• Healthcare cost-savings initiative to evaluate existing brands of DHA supplement in KKH formulary
  • Lack of evidence to support a particular DHA to Eicosapentaenoic Acid (EPA) ratio as advertised by certain brands

Beyond their daily duties, the team consisting Lim Kae Shin, Irene Quay, Jamie Stephanie, Dorothy Koh and Seow Meow Kwei, undertook an initiative in early 2013 to review DHA supplements in their formulary. 

DHA supplements, consumed during pregnancy and lactation, are prescribed to mothers for the benefit of their infant’s development. 

Historically, KKH has only carried two brands of supplements. The team, however, found that no formal evaluation was done on the DHA supplements used in their hospital’s formulary. 

These brands, which have monopolised the market, are perceived to be of a higher grade than others mainly due to their effective marketing strategies. They are also more expensive. 

To help patients cope with rising healthcare costs, the team first performed a literature review to identify the DHA requirements for pregnancy and breastfeeding.   A Request for Proposal (RFP) for DHA supplements was then called and opened to companies that fulfilled the criteria. Hospital obstetricians, the prescribers of these supplements, were also consulted for their input.

“It was challenging to decide which brands to include in the formulary due to unsupported claims and lack of scientific evidence,” said Ms Lim Kae Shin.

“We performed a thorough evaluation that ensured that the ingredients of the supplements were within the recommended limits and had no safety concerns.”

After the review, a suitable third brand was introduced in June 2013 – it was not only approved by the Hospital’s Pharmacy and Therapeutics (P&T) Committee, but also priced 28 to 44 per cent cheaper than the two brands traditionally used by KKH. The two brands were subsequently removed from its formulary. 

The review also revealed that there is no evidence to support a particular DHA to Eicosapentaenoic Acid (EPA) ratio as advertised by certain brands.

“Although the usage for the third brand was low initially, our analysis has shown an increasing acceptance of use, translating into more costs savings for both the hospital and the patient,” said Ms Lim.

“Substantial cost-savings can be achieved through a methodological evaluation that is evidence-based.   We have also conducted a similar review for multivitamin syrups.”
“In the future, we can extend the same method to other supplements and retail products to increase the value for healthcare consumers.” 

Health care cost savings initiative from evidence based review of DHA supplements in KKH formulary was a winning poster in the Finance category at the 2014 Singapore Healthcare Management.

The Singapore Healthcare Management is the premier congress for healthcare administrators, with thought leaders from the areas of healthcare management, supply chain management and enterprise risk management sharing their insights and best practices.

44 per cent cost savings for patients through evidence-based reviews

44 per cent cost savings for patients through evidence-based reviews