Table 3
Comparison of procured volumes in 2017 with the previous tender in 2016
and total savings as a percentage of 2016 volume
Previous tender in
2016 Total volume in 2016 (€) STEPSelected product Procured volume in
2017 (€)
Drug A 127,421 Drug A 203,058
Drug B 41,612 Drug C 65,356 Total 234,389
203,058
Total savings 31,331
Total savings as % of
2016 volume 13.4%
class was selected because the number of products
in the class was limited, products had a similar
range of effects and an updated LMWH matrix was
available due to a recent product selection using
this matrix in Northern Ireland. An important
contributing factor to accelerate the uptake of the
STEPSelect methodology at the University Hospital
was the support of the project by senior medical
management.
Results of the project show that, in a therapeutic
class such as the LMWHs, efficiencies of scale can be
realised, despite price erosion which has taken place
in Poland in this class the past few years.
The described steps parallel a recent selection and
procurement of LMWHs in Northern Ireland, where
all were conducted within the procurement process.
In Northern Ireland, suppliers were invited to submit
additional clinical evidence as part of the tender
response and a final clinical evaluation matrix was
agreed. Product selection (award) was based on the
cumulative total score collated into a final evaluation
matrix ie clinical evaluation, risk assessment and
budgetary impact analysis. In Northern Ireland, the
procurement process commenced on 18 March 2016
and the tender resulted in award to a single drug
entity for both prophylaxis and treatment. While
one drug entity was awarded, it was recognised that
an alternative might be selected based on individual
patient needs. The contract commenced on 1 August
2016, delivering efficiencies in the region of 25%. The
overall selection and procurement process of LMWHs
in Northern Ireland took approximately as long as the
process described here in Poland, that is, about seven
months.
In Poland, feedback received from clinicians and
pharmacists taking part in the selection process,
using the matrix and SOJA formats of the first step of
STEPSelect, was very positive. All participants liked
the combination of a knowledge system (incorporated
in the matrix production) and a transparent decision
making tool (the web-based SOJA format). They all
agreed that a combination of these two features
greatly facilitates the work of any hospital formulary
committee and minimises bias in decision making
and undue influences. Thus, the tool can be a
powerful instrument to counter anti-competitive
behaviour and increase efficiency in making drug
product selections. The following positive points
were made in relation to the use of STEPSelect for the
selection and procurement of LMWHs:
• Selection decisions for the hospital formulary can be
multidisciplinary and a joint decision making effort
14 | Issue 90 | 2018 | hospitalpharmacyeurope.com
rather than the previous system, where decisions
were often taken by individuals. The evaluation is
performed by the whole team/committee/hospital in
an interactive manner without the direct influence of
individuals;
• The format allows a broader group of evaluators
(even entire hospital level);
• Information in a matrix is regularly updated in line
with scientific data. The fact that both a Dutch and a
Northern Ireland panel authored the original version
of the matrix was conducive to accepting the rigour of
the methodology at the University Hospital;
• Due to the interactive web-based format, evaluation
takes a short time for a therapeutic class (5–10 mins),
once the methodology is clear to the evaluator.
The following points were suggested in order to
further improve the operational use of STEPSelect:
• The methodology is not easy to understand at first
glance. A considerable amount of demonstration
and training might be needed, particularly when the
intention is to use the method across the hospital;
• An advantage is the updated presentation of matrix
drug productions. However, the process of updating
may be presented in a clearer way. This also applies to
information about the experts involved in preparation
of a matrix production;
• Although the pharmaceutical industry is invited
to comment on inclusions in matrix productions,
the local representatives of the industry in Gdansk
did not grasp the full implication of this. Better
communication and early engagement with the local
industry representatives is needed.
In addition to the use of the method, it would be
good if standard documentation could be provided to
support decisions reached, for example, a standard
protocol to document final product selections.
Recommendations
Based on the project at the University Hospital in
Gdansk, the following recommendations can be made:
• The method can be applied across a range of
therapeutic classes of high versus low volume and
high versus low prices;
• At the University Hospital in Gdansk, STEPSelect
could be considered for other therapeutic classes as
the issue of appropriately training the clinical and
pharmacy staff has been addressed and a methodology
has been developed to adapt relevant matrix
productions to Polish variation;
• At other hospitals in Poland and elsewhere,
STEPSelect could be introduced in similar LMWH
pilots.
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Acknowledgments
and affiliations
Authors have reported
no conflict of interest.