Types and Costs of Medications Returned by Outpatients at a Malaysian Teaching Hospital: A One-Year Cross-Sectional Study.

Authors

  • NOR AKILAH JAMALUD-DIN Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang
  • Tengku Karmila Tengku Mohd Kamil Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.
  • Mery Hu Wei Ying Department of Pharmacy, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200, Kuantan, Pahang.
  • Mohamed Hassan Elnaem Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.
  • Abdulkareem Mohammed Ahmed Al-Shami Department of Pharmacy Practice & Clinical Pharmacy, Faculty of Pharmacy, PICOMS International University College, Batu Caves, Kuala Lumpur.
  • Nor Ilyani Mohamed Nazar Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.
  • Nor Hidayah Mohd Taufek Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

DOI:

https://doi.org/10.31436/jop.v2i2.150

Keywords:

cost, returned medications, types, outpatients, factors

Abstract

Introduction: Medication wastage is attributable to various factors, including therapeutic failure, over-prescription, and poor compliance. Data regarding the cost and types of returned medications are essential to estimate the financial burden that can be reduced locally through targeted intervention. This study aimed to investigate the types and cost of medications returned by outpatients at a teaching hospital in Kuantan, Pahang.

Materials and methods: This cross-sectional study collected data from the electronic medical record based on the list of returned medications at the outpatient pharmacy department at Sultan Ahmad Shah medical Centre (SASMEC)@IIUM between January and December 2021. All medications with SASMEC patients' label were included. The medications were classified according to the classification index based on the British National Formulary. The data were analysed using Microsoft Excel version 16.52. The cost associated with returned medications was calculated, referring to the latest cost price of the respective medications.

Results: A total of 134 patients returned their medications in 2021 (mean ± SD age: 63 ± 13 years), with 52% females. The total quantities of returned medications were 11,054 units. These included pills, devices (inhalers, insulin pens), bottles, and plastic containers. The overall cost of these medications was Ringgit Malaysia (RM) 13,594.90 (mean per patient: RM 101.45). The highest number of returned medications was from the cardiovascular group (32.5%), followed by the endocrine group (26%) and musculoskeletal group (11.9%). The highest cost for returned medications was the endocrine group (49%), followed by the cardiovascular group (20%) and the musculoskeletal group (10%).

Conclusion: Medications used for cardiovascular diseases were the most frequently returned at outpatient pharmacy, whereas those for endocrine diseases contributed to the highest cost. Future research could focus on identifying modifiable factors that can contribute to the sustainability of health resources by reducing the cost of returned medications.

Author Biographies

NOR AKILAH JAMALUD-DIN, Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Tengku Karmila Tengku Mohd Kamil, Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Mery Hu Wei Ying, Department of Pharmacy, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Department of Pharmacy, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Mohamed Hassan Elnaem, Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Abdulkareem Mohammed Ahmed Al-Shami, Department of Pharmacy Practice & Clinical Pharmacy, Faculty of Pharmacy, PICOMS International University College, Batu Caves, Kuala Lumpur.

Department of Pharmacy Practice & Clinical Pharmacy, Faculty of Pharmacy, PICOMS International University College, Batu Caves, Kuala Lumpur.

Nor Ilyani Mohamed Nazar, Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang

Nor Hidayah Mohd Taufek, Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

Quality Use of Medicine Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang.

References

Al-Siyabi, K., & Al-Riyami, K. (2007). Value and types of medicines returned by patients to Sultan Qaboos University Hospital pharmacy, Oman. Sultan Qaboos University Medical Journal, 7(2), 109–115. Retrieved from https://journals.squ.edu.om/index.php/squmj/index

Aitken, M., Kleinrock, M., Lyle, J., Nass, D., & Caskey, L. (2014). Global Outlook for Medicines Through 2018. IMS Institute for Healthcare Informatics, November, 42. Retrieved from http://www.imshealth.com/

Alhamad, H., Patel, N., & Donyai, P. (2017). How do people conceptualise the reuse of medicines? An interview study. International Journal of Pharmacy Practice, 26(3), 232–241. https://doi.org/doi: 10.1111/ijpp.12391

Ali, S E, & Ibrahim, M. I. M. (2009). Extent of Medication Wastage and Cost among Female Students in a University Setting. Mahidol University Journal of Pharmaceutical Science, 36(1–4), 34–43. Retrieved from https://pharmacy.mahidol.ac.th/journal/

Alnahas, F., Yeboah, P., Fliedel, L., Abdin, A. Y., & Alhareth, K. (2020). Expired medication: Societal, regulatory and ethical aspects of a wasted opportunity. International Journal of Environmental Research and Public Health, 17(3). https://doi.org/10.3390/ijerph17030787

Arkaravichien, W., Ruchipiyarak, T., Thawinwan, W., & Benjawilaikul, S. (2014). A Threat to the Environment from Practice of Drug Disposal in Thailand. EnvironmentAsia, 7(1), 13–18.

