Assessment of drug costs for management of diabetes and its complications at Muhimbili National Hospital outpatient pharmacy

Abstract

Introduction: The estimated numbers of diabetes mellitus patients in Tanzania are most probably going to increase as a result of longer expected life expectancy, urbanization associated with a high prevalence of obesity and sedentary lifestyle. Drugs cost for the management of diabetes and its complications as a key factor for the determination of patients’ affordability should be looked with critical eye for the better function of the health care system. Study objective: The objective of the study was to assess drug costs for management of diabetes and its complications at Muhimbili National Hospital (MNH) outpatient pharmacy. Methodology This was cross sectional retrospective study. Data was collected through Retrieval and review of electronic data of all diabetes outpatients registered from 1st January 2012 to 31st December 2012 available in the MNH JEEVA Database. The drug cost – prices was obtained from the Public distributor of drugs (Medical Stores Department), price of the Hospital buying consortium and the retail price at the intramural practice pharmacy at MNH. Results The most commonly prescribed medicines for diabetes, cardiovascular and elevated cholesterol were metformin, losartan and atorvastatin respectively. One third of Diabetes out patients at MNH had cardiovascular and elevated cholesterol complications. The mean cost per prescription for patients prescribed diabetes medicines only was Tshs. 17,191.3/=. Patients prescribed diabetes and cardiovascular medicines had a significantly higher mean prescriptions cost of 51.8 %,( P-value <0.01) as compared to patients prescribed diabetes medicines alone. Similarly diabetes patients prescribed both diabetes medicines and lipid lowering medicines drugs also had a significantly higher mean prescriptions cost of 121.9 %,( P value <0.01) as compared to patients prescribed diabetes medicines alone. However the most striking and significant mean prescription cost of 207.4 % (P value <0.01) was seen in patients prescribed Diabetic, Lipid lowering and cardiovascular medicines as compared to patients prescribed diabetes medicines alone. Conclusion and recommendation About one third of Diabetes mellitus out patients attended at MNH for the study period were also suffering from cardiovascular or elevated cholesterol complications. The cost of treating these complications is significantly higher compared to the cost of treating patients with diabetes alone. The Government should improve efforts for timely diagnosis of diabetes by mandating community pharmacies to screen for diabetes and elevated cholesterol so as to reduce diabetes complications and reduce the cost of treating diabetes complications.