Cost analysis of a medication dispensing service in community pharmacy in Brazil

Cardoso, Thaissa Costa; Simoens, Steven; Itria, Alexander; Dewulf, Nathalie de Lourdes Souza

doi:10.1590/s2175-97902019000418715

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Brazilian Journal of Pharmaceutical Sciences

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Article • Braz. J. Pharm. Sci. 56 • 2020 • https://doi.org/10.1590/s2175-97902019000418715 copy

Cost analysis of a medication dispensing service in community pharmacy in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study was aimed to calculate in detail the costs of a medication dispensing service in community pharmacy in Brazil. Descriptive and retrospective analysis with a cost analysis based on mixed costing; absorption costing and time-driven activity based-costing, considering year 2018 and both public and private health system perspectives within a one-year time horizon to estimates costs related to implement and to deploy the service, costs per patient and costs per activity of process (US$ 1 = R$ 3.8310 in October, 2018). Total costs of dispensing service ranged from US$ 24,451.61 to US$ 37,914.48. Costs per patient ranged from US$ 2.43 to US$ 3.77. Costs per activity of the process ranged from US$ 0.39 in pharmacotherapy assessment to US$ 2.46 in pharmaceutical interview. This provides evidence to deploy and implement a structured medication dispensing service in community pharmacy in Brazil with a view to optimize the usage of medicines.

Keywords:
Community pharmacy services; Costs and cost analysis; Health care costs; Pharmaceutical services

Cost component	Cost item	Capital outlay	Recurrent cost
Infrastructure	Physical structure^* * In private system perspective it was considered a recurrent cost (rent value per m2).	X
Infrastructure	Maintenance expenses		X
Office equipment and supplies	Office equipments	X
Office equipment and supplies	Office supplies		X
Human resources	Salary		X
Professional training	Post-graduate at the interest area		X
Individual protection equipment	Coats		X
Patient handout	Advertising and informative leaflets		X
Information sources to pharmacist	Scientific journals and databases		X

Activity of process	Average time (seconds)
Pharmaceutical interview	448.30
Pharmacotherapy assessment	109.87
Medicine delivery	130.02

Cost items	Measurement of costs	Valuation of costs	Data source
Physical structure	Ratio between the total area of university and the area used to medication dispensing service and administration.	Medication dispensing service area: 46.75 m² (0,01335%). Administrative area: 9.46 m² (0,0025%) with depreciation and inflation adjustment in capital outlays.	Construction industry trade union of state and Center of management of physical space (Sinduscon, 2016; Universidade Federal de Goiás) and prices quotations per m²
Maintenance expenses	Relation between total maintenance costs and areas from dispensing service.	Attributable fractions from physical structure.	Department of administration and finances (Universidade Federal de Goiás)^* * The valued costs from public system perspective were used in private system perspective.
Office equipments	Number and type of office equipment was obtained at the place where the service is performed.	Depreciation and inflation adjustment in capital outlays.	Department of materials and property and Department of Planning, Budget and Management (Universidade Federal de Goiás) and price quotations
Office supllies	The amount of office supplies was obtained by estimates of consumption according a previous study to one year.	Inflation adjustment was performed to year 2018.	Department of Planning, Budget and Management (Universidade Federal de Goiás) and Ferreira et al. (2016) and price quotations
Salary	One pharmacist performing medication dispensing service in full-time and another one in administrative activities.	It included the gross salary in public health system perspective and also charges on remuneration in private health system perspective.	Department of administration and finances (Universidade Federal de Goiás) and association responsible for salary regulation
Post-graduate at the interest area	Specialization course of 400 hours in clinical pharmacy.	Inflation adjustment was performed.	Obtained by price quotations^ The valued costs from private system perspective were used in public system perspective.
Coats	One coat per pharmacist.	Inflation adjustment was performed.	Obtained by price quotations^ The valued costs from private system perspective were used in public system perspective.
Advertising and informative leaflets	Delivery of three flyers per patient.	Inflation adjustment was performed.	Obtained by price quotations^ The valued costs from private system perspective were used in public system perspective.
Scientific journals and databases	The access to scientific journals and databases, such as Micromedex^® is provided by UFG. This cost item could not bevaluated.	______	______