Aziz, H., Hatah, E., Makmor-Bakry, M., Islahudin, F., Ahmad Hamdi, N., & Mok Pok Wan, I. (2018). A comparison of medication adherence between subsidised and self-paying patients in Malaysia. Malaysian Family Physician, 13(2), 2–9. Retrived from https://e-mfp.org

Batavia, A. S., Balaji, K., Houle, E., Parisaboina, S., Ganesh, A. K., Mayer, K. H., & Solomon, S. (2010). Adherence to antiretroviral therapy in patients participating in a graduated cost recovery program at an HIV care center in South India. AIDS and Behavior, 14(4), 794–798. https://doi.org/10.1007/s10461-009-9663-6

Bettington, E., Spinks, J., Kelly, F., & Wheeler, A. J. (2018). Returning unwanted medicines to pharmacies: Prescribing to reduce waste. Australian Prescriber, 41(3), 78–81. https://doi.org/10.18773/austprescr.2018.015

Bicket, M. C., Long, J. J., Pronovost, P. J., Alexander, G. C., & Wu, C. L. (2017). Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surgery, 152(11), 1066–1071. https://doi.org/10.1001/jamasurg.2017.0831

Chiatti, C., Bustacchini, S., Furneri, G., Mantovani, L., Cristiani, M., Misuraca, C., & Lattanzio, F. (2012). The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people a systematic review. Drug Safety, 35(SUPPL. 1), 73–87. https://doi.org/10.1007/BF03319105

Chou, R., Gordon, D. B., De Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., . . . Wu, C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American pain society, the American society of regional anesthesia and pain medicine, and the American society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. Journal of Pain, 17(2), 131–157. https://doi.org/10.1016/j.jpain.2015.12.008

Ebrahim, A. J., Teni, F. S., & Yimenu, D. K. (2019). Unused and Expired Medications: Are They a Threat? A Facility-Based Cross-Sectional Study. Journal of Primary Care and Community Health, 10, 1–11. https://doi.org/10.1177/2150132719847857

El-Hamamsy, M. (2011). Unused Medications: How Cost and How Disposal of in Cairo, Egypt. International Journal of Pharmaceutical Studies and Research, 16(I), 21–27. Retrieved from http://technicaljournalsonline.com/ijpsr/

Elnaem, M. H., Irwan, N. A., Abubakar, U., Sulaiman, S. A. S., Elrggal, M. E., & Cheema, E. (2020). Impact of medication regimen simplification on medication adherence and clinical outcomes in patients with long-term medical conditions. Patient Preference and Adherence, 14, 2135–2145. https://doi.org/10.2147/PPA.S268499

Fabbiani, M., Zaccarelli, M., Grima, P., Prosperi, M., Fanti, I., Colafigli, M., D’Avino, A., Mondi, A., Borghetti, A., Fantoni, M., Cauda, R., & Di Giambenedetto, S. (2014). Single tablet regimens are associated with reduced Efavirenz withdrawal in antiretroviral therapy naïve or switching for simplification HIV-infected patients. BMC Infectious Diseases, 14(1), 1–7. https://doi.org/10.1186/1471-2334-14-26

Ghinea, N., Lipworth, W., & Kerridge, I. (2016). Propaganda or the cost of innovation? Challenging the high price of new drugs. BMJ (Online), 352(March 2016), 2–5. https://doi.org/10.1136/bmj.i1284

Guirguis, K. (2010). Medications collected for disposal by outreach pharmacists in Australia. Pharmacy World and Science, 32(1), 52–58. https://doi.org/10.1007/s11096-009-9340-x

Hassali, M. A., & Shakeel, S. (2020). Unused and Expired Medications Disposal Practices among the General Public in Selangor, Malaysia. Pharmacy, 8(4), 196. https://doi.org/10.3390/pharmacy8040196

Hassali, M. A., Supian, A., Ibrahim, M. I., Al-Qazaz, H. K., Al-Haddad, M., Salee, F., & Palaian, S. (2012). The Characteristics of Drug Wastage at The Hospital, Tuanku Jaafar Seremban, Malaysia: A descriptive study. Journal of Clinical and Diagnostic Research, 6(5), 787–790. Retrieved from https://www.scimagojr.com/journalsearch.php?q=16400154778&tip=sid

