin
IpcamoX@
Amoxycillin trihydrate
Len V.K.@
Phenoxymethylpenicillin potassium
Macropen@
Amoxycillinlflucloxacillin
Maxcil@
Amoxycillin trihydrate
MegamoX@
Ampicillin/cloxacillin
Megapen@
Amoxycillinlflucloxacillin
Moxan@
Amoxycillin
Moxyclav<ii>
Amoxycillin/clavulanic acid
ADDendix J
r Therapeutic class d II
='"Traaename =
H
'w c
Active iaient/s
>:»d:
I Moxypen@
Amoxycillin trihydrate
I NOVOVK@
Phenoxymethylpenicillin potassium
I Novocillin@
Procaine penicillin
I Novopen@
Na-benzylpenicillin
I Orbenin@
Cloxacillin sodium
I Penbritin@
Ampicillin trihydrate
Penilente Forte@
Benzathine benzyl penicillin/procaine
penicillinlbenzyl penicillin
Penilente LA@
Benzathine penicillin
Petercillin@
Ampicillin trihydrate
Procillin@
Procaine penicillin
Promoxil@
Amoxycillin
Ranamp@ Ampicillin sodium
RandaV@
Amoxycillinldavulanic acid
Randosil@
Ampicillinldoxacillin
Ranmoxy@ Amoxicillin trihydrate
Rolab-AmoclaV@
Amoxycillinldavulanic acid
Rolab-Amoxycillin@ Amoxycillin trihydrate
Rolab-AmoxycilliniFludoxacillin@ Amoxycillinlfludoxacillin
Rolab Ampicillin@ Ampicillin trihydrate
Rolab-Cloxacillin@ Cloxacillin sodium
Rolab-Flucloxacillin @ Fludoxacillin sodium
Rolab-Pen-V-K@
Phenoxymethylpenicillin potassium
Spectracil@ Ampicillin trihydrate
SpectramoX@ Amoxycillin trihydrate
Suprapen@ Amoxycillinlfludoxacillin
Tazocin@
Piperacillinltazobactam
Ultracillin@
Benzathine penicillinlbenzylpenicillin
sodium/procainpenicillin
Zoxil@
Amoxycillin trihydrate
Cephalosporins
Adco-Cefador@ Cefador
cec@ Cefador
CeClor@ Cefador
Cedax@ Ceftibuten
Cefacidal@ Cefazolin
Cefazolin Soduim-Fresenius Vials@ Cefazolin sodium
Cefril@
Cephradine
Cefrom@
Cefpirome sulphate
ADDendix J
[
Cipadur$
CipofiX@
Claforan@
Trade name-""""""
--
Cloracef@
CPLAllianceCephalexin@
Dacef@
FiximeCB>
Fortum@
KefdoleCB>
KefleX@
KeflinCB>
Kefzim@
Kefzol@
Klafotaxim@
Lenocef@
Lifurom@
Lilly-Cefaclor$
Mandokef@
MaxipimeCB>
MefoxinCB>
OframaX@
OreloX@
Pharmacare-CefotaximeCB>
Pharmacare-CefoxitinCB>
Pharmacare-CeftriaxoneCB>
Pharmacare-CefuroximeCB>
Prozef@
Ranceph@
RanfradinCB>
Ranzol@
ReftaX@
RocephinCB>
Rolab-Cefaclor$
Rolab-Cephalexin@
Totam@
Vercef@
Zinacef@
ctlve Ingredient/If
Cefadroxil
Cefuroximesodium
Cefotaxime
Cefaclor
Cephalexin monohydrate
Cefadroxilmonohydrate
Cefixime
Ceftazidime penta hydrate
Cefamandole nafate
Cephalexin monohydrate
Cephalotin sodium
Ceftazidime
Cefazolin sodium
Cefotaxime sodium
Cephalexin
Cefuroximesodium
Cefaclor
Cefamandole nafate
Cefepime
Cefoxitinsodium
Ceftriaxone
Cefpodoximeproxetil
Cefotaxime
Cefoxitin sodium
Ceftriaxone
Cefuroximesodium
Cefprozilmonohydrate
Cephalexin monohydrate
Cefradine
Cefazolinsodium
Cefotaxime sodium
Ceftriaxone
Cefaclor
Cephalexin
Cefotaxime
Cefaclor
Cefuroximesodium
ADDendix J
Other
Zinnat@
Azactam@
Lorabid@
Meronem@
Tienam@
Trade name
~ctJve iJ
Cefuroxime
Aztreonam
Loracarbef
Meropenem trihydrate
Imipenem/cilastatin soduim
ADDendix K
Table 1K: Total cost saving according to original and generic antibiotic products. May
2002 to April 2003.
Medschemii@ Piice/..ist lMPI..)
, N.:,,,,
Product Period
Totalcost (R) !
