Impact of group purchasing in cooperative of hospital in Colombia, using a price index from 1999 to 2012
The application of price indices is useful to analyze the behavior of prices as an important component in patients' access to essential medications over a period of time. The present work analyzed the variation in the prices of 303 medications sold by a cooperative of hospitals in central Colombia between 1999 and 2010 by applying inflation-adjusted price indices and Laspeyres-Paasche quantities by ABC groups and principal therapeuticals in the first and second ATC (anatomic, therapeutical, chemical) level, taking 1999 as the starting year. The medications of type A and B, as well as those belonging to the first four therapeutical groups in the first ATC level in cost and for seven groups in the second ATC level, registered a drop between 40 and 53% (P < 0.05) in the applied price indices. In addition, all the ABC and ATC groups showed increases between 9 and 12 times (P < 0.01) when applying the indices on units sold. The estimated net saving in 2010 at prices of 1999, went above $ 16.9 billion COP. This impact on prices has helped to expand the coverage in essential medications supplied to the public hospitals which are afterwards administered to the patients of this region of Colombia.
Public drug procurement: the lessons from a drug tender in a teaching hospital of a transition country
IntroductionThere are scarce descriptions of hospital drug procurement in the primary literature. The aim of this study was to analyse the drug tender led by a clinical pharmacologist in a 1200-bed university hospital in Serbia, a developing country in socio-economic transition, and to give recommendations for future steps in hospital drug policy.Procedure and outcomesDrug tendering was conducted according to the public procurement law from January to April 2003. Analysis included the method of defined daily doses and anatomical therapeutic chemical classification, as well as minimal tender prices, free market prices, essential drugs and domestic and foreign manufacturers. The drug tender list consisted of 548 products, 1,315,501 pharmaceutical units and 312 drug entities, among which 164 were essential. For purchasing purposes, 479 drug formulations were selected, costing approximately 1.4 million Euros (~10% of hospital budget). Three-quarters of the expenditure consisted of antimicrobials (29.1%), cytotoxics (28.8%) and intravenous infusions (17.7%). The top 20 drugs consumed 62.2% of the total drug expenditure. Competition for the most expensive and/or most used drugs was the key for financial success of applicants, even when they offered a limited number of drugs. The tender achieved 4.6% and 17.2% cost savings in comparison with minimal tender price and free-market price, respectively. The tender did not provide a fair balance between domestic and foreign manufacturers.ConclusionThe drug tender is resource-consuming, laborious, and risky job. Aggregation of individual tenders, on a national level and/or regional ones, is probably the best choice for hospitals in transition countries at this time.
Mechanism of the depressor response to dopamine in the rat treated with phenoxybenzamine.
Alterations of hypotensive responses to dopamine by antagonists were characterized in alpha-blocked, anaesthetized rats. Responses were not affected by d-propranolol (0.1 mg/kg) whereas d,1-propranolol (0.1 mg/kg) or haloperidol (1.0 mg/kg) attenuated them; higher doses of inhibitors (1.0 mg/kg; 5.0 mg/kg, respectively) failed to produce a higher inhibition, but combinations of low doses abolished the depressor responses. In adrenalectomized rats, hypotensive responses decreased; haloperidol always attenuated the responses while d,1-propranolol became ineffective. Dopamine produced an enhancement of plasma adrenaline and noradrenaline levels, which was decreased by d,1-propranolol and increased by haloperidol. The data suggest that in rats the depressor component of dopamine is due to activation of both dopaminergic and beta-adrenoceptors. The beta component appears to be due to the release of adrenaline. The results also support the concept of the existence in sympathetic nerve endings and adrenal glands of stimulatory beta-adrenergic and inhibitory dopaminergic prejunctional receptors.