Hernández Arroyo, M. J., Cabrera Figueroa, S. E., Sepúlveda Correa, R., Valverde Merino, M. P., Luna Rodrigo, G., & Domínguez-Gil Hurlé, A. (2016). Influence of The Number of Daily Pills and Doses on Adherence to Antiretroviral Treatment: A 7-year study. Journal of Clinical Pharmacy and Therapeutics, 41(1), 34–39. https://doi.org/10.1111/jcpt.12343

Ibrahim MIM, Awang R, Razak DA. (1997). A drug wastage and utilisation study: A preliminary community project. International Conferences on Improving Use of Medicines 1997. Retrieved from https://www.isium.org/conference-proceedings-icium/

Jörgensen, T., Johansson, S., Kennerfalk, A., Wallander, M. A., & Svärdsudd, K. K. (2001). Prescription drug use, diagnoses, and healthcare utilization among the elderly. Annals of Pharmacotherapy, 35(9), 1004–1009. https://doi.org/10.1345/aph.10351

Kuna, P., Creemers, J. P. H. M., Vondra, V., Black, P. N., Lindqvist, A., Nihlen, U., & Vogelmeier, C. (2006). Once-daily dosing with budesonide/formoterol compared with twice-daily budesonide/formoterol and once-daily budesonide in adults with mild to moderate asthma. Respiratory Medicine, 100(12), 2151–2159. https://doi.org/10.1016/j.rmed.2006.03.016

Laliberte, F., Bookhart, B. K., Nelson, W. W., Lefebvre, P., Schein, J. R., Rondeau-Leclaire, J., & Duh, M. S. (2013). Impact of once-daily versus twice-daily dosing frequency on adherence to chronic medications among patients with venous thromboembolism. Patient, 6(3), 213–224. https://doi.org/10.1007/s40271-013-0020-5

Ma, A., Chen, D. M., Chau, F. M., & Saberi, P. (2010). Improving adherence and clinical outcomes through an HIV pharmacist’s interventions. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 22(10), 1189–1194. https://doi.org/10.1080/09540121003668102

Matsuda, S. (2019). Health Policy in Japan – Current Situation and Future Challenges. JMA Journal, 2(1), 1–10. https://doi.org/10.31662/jmaj.2018-0016

Morgan, T. M. (2001). The Economic Impact of Wasted Prescription Medication in an Outpatient Population of Older Adults. Journal of Family Practice 50(9), 779– 781. Retrieved from https://www.frontlinemedcom.com/brands-posts/the-journal-of-family-practice/

National Institutes of Health. (2016). World's older population grows dramatically. Retrieved from https://www.nih.gov/news-events/news-releases/worlds-older-population-grows-dramatically

Newman, C. B., Preiss, D., Tobert, J. A., Jacobson, T. A., Page, R. L., Goldstein, L. B., . . .Welty, F. K. (2019). Statin Safety and Associated Adverse Events A Scientific Statement from the American Heart Association. In Arteriosclerosis, Thrombosis, and Vascular Biology 39(2). E38-E81. https://doi.org/10.1161/ATV.0000000000000073

Nurolaini, K. (2016). Medication Wastage and its Disposal Amongst Patients at Suri Seri Begawan Hospital in Brunei Darussalam. Medicine & Health (Universiti Kebangsaan Malaysia), 11(2), 139. Retrieved from https://www.medicineandhealthukm.com

Oh, C. K., Bang, J. B., Kim, S. J., Huh, K. H., Kim, S. J., Jeon, J. S., Han, S. Y., Cho, H. R., Kwon, Y. J., Lee, S. H., & Kim, Y. S. (2020). Improvement of Medication Adherence with Simplified Once-daily Immunosuppressive Regimen in Stable Kidney Transplant Recipients: A prospective cohort study. Asian Journal of Surgery, 43(6), 660–667. https://doi.org/10.1016/j.asjsur.2019.07.011

Ong, S. C., Ooi, G. S., Shafie, A. A., & Hassali, M. A. (2020). Knowledge, attitude and disposing practice of unused and expired medicines among the general public in Malaysia. Journal of Pharmaceutical Health Services Research, 11(2), 141–148. https://doi.org/10.1111/jphs.12333

Paes, A. H. P., & Barker, A. (1997). Impact of Dosage Frequency on Patient Compliance. Clinical Care Education Nutrition, 20(10). http://doi.org/ 10.2337/diacare.20.10.1512

Rahim, R. (2016). Ministry destroys RM2mil worth of expired meds. Retrieved from https://www.thestar.com.my/news/nation/2016/12/27/ministry-destroys-rm2mil-worth-of-expired-meds

Roca, B., Lapuebla, C., & Vidal-Tegedor, B. (2005). HAART with didanosine once versus twice daily: Adherence and efficacy. International Journal of Infectious Diseases, 9(4), 195–200. https://doi.org/10.1016/j.ijid.2004.07.006

Rubio, R., Serrano, O., Carmena, J., Asensi, V., Echevarría, S., Flores, J., . . . González-García, J. (2010). Effect of Simplification from Protease Inhibitors to Boosted Atazanavir-Based Regimens in Real-Life Conditions. HIV Medicine, 11(9), 545–553. https://doi.org/10.1111/j.1468-1293.2010.00827.x

Sim, S. M., Lai, P. S. M., Tan, K. M., Lee, H. G., & Sulaiman, C. Z. (2018). Development and Validation of the Return and Disposal of Unused Medications Questionnaire (ReDiUM) in Malaysia. Asia-Pacific Journal of Public Health, 30(8), 737–749. https://doi.org/10.1177/1010539518811161

Smale, E. M., Egberts, T. C. G., Heerdink, E. R., van den Bemt, B. J. F., & Bekker, C. L. (2021). Waste-minimising measures to achieve sustainable supply and use of medication. Sustainable Chemistry and Pharmacy, 20(2021), 100400. https://doi.org/10.1016/j.scp.2021.100400

Times of Malta. (2012). Returned Unused Medicines are "Tip of The Iceberg." Retrieved from https://timesofmalta.com/articles/view/returned-unused-medicines-are-tip-of-the-iceberg.414136

Trueman, P., Lowson, K., Blighe, A., & Meszaros, A. (2011). Evaluation of the Scale, Causes and Costs of Waste Medicines Evaluation of the Scale, Causes and Costs of Waste Medicines. York Health Economics Consortium, 17, 327–349. http://evi.sagepub.com/cgi/doi/10.1177/1356389011421697

Ueki, T., Sanematsu, E., Kawano, S., Nakamura, Y., Kawamichi, N., Shinohara, Y., Yatera, K., & Tanaka, F. (2022). Medication Wastage in a University Hospital in Japan. Biological and Pharmaceutical Bulletin, 45(1), 118–123. https://doi.org/10.1248/bpb.b21-00761

Watkinson, A. J., & Costanzo, S. D. (2017). Antimicrobials and Antimicrobial Resistant Bacteria in Australia. Antimicrobial Resistance in Wastewater Treatment Processes, 109–127. https://doi.org/10.1002/9781119192428.ch7

West, L. M., Diack, L., Stewart, D., & Cordina, M. (2015). Applying the Delphi Technique to Define "Medication Wastage." European Journal of Hospital Pharmacy, 22(5), 274–279. https://doi.org/10.1136/ejhpharm-2014-000593

Wheeler, A. J., Kelly, F., Spinks, J., & Bettington, E. (2016). National Return and Disposal of Unwanted Medicines Project Audit 2016: Final Report. Brisbane: Griffith University, November, 2016. Retrieved from https://returnmed.com.au/wp-content/uploads/2017/08/NatRUM-Project-Final-Report-Griffith-University.pdf

Wijekoon, C. N., Samarawickrama, M. T., Mendis, G. S. C., Wanigasuriya, J. K. P., & Wijekoon, P. W. M. C. S. B. (2020). Factors Associated With Uncontrolled Hypertension in Patients Attending a Medical Clinic of A Tertiary Care Hospital in Sri Lanka. Journal of the Ceylon College of Physicians, 51(2), 96. https://doi.org/10.4038/jccp.v51i2.7903

Wouters, H., Van Dijk, L., Geers, H. C. J., Winters, N. A., Van Geffen, E. C. G., Stiggelbout, A. M., & Bouvy, M. L. (2016). Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients. PLoS ONE, 11(1), 1–12. https://doi.org/10.1371/journal.pone.0146272

Downloads

Published

2022-07-31

How to Cite

JAMALUD-DIN, N. A., Tengku Mohd Kamil, T. K. ., Wei Ying, M. H. ., Elnaem, M. H. ., Al-Shami, A. M. A. ., Mohamed Nazar, N. I. ., & Mohd Taufek, N. H. . (2022). Types and Costs of Medications Returned by Outpatients at a Malaysian Teaching Hospital: A One-Year Cross-Sectional Study . Journal of Pharmacy, 2(2), 141–148. https://doi.org/10.31436/jop.v2i2.150

Issue

Section

Original Articles

Most read articles by the same author(s)