Managing Hospital Medicine Costs in Healthcare Reform Plan: Real Case of Shari'ati Hospital

A continuous growth in the costs of healthcare and medicine as a strategic commodity has prompted researchers to seek tools to identify high-cost populations and achieve cost control. in the case of iran, after implementing the healthcare reform plan in the country, a huge share of hospital funding was spent on undesirable costs due to changes in the use of medicines and instruments. the aim of this study is to compare the cost of medicines in both pre and post periods of health plan implementation to detect abnormalities and low-frequency patterns in medical prescriptions that account for more than 30% of hospital budget funds. for this purpose, a data mining model was used to detect anomalies in the prescription information; first, by forming cross-over matrices on the cross-attributes, the prescription data were categorized; then, by applying a normalized distance-based risk function, anomalies and high-cost elements were identified based on the distance between the input data and the mean data. the data used included 15078 records containing information of patients' records during the years 2012-2016 of tehran shariati hospital information system. according to the results, the model presented at a positive likelihood ratio of 6.35 was viably able to identify domains and drugs whose costs have skyrocketed following the implementation of the health reform plan. based on the results, among the 5 costly drugs to which the highest hospital budget was dedicated, albumin had the highest unbalanced cost growth after the implementation of health reform plan; pantoprazole and ciprofloxacin were next in line regarding the unbalanced cost growth. these cases require to be reviewed by the hospital's pharmacy committee to keep costs down in order to prevent their inflation. although imipenem and meropenem are both expensive, common drugs need to be redefined in order to rationalize their use. according to the heat map charts, the highest average prescription cost per medication and age in the pre-treatment period belonged to a group of people with 80 years and above; a significant decrease in cost was observed after the reform plan. the most expensive category was allocated to the age group of 5 to 14 years. thus, applications whose cost of prescriptions with data usage patterns before the reform plan has been identified are given to experts for further consideration.