Health is a fundamental human right. Access to health care, which includes providing apopulation with safe, effective, good quality drugs at the least possible cost, is a prerequisite torealising that right. Drugs or medicines play a fundamental role in the effectiveness, efficiencyand responsiveness of health care systems. Drugs also constitute a major recurrent expense inboth state-run and private sector health care. To ensure that health care workers prescribe themost cost-effective drugs through the essential drugs list, training, as well as evaluation andmonitoring systems must be regarded as important elements of containing costs.Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisationreview (DUR), evidence-based medicine and disease management have emerged as tools toensure cost-effective selection and use of drugs, particularly for chronic diseases. Thesemanaged care tools are often investigated to determine whether new technologies orinterventions are appropriate and have "value".Affordable prices of medicines, on their own, however, do not ensure access to medicines. Alsoimportant are reliable procurement, distribution and storage systems, and appropriately trainedpersonnel to manage these components of drug management. Poorly regulated drug supplysystems can have serious consequences such as antibiotic resistance, problems with safety orquality and most importantly wastage, as it is believed that a significant proportion of drugspurchased by the state in South Africa find their way into the private sector market through a"grey market".The general objective of this study was to review and analyse the cost and medicine usage of the"top twenty" pharmaceutical products according to the monthly pharmaceutical purchasingreports of the Department of Health in the North West Province.The research can be classified as retrospective and quantitative. The data used for the analysiswere obtained over a two-year study period (1 Apr 2000 - 28 Feb 2002) from the privateprovider operating the medical stores in the North West Province.The results of the empirical investigation, showed the total number of "top twenty" productsappearing during the study period amounted to 460 different products having a total purchasingcost of R 66,263,674.51 representing 37.2% (n = R 178,163,061.50) of all pharmaceuticalproducts purchased during the two-year period.Through analysis it was found, when classified according the Anatomical Therapeutic Chemical(ATC) therapeutic main group, antihypertensives had the highest quantity purchased for year one(20.69%; n = 134,515,640) with cough and cold preparations revealing the highest purchasingquantity for year two (40.55%; n = 103,567,031) of all "top twenty" pharmaceuticals during thestudy period.Antibacterials for systemic use presented with the highest cost percentages for both years,representing 20.68% (n = R35, 568,221.31) and 16.72% (n = R 31,370,435.51) respectively.Hydrochlorothiazide presented with the highest purchasing quantity for both years whenclassified according to chemical substance with, Methyldopa having the highest purchasing costfor year one followed by vaccine Hib-DTP 10 dose vial (Haemophilus influenzae type Bvaccine-diphtheria, pertusis and tetanus vaccine) for year two. Furthermore it was also foundthat the majority of the "top twenty" products were in the oral dosage form. Finally it wasconcluded that drugs used in the treatment of hypertension and cardiac failure were the mostutilised in comparison to other "top twenty" products during the study period. Possiblemisappropriation based on the defined daily dose of the "top twenty" products might haveoccurred.In completion of this study, recommendations for future research were made.