Perspective	Costs	Center cost	Costs components	Costs items	Total (US $)	%
Public	Recurrent	Dispensing cost center	Infrastructure	Water and sewage	55.99	0.15
				Eletricity	290.58	0.80
				General services	19.33	0.05
				Building maintenance	117.60	0.33
				Cleaning service	302.16	0.84
				Surveillance	454.56	1.26
				Fixed telephony/ internet	23.17	0.06
				Management software	164.90	0.46
			Office supplies	Office supplies	272.48	0.75
			Human resources	Salary	29,142.57	80.65
			Training	Post-graduate at the interest area	3,889.64	10.76
			Individual protection equipment	Coat	28.55	0.08
			Patient handout	Advertising and informative leaflets	61.27	0.17
			Information sources to pharmacist	Scientific journals and databases	0.00	0.00
		Management cost center	Infrastructure	Water and sewage	0.46	0.00
				Eletricity	2.36	0.01
				General services	0.16	0.00
				Building maintenance	0.96	0.00
				Cleaning service	2.46	0.01
				Surveillance	3.70	0.01
				Fixed telephony/ internet	0.19	0.00
				Management software	33.33	0.09
			Human resources	Salary – management cost center	1,267.70	3.51
	Outlay	Dispensing cost center	Infrastructure	Physical structure	693.28	70.40
		Dispensing cost center	Office equipment	Office equipments	261.42	26.55
		Management cost center	Infrastructure	Physical structure	6.10	0.62
		Management cost center	Office equipment	Office equipments	23.95	2.43
Private	Recurrent	Dispensing cost center	Infrastructure	Water and sewage	55.99	0.23
				Eletricity	290.58	1.21
				General services	19.33	0.08
				Building maintenance	117.60	0.49
				Cleaning services	302.16	1.25
				Surveillance	454.56	1.89
				Fixed telephony/ internet	23.17	0.10
				Management software	164.90	0.68
			Office supplies	Office supplies	272.48	1.13
			Recursos humanos	Salary	17,610.85	73.07
			Training	Post-graduate at the interest area	3,889.64	16.14
			Individual protection equipment	Coat	28.55	0.12
			Patient handout	Advertising and informative leaflets	61.27	0.25
			Information sources to pharmacist	Scientific journals and databases	0.00	0.00
		Management cost center	Infrastructure	Water and sewage	0.46	0.00
				Eletricity	2.36	0.01
				General services	0.16	0.00
				Building maintenance	0.96	0.00
				Cleaning services	2.46	0.01
				Surveillance	3.70	0.02
				Fixed telephony/ internet	0.19	0.00
				Management software	33.33	0.14
			Human resources	Salary – management Center cost	766.07	3.18
	Outlay	Dispensing cost center	Infrastructure	Physical structure (rent per m²)	347.78	54.66
		Dispensing cost center	Office equipment	Office equipments	261.42	41.09
		Management cost center	Infrastructure	Physical structure (rent per m²)	3.06	0.48
		Management cost center	Office equipment	Office equipments	23.95	3.77

Analysis perspective	Service situation	Cost per hour (US$)	Pharma-ceutical interview (US$)	Pharmacothe-rapy assessment (US$)	Medicine delivery (US$)	Total cost per patient (US$)
Private health system	Implemented service	12.74	1.59	0,39	0.46	2.43
Private health system	Service to be deployed	12.88	1.60	0.39	0.47	2.46
Public health system	Implemented service	19.23	2.40	0.59	0.69	3.68
Public health system	Service to be deployed	19.75	2.46	0.60	0.71	3.77

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

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[1] *Correspondence: T. C. Cardoso. Laboratório de Pesquisa em Educação e Serviços em Saúde. Faculdade de Farmácia. Universidade Federal de Goiás. Rua 240, Setor Leste Universitário. 74605-170, Goiânia, Goiás, Brazil. Tel.: +55 (62) 32096044. E-Mail: thaissacc@gmail.com