[e-drug] Acceptable amount of drug wastage due to expiry (cont'd)

[Kirsten Myhr <myhr@online.no>]

E-drug: Acceptable amount of drug wastage due to expiry (cont'd)
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Libby,

A survey of 14 Norwegian pharmacies was carried out in 1994
(Thormodsen M et al. What's left? Unused medicine as a quality
indicator in pharmacotherapy. Tidsskr Nor Laegeforen 1997; 117:
3517-20). All returned medicines to these pharmacies were
registered for three months. 641 persons returned 4860 packages,
one third being unopened, one third had more than half of the
content left. Even of antibiotics, more than half of the packages
returned were unopened or had more than 50% of content left.
Value 0.5 mill NOK = USD 60 000. Extrapolated to annual national
level, this amounts to NOK 40 mill = USD 4.4 mill. If you assume
that not more than 10% is returned, the value is about 44 mill USD.
That is approx. 0.6% of total annual sales value for 1994.
These are very crude data, but you get an indication. As far as I
remember from being a hospital pharmacist, wastage would be
roughly 2.5% of total value in the hospital.

We do not know how much is unnecessary either, but I am sure
much of it is. Some reasons:
- doctors may write a reimbursable prescription for 3 months. Some
times the patients do not tolerate the drug, some times they see
more than one doctor. Pharmacies are allowed to give out less, e.g.
for a month at a time, but this does not happen very often.
- patients go to hospital where they are not allowed to use (up) 
their own medicines, some times they are switched to 'me too'
drugs when discharged, some times the medicines are the same but
are just not returned.
- keeping patient records, and using them actively, is not common
- in hospitals in Norway wards are allowed to stock medicines and
nurses are not very good at estimating drug needs. This causes
overstocking, particularly before holidays.

This is a problem for the environment as well as for our social
insurance fund! How do some solve it: by donating of expired and
short-dated drugs to other countries - fortunately not so common in
Norway.

Kind regards,

Kirsten

Kirsten Myhr, MSCPharm, MPH
Head of Eastern Health Region Drug Information Centre

RELIS Ost
Ulleval University Hospital
0407 Oslo, Norway
Tel.: +47 23 01 64 11(o)   Fax: +47 23 01 64 10
+47 22 56 05 85 (h)   mobile: +47 416 38 747
myhr@online.no (h)
kirsten.myhr@relis.ulleval.no (w)
www.relis.no


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