Budget impact analysis of pemetrexed introduction: case study from a teaching hospital perspective, Thailand.

OBJECTIVE: Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to a Thai teaching hospital. MATERIAL AND METHOD: The budget impact model was conducted in accordance with the Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the model. RESULTS: The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12, 118, 144 Baht, 17,820,800 Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately 127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles andproportion of patients assumed to be treated with pemetrexed were the two most important influencing factors in the model. CONCLUSION: New costly innovative interventions should be evaluated using the BIA model to determine whether they are affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to assist in the determination of listing and subsidizing decision for medicines.

Quality of cold storage drugs transportation and delivery to Thai hospitals.

BACKGROUND: In Thailand there is no regulation and standard guideline to control the quality of drug transportation, including cold storage drugs. OBJECTIVE: To explore the condition of cold storage drugs transportation and delivery to general public hospitals, community hospitals and private hospitals. MATERIAL AND METHOD: This is a cross-sectional survey research. There were 301 questionnaires returned from 720 questionnaires sent (41.8% response rate) RESULTS: The serious problems of cold storage drugs on delivery were (1) Cold storage drugs (2 degrees C - 8 degrees C) were delivered to the hospitals without controlled temperature boxes, was found in private, public and community hospitals at the rate of 46.7%, 48.3% and 72.9% respectively. (2) Cold storage drugs (-20 "C), i.e., polio vaccine came to the hospitals with a temperature higher than 8C or ice melting in the box, was found in private, public and community hospitals at the rate of 22.9%, 12.7% and 35.0% respectively. CONCLUSION: There are differences in quality of cold storage drug transportation and delivery among types of hospitals. It is highly recommended that Thai FDA should develop a standard and implement the control system for logistics management of cold storage drugs.