Total
[EHKt=J
calculated cost
Saving %"
(R)
P4
186321.34
110554.31 II
-75767.03 -40.66
Original Amoxycillin
P5
188074.36
63175.69II
-124898.67 -66.41
P6
64206.72 57774.82 -e431.90 -10.02
I
Total
438602.42 231504.82 -207097.60 -47.22
P4
4779405.26 4697981.43 -81423.83 -1.70
Generic Amoxycillin P5
3281775.66 3236054.35 -45721.31 -1.39
P6
3790263.36 3550352.67 -239910.69 .33
I
Total
11851444.28 11484388.45 -367055.83 -3.10
P4
630123.72 536983.13 -93140.59 -14.78
Original
P5
Amoxycillinlclavulanic acid
431926.88 375802.84 -56124.04 -12.99
P6
297478.40 281567.33 -15911.07 -5.35
I
Total
I
1359529.00 1194353.30 -165175.70 -12.15
I
P4
16856987.88 16761661.41 -95326.47 -0.57
Generic
P5
11937190.93 11920088.75 -17102.18 -0.14
Amoxycillinlclavulanic acid
P6
14505357.42 14326298.68 -179058.74 -1.23
I
Total
43299536.23 43008048.84 -291487.39 -0.67
P4
50025.13 34816.00 -15209.13 -30.40
Original
P5
AmoxycillinIfIucloxacillin
28561.48 22275.00 286.48 -22.01
P6
29885.26 27931.60 -1953.66 .54
I
Total
108471.87 85022.60 -23449.27 -21.62
P4
1000584.04 984005.40 -16578.64 -1.66
Generic
Amoxycillinlflucloxacillin
P5
857218.89 840269.50 0.98 0.00
P6
1092302.08 1080368.38 -11933.70 -1.09
I
Total
2950105.01 2904643.28 -28511.36 -0.97
P4
Original Ampicillin P5
P6
I
Total
P4
55502.64 58002.14 2499.5 4.50
Generic Ampicillin
P5
39443.75 46851.6 7407.85 18.78
P6
50142.02 59871.7 9729.68 19.40
I
Total
145088.41 164725.44 19637.03 13.53
-- ---
Appendix K
'lfm'eIit:ePt;lll'e'r
II II I'
,,'," < '''' ''' "''''''''''''",'"",,''
:1 .:2::::::.ii{::::':'."""""",*,""<"':"':'''"7''IJF-'»>:«' _<,:':':'::::_','E""""'''':':':':''''u'''':''4'1
ProduCt
.. ,.. <II
calculatedc:pst
Efft(ttr)
I
.. 74072.66 II 157989.2 II 83916.49 II 113.29
Original
Ii
P5
-8573.32 II -19.15
Ampicillin/cloxacillin
II 44772.62 II 36199.3 II
.1
P6
II 41100.41II 39076.5 II
-2023.91II
-4.92
Total
'I II
159945.69 II 233265.00 II 73319.26 II
45.84
P4
II 248131.20 II 268136.40 II 20005.18 II 8.06
Generic
I
Ampicillin/cloxacillin
II 212413.80 II 210968.90II -1444.93II -0.68
P6 II
271906.20 II 266465.00 II -5441.21II
-2.00
Total II II
732451.20II 745570.30 II 13119.0411
1.79
P4 II
78530.66II 61686.00 If
-16844.7 II -21.45
Original Cefaclor II P5
II 52114.33 II
44520.24
-7594.09II
-14.57
P6 II
39484.85 I
37763.77
-1721.08 II
-4.36
Total II II
170129.84 143970.01
-26159.87If
-15.38
I
P4
1408128.00 1104934.00
-303195.00 -21.53
Generic Cefaclor
P5
688348.50 941060.60
252712.10 36.71
P6
824472.40 1046854.00
222381.90 26.97
Total
2920948.90 3092848.60
171899.00 5.89
P4
6105.09 6035 -70.09
-1.15
Original Cefadroxil P5
13921.21 1378.00
-12543.21 -90.10
P6
1936.17 2408.40
472.23 24.39
Total
21962.47 9821.40
-12141.07 -55.28
P4
161173.2 337546.20
176373 109.43
Generic Cefadroxil
P5
82463.85 81246.80
-1217.05
-1.48
P6
102019.15 100430.40
-1588.75 -1.56
Total
345656.20 519223.40
173567.20 50.21
P4
86378.58 24700.95
-61677.63 -71.40
Original Cephalexin P5
57264.39 18903.28
-38361.11
-66.99
P6
37823.21 19723.35
-18099.86
-47.85
Total
181466.18 63327.58
-118138.60
-65.10
P4
369966.82
360231.85 -9734.97
-2.63
Generic Cephalexin P5
254215.97 249866.10
-4349.87
-1.71
P6
357242.51 347162.85
-10079.66 -2.82
Total
981425.30
957260.80 -24164.50
-2.46
P4
9274.50 8323.10 -951.40
-10.26
Original Cloxacillin P5
8908.46
8110.80 -797.66
-8.95
P6
3927.19 3698.62
-228.57 -5.82
.-
ADDendix K
* (-) Product/medicine not paid by medical aid due to "higher" cost than "MPL" cost. Possibly funded by either patient
or provider.
# Percentage saving calculated by dividing the MPL effect by the total cost claimed multiplied by hundred.
- --
'Medscheme@ Pnce List (MPr]
. . . . 'c 0 WY "
Product Period
Total cost (R)
Total
calculated cost
Effect (+/-)* Saving %.
(R)
I
Total 22110.15 20132.52 -1977.63
-8.94
P4
172955.10 186704.00 13748.90 7.95
Generic Cloxacillin
P5
68260.23 72379.55 4119.32 6.03
P6
268017.36 320333.62 52316.26 19.52
I
Total 509232.69 579417.17 70184.48
13.78
P4 42880.24 496980.00 454099.76
1059.00
Original Flucloxacillin
P5 60159.9 66038.45 5878.55
9.77
P6 83926.10 93262.40 9336.30
11.12
I
Total
186966.24 656280.85 469314.61 251.02
P4
Generic Flucloxacillin P5
P6
I
Total
P4
Original Penicillin VK P5
251.19 241.20 -9.99 -3.98
P6
I
Total
251.19 241.20 -9.99 -3.98
P4
97695.04 112903.98 15208.94
15.57
Generic Penicillin VK
P5
82709.08 92667.48 9958.40 12.04
P6
90439.12 106046.63 15607.51 17.26
I
Total 270843.24 311618.09 40774.85
15.05