National Tenders Update: The experience in Thailand

1
National Tenders Update The experience in
Thailand

• Sorakij Bhakeecheep, MD.
• Deputy Director
• Bureau of Disease Management Initiative
• National Health Security Office.
• (NHSO)

2
Objectives

• To share experiences on national tenders for
  procurement of factor concentrates in Thailand.
• To propose another method for unified procurement
  system, single-price system.

3
Contents of presentation

• Background of national hemophilia care in
  Thailand.
• The process of tender.
• The results of national tenders and their
  consequences.
• Lessons we have learned.

4
WFH-GAP Program

• In 2004, National Hemophilia Foundation of
  Thailand (NHFT) received WFH-GAP Program.
• It was designed as the model of national health
  care with six subcommittees including treatment
  product.
• To achieve for National Hemophilia Program in
  Thailand.

5
National Hemophilia Program
National hemophilia program was organized by four
alliances.

• National Health Security Office (NHSO).
• National Hemophilia Foundation of Thailand
  (NHFT).
• International Hemophilia Training Center (IHTC).
• Ministry of Public Health (MOPH)

To increase quality of care, to improve quality
of life, and to reduce mortality and morbidity in
people with hemophilia.
6
How to get adequate blood products at affordable
prices?

• Unified procurement system at a national level.
• Use open tender procedure.
• An integrated tender committee was appointed by
  NHSO.(7 people from NHSO, 2 technical advisors
  from NHFT)
• The goal of tender was to reach NHSOs expected
  price.(16 c/IU)
• January, 19th 2006 - 1st national tender with 20
  million units of FVIII.
• February, 15th 2006 2nd national tender with 10
  million units of FVIII.

7
Product Characteristic

• Human coagulation Factor VIII - PD
• Product Identity pass
• Content (FactorVIII) 80.0-140.0
• pH 6.5 - 7.5
• Solubility less than 10 min
• Total protein less than 0.0125 g./ml.
• Sterility pass
• Pyrogen test pass
• Sodium content less than 175 meq./L
• Viral Inactivation Double (env./non-env.) or
  Single (Solvent detergent)

8
Results of National Tenders

• Prices excluded VAT.
• US 1 40 baht.

9
Consequences After Tender

• NHSOs procurement policy on blood products
  provision had been changed.
• From central purchasing to central bargaining
  with local purchasing.
• Allocating budgets by unit cost instead of
  supplying factor concentrates directly to
  hemophilia center using single-price system
  (multiple negotiated tender).
• Factor concentrates could be purchased
  individually using quoted prices from negotiated
  tender.

10
New Payment System
Early Bleeding Treatment
Emergency surgery / Life threatening bleeding
US 1 40 Baht (approx.)
This budget covers cost of factor concentrate
only. Other cost of treatment can be reimbursed
by regular system.
11
Price Summary

• Prices excluded VAT.
• US 1 40 baht.

12
What weve learned?

• National tenders may not be the only way to yield
  the favorable outcome.
• Negotiated tender can encourage open-price
  bidding, avoid monopoly and allow fair
  competition in the market.
• Increased total cost due to additional expense of
  administration. (stocking, cold room storage,
  cold chain logistic)
• Separation of purchasing order could reduce
  additional expenses.

13
What weve learned? (cont.)

• Encourage effective drug utilization and patient
  participation.
• With negotiated tenders, retail prices might be
  as low as tender price.
• Same price but buying in small lot!
• Get educational funding and patient activity
  supports from multiple sources.

14

• Lady dressing different costume day by day
  looks more gorgeous than one wearing the same
  dress everyday
• Pat Israngkura, MD, DSc.
• President, National
  Hemophilia Foundation of Thailand.

15
Acknowledgement

• World Federation of Hemophilia (WFH).
• Prof. Pat Israngkura, President, National
  Hemophilia Foundation.
• Mr. Brian OMahony, President, Irish Hemophilia
  Society.
• Mr. Robert Leung, Regional Program Manager, WFH.
• Dr. Sanguan Nittayarumphong, Secretary General,
  NHSO.
• Dr. Winai Sawasdivorn, Deputy Secretary General,
  NHSO.
• Dr. Prateep Dhanakijcharoen, Deputy Secretary
  General, NHSO.
• Dr. Triroj Krutvecho, Secretary General, NHFT.
• Dr. Chuchai Sornchumni, Director, Bureau of
  Disease Management Initiative, NHSO.
• National Hemophilia Foundation of Thailand
  (NHFT).
• National Health Security Office (NHSO).
• Baxter BioScience, Thailand.