Makkawi Ayat Mohammed Elhassan, Mousnad Mohamed Awad, Mohamed Gamal Khalafalla
Health Economics Centre, Faculty of Economic and Social Studies, University of Khartoum, Sudan.
Pharmacy Practice Department, Faculty of Pharmacy, International University of Africa (IUA), Khartoum, Sudan.
Glob J Qual Saf Healthc. 2020 May 26;3(2):72-80. doi: 10.36401/JQSH-20-6. eCollection 2020 May.
The objective of this study was to evaluate the economic impact of supply chain investment on the performance of the National Supply System of Essential Medicines in Sudan from 2011 to 2014.
This is a retrospective cross-sectional study designed from National Medical Supplies Fund documents. The cost-effectiveness analysis involved an economic evaluation of the performance of the supply chain system, with the cost calculated by using the activity-based costing method, by examining a supply chain according to its main components or functions including the cost of procurement, central storage, distribution and management, and administrative function. Effectiveness of supply chain investment was measured as an indicator of supply chain performance, which includes availability, coverage, affordability, and building capacity indicators. Statistical analysis was performed by using Microsoft Excel 2010, STATA (version 14) and the level of statistical significance was set at < .05 for all analyses.
The new system in 2014 (Model B), which reflects the performance of the system after the NMSF started investing more in the supply chain, will probably be more costly than the baseline system of 2011 (Model A) but will produce a much higher level of performance. The incremental cost-effectiveness ratios of moving from the baseline system of 2011 (Model A) to the new system in 2014 (Model B) were $286,826.02 per percentage of availability of medicines at the central warehouse; $310,728.18 per percentage of medicines procured that have a median price ratio of 1 or less than 1; $149,149.53 per percentage of public health institutions' coverage by National Medical Supplies Fund (NMSF) services; and $12,682.78 per number of NMSF staff trained. A paired test showed that there was a statistically significant difference between the average cost-effectiveness ratios of the 2 models.
The investment in the supply chain had a significant impact on the performance of the National Supply System of Essential Medicines in Sudan. The new policies and interventions as embedded in the new 2014 model represent a more efficient and cost-effective approach, and a better performing system than the baseline model of 2011.
本研究的目的是评估2011年至2014年供应链投资对苏丹基本药物国家供应系统绩效的经济影响。
这是一项基于国家医疗用品基金文件设计的回顾性横断面研究。成本效益分析涉及对供应链系统绩效的经济评估，成本通过作业成本法计算，通过根据供应链的主要组成部分或功能（包括采购成本、中央存储、配送与管理以及行政职能）来审视供应链。供应链投资的有效性作为供应链绩效的指标进行衡量，包括可得性、覆盖范围、可承受性以及能力建设指标。使用Microsoft Excel 2010、STATA（版本14）进行统计分析，所有分析的统计显著性水平设定为<0.05。
2014年的新系统（模式B）反映了国家医疗用品基金在供应链上加大投资后的系统绩效，可能比2011年的基线系统（模式A）成本更高，但绩效水平会高得多。从2011年的基线系统（模式A）转变为2014年的新系统（模式B）的增量成本效益比为：中央仓库药品可得性每提高一个百分点为286,826.02美元；采购的药品中价格中位数比率为1或低于1的药品每增加一个百分点为310,728.18美元；国家医疗用品基金服务覆盖的公共卫生机构每增加一个百分点为149,149.53美元；以及接受培训的国家医疗用品基金工作人员每增加一人为12,682.78美元。配对t检验表明，这两种模式的平均成本效益比之间存在统计学上的显著差异。
供应链投资对苏丹基本药物国家供应系统的绩效产生了重大影响。2014年新模型中所包含的新政策和干预措施代表了一种比2011年基线模型更高效、更具成本效益的方法以及一个绩效更好的系统。
