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Public drug procurement: the lessons from a drug tender in a teaching hospital of a transition country

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Abstract

Introduction

There 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 outcomes

Drug 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.

Conclusion

The 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.

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Acknowledgements

We thank Dragana Nedovic for calculation of drug utilisation and Mrs. Nevena Milovanovic for English editing. We are grateful to our colleagues from the hospital financial and pharmacy departments for technical assistance. We also thank Mr. Tim Dodd, a pharmaceutical consultant and Dr. Vasilije Antic, a deputy of the Minister of Health, for providing the data within the personal communications. There is neither conflict of interest nor funding sources to disclose.

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Correspondence to Dragan R. Milovanovic.

Additional information

The contributors included the following investigators. D. Milovanovic (MD, PhD) is a clinical pharmacologist, assistant professor of pharmacology and chairman of the hospital procurement committee. S. Jankovic (MD, PhD) is a surgeon and clinical pharmacologist, professor of pharmacology, director of clinical pharmacology department and also the adviser to the Minister of Health for pharmacotherapy. R. Pavlovic (MD, PhD) is a chief hospital manager and M. Folic (MD, PhD) is a deputy of procurement committee chairman.

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Milovanovic, D.R., Pavlovic, R., Folic, M. et al. Public drug procurement: the lessons from a drug tender in a teaching hospital of a transition country. Eur J Clin Pharmacol 60, 149–153 (2004). https://doi.org/10.1007/s00228-004-0736-1

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