THE EXTENT OF MEDICATION USE AND WASTE
AMONG FAMILES IN SAUDI ARABIA
.
Hisham S. Abou-Auda, Ph.D.
Department of Clinical Pharmacy
College of Pharmacy
King Saud University
P.O. Box 2457
Riyadh-11451
Saudi Arabia
Tel: 966-1-467-7470
Fax: 966-1-467-6789
E-mail: hisham@ksu.edu.sa
ABSTRACT
Background: Expenditure for drug products and pharmaceuticals constitute a large
percentage of the total expenditure on health care. In Saudi Arabia and other
countries, the cost of maintaining the health care system is escalating out of control.
Governments, health care providers and consumers have to find ways to reduce these
escalating costs while maintaining the quality of care that these countries have grown
to expect. Medication waste is an unnecessary burden on an already fiscally restrained
health care system.
Objective: This study has been conducted to shed some light on the extent of drug use
and wastage among families in Saudi Arabia.
Methods: A questionnaire was administered in 1554 households in 5 regions in Saudi
Arabia.
Results: The average Saudi family size was found to be 6.6±0.1 ( X  SEM ). Only
0.3% of the households in Saudi Arabia had no medicines, while more than 75% of
the families had 5 or more medicines and more than 25% had 10 or more medicines.
The average number of medicines per household was 8.45±0.14. Respiratory (16.8%),
analgesics and anti-inflammatory (16.4%) medications and antibiotics (14.3%) were
the therapeutic classes of medicines of the highest frequency in these households. The
average number of medicines left unused, deteriorated or expired was 2.2 per
household. The medication wastage was estimated to be 25.8% based on the number
of medicines expired or deteriorated, or 19.2% based on the cost of these medicines.
The out-of-pocket expenditure for medication averaged 0.7% of the annual income in
Saudi Arabia compared with 0.9% in the United States.
Conclusion: The total dollar value of medication waste in households was estimated
to be in the close vicinity of 150 million dollars a year from the budget allocated to
health care. If this figure is extrapolated to the United States based on population
ratio, the medication waste will exceed US$ 2 billion. There are no immediate
solutions to the problem of wastage among families. The use of generic alternatives
should be promoted and national pharmacovigilance systems should be implemented.
Key words: Drug Consumption, Wastage, Pharmacoeconomics, Out-of-pocket
expenditures, Saudi Arabia, Gulf States, Kuwait, Qatar, United Arab Emirates, Oman.
2
INTRODUCTION
The cost of maintaining health care and drug costs in particular, have been
escalating out of control over the past few decades. In Saudi Arabia, drugs are the
fastest rising cost in the health care system and expenditure for drug products and
pharmaceuticals constitutes a large percentage of the total expenditure on health care
(1-2). Many nations are seeking ways to cut down budgets allocated for buying drugs.
A contributing factor in the increased costs is the marketing strategies of
pharmaceutical firms and the expenses incurred in producing new drug moieties.
Among the major reasons behind the increased expenditure on medication is
medication waste which is an unnecessary burden on an already fiscally restrained
health care system in these countries (3-4). Medication wastage may be due to poor
compliance of patients (5), excessive and irrational prescribing (6) or the lack of
control on the sales of prescription in the community pharmacy (7).
An extensive MEDLINE and IPA searches for drug or medication wastage
produced very few references which are not closely relevant to the subject. The
problem of wastage is almost universal. In Great Britain, the scale of the problem of
wastage is enormous, research suggests that as many as 50% of the patients fail to
comply with the terms of their prescription (8). A survey of 111 households was
performed in England to determine the quantity and types of medicines in the homes
and to investigate the incidence of double prescribing, wastage and hoarding (9). The
investigators found that 51% of the medicines were not in current use by the patients
and of those 40% were considered out of date. Another survey in England
commissioned by a television station (10) found that each year a third of the
3
population fail to complete a course of prescribed medication. In addition, almost
25% of all adults admitted to having unused medicines in their homes.
In Canada, two studies have sorted through piles of discarded medications
seeking reasons why the waste of drugs is of "mammoth proportions" (3-4). The top
medicines wasted regarding their dollar value were antihypertensive drugs followed
by analgesics and anti-inflammatory drugs. Similar findings were obtained in drug
wastage studies in Israel (11) and Algeria (12).
The objectives of this study is to attempt to quantify drug use and wastage in
Saudi Arabia.
METHODOLOGY
The study was conducted in 2001. A 6-page questionnaire was administered in
1641 families in Saudi Arabia. An adult who can understand instructions was asked to
fill the first two sections of the questionnaire and answer relevant questions to the
family under investigation in the presence of an investigator’s helper. The
questionnaire was divided into three sections. The first section was intended to
determine the demographic information pertaining to the family, including family
size, number of dependents and their ages, education and profession of parents, and
socioeconomic status. The second part was structured to gather data on variables such
as the health status of the family, number of hospital and community pharmacy visits,
attitude towards pharmacy and interaction with pharmacist, health-related expenses
per year, the use of alternative medicines, self-medication, and a host of other aspects
of medication use among members of the family. The third section dealt with the
actual medication storage, consumption and pharmacoeconomic implications of
medication use and wastage. This section involved recording and inspection of all
4
medicines and medicine containers found in the home at the time of the study. In a
specially-designed form, the investigator recorded the name of the medicine, its
dosage form, strength, manufacturer, manufacturing date, expiration date, original
number of units (tablets, capsules, etc.) or volume, remaining or unused units, original
cost and the cost of the remaining units or portions of the medicines judged by the
investigator as expired or unusable based on their recorded dates or due to apparent
physical or chemical deterioration. The knowledge of household members of the use
of these medications and frequency of use were also recorded.
The questionnaire, in its three parts, consisted of 42 questions of varied
format, including checklists and open- and closed-ended questions. Families were
assured anonymity and that the aggregate data will be reported. The first two sections
of the questionnaire were administered in the presence of one of the assigned
investigator's helpers. This ensured that the respondent understood and interpreted
questions as intended and, consequently, answered them truthfully.
Data Analysis
Responses to each question were coded individually, and data were analyzed
using the Statistical Package for Social Sciences (SPSS) for Windows© (ver. 10.0,
2000). The analysis included frequencies of discrete variables and condescriptives.
Medicines were recorded and cost of the expired or unusable remaining units or
portions was calculated. Medications were also classified according to their
pharmacologic or therapeutic classes using the classification of drugs adopted in the
Saudi National Formulary (SNF) (13). The total cost of drugs per family and the cost
of drugs deemed expired or unusable per family were calculated using recorded prices
on the drug packages or prices listed in SNF. Results were analyzed depending on the
5
type of data and the appropriate statistical tests were used for comparisons, e.g.,
independent t-test was used to compare continuous variables such as family size,
number of children, annual income, cost of medication, etc. Chi-square, Fisher Exact
test and Wilcoxon rank sum or Mann-Whitney U tests were used to evaluate the
differences in case of discrete variables. Agreement in drug classes found in
households in Saudi Arabia and Gulf States was evaluated using Kendall's tau-b and
Spearman's rho. Other tests such as ANOVA and Kruskal-Wallis tests were also
utilized when appropriate. If the question of data normality arose based on a
probability plot, log-transformed data were used followed by a parametric test.
Otherwise, one of the nonparametric alternatives would have been used.
RESULTS
No questionnaires were excluded from the study since all questionnaires were
administered in the presence of investigator's helpers. Family medication consumption
was assessed in a total of 1554 families from Saudi Arabia. Of the families surveyed,
1369 (88.1%) families were Saudi nationals and 185 (11.9%) were expatriates
residing in Saudi Arabia for, at least, the last five years. Most of the work has been
conducted in Riyadh metropolitan area and the central province of the kingdom with
1296 (83.4%) homes surveyed. A sample from other regions of the kingdom was
obtained for comparative purposes. Due to the cost involved, only 29 (1.9%), 169
(10.9%), 31 (2.0%) and 29 (1.9%) households were surveyed in the western, eastern,
northern and southern provinces of the kingdom, respectively.
The demographic and socioeconomic characteristics of the families under
investigation are summarized in table 1. The health expenses and number of hospital
visits per year were also presented in the table. The sample for Saudi Arabia is of
6
sufficient size (power>0.9) to draw meaningful conclusions about drug consumption
and wastage in this country. It was estimated that 384 families are needed to get a
power of 0.8.
Each family spent US$ 587.5±20 on health-related matters, whereas health
expenses. These expenses represent about 2.6% of the family income in Saudi Arabia.
The number of hospital visits per family is about 7 times a year in which, at least, one
of the family members visits the hospital (as inpatient or outpatient) or doctor's clinic
for treatment or consultation.
On the other hand, there are statistically significant differences between Saudi
and non-Saudi families in all of the demographic and socioeconomic characteristics
except health expenses per year (Table 2). Despite the differences in annual income
among these families, only 10% of the families in Saudi Arabia pay more than US$
300/year to buy drugs from community pharmacies since most of the drug
requirements of these families are furnished, at no cost, through governmental
institutions. Of the 1554 families interviewed, 647 (41.6%) families refer to a
governmental hospital, 552 (35.5%) to a private hospital and 301 (19.4%) to both, and
consequently, get most of their needs of prescription medications from these hospitals.
Hereditary or chronic diseases are major factor in drug consumption profile
among families. The number of Saudi families with a hereditary disease was 291
(21.3%) compared with 29 (15.8%) for non-Saudi families residing in Saudi Arabia.
The existence of a chronic disease for which, at least, one member of the family is
consuming medication was also investigated. It was found that in 603 (44.1%) and 59
(32.1%) of the Saudi and non-Saudi, respectively, at least, one member of the family
was suffering from a chronic disease.
7
Although drug inventory was performed on households only, the storage of
drugs in glove compartment of the family car was also investigated. Some drugs are
kept in the cars of 195 (14.2%) and 46 (24.9%) of Saudi and non-Saudi families,
respectively, under the atmospheric conditions of heat and humidity.
Overall, the study revealed that more than 80% of the families sought advice
of the pharmacist in prescribing a medication for their minor ailments, and more than
20% of the families took medicines originally prescribed for their friends or relatives.
In addition, more than 40% of the families bought medicines based on the advice of
their friends and relatives (Table 3). These figures are a striking example of the
prevalence of self medication in these societies which contributes to drug abuse and
wastage.
Another pronounced reason for medication wastage is the failure to
completing a course of prescribed medication as admitted by 387 (24.9%) of the
families in Saudi Arabia. Only 54.8% and 43.7% of the families used medication till
the end of duration of use decided by their physicians in Saudi Arabia and Gulf States,
respectively. