Cost analysis of returned medicines at the outpatient pharmacy of a Malaysian state hospital.

Abstract

Introduction: Returning unused medications to pharmacies is encouraged to reduce environmental pollution and safety hazards. However, this practice can impose financial losses on public health providers due to wasted drug supplies. This study aimed to quantify the costs of returned medicines at a Malaysian state hospital outpatient pharmacy and to characterise the returned items by therapeutic class and procurement category.

Materials and methods: This was a prevalence-based, bottom-up cost-analysis study of all solid medicines at the outpatient pharmacy of Hospital Tuanku Fauziah from May to October 2023. Returned items (tablets/capsules) were collected, identified by WHO Anatomical Therapeutic Chemical (ATC) class and hospital's Always Better Control (ABC) inventory group, and recorded. Acquisition costs were obtained from hospital procurement records, and retail values were estimated using the Malaysian Consumer Price Guide. Disposal cost was calculated based on the contracted waste service. Descriptive statistics were used to summarise quantities and costs.

Results: The total government acquisition cost for returned medicines was RM18,487, with a retail replacement value of RM101,300. The top five returned medicines by quantity were metformin (14.3%), atorvastatin (6.9%), calcium carbonate (5.3%), ferrous fumarate (3.8%) and trimetazidine MR (3.8%). The top three pharmacological groups returned were cardiovascular system (39.6%), alimentary/endocrine (31.7%), and blood and blood-forming organs (10.9%). Group A medicines, according to ABC analysis, constituted the highest return in both acquisition cost (66.8%) and quantity (34.1%). The median (IQR) acquisition and retail values of medicines returned per month were RM5,429 (8,010) and RM19,609 (12,027), respectively. The monthly disposal cost ranged RM22.32-55.80 (excluding transportation fees).

Conclusion: Returned medicines lead to significant financial losses from both medication wastage and disposal for public providers. Shorter refill durations, medication adherence support, deprescribing and controls on highvalue ABC group A items could reduce wastage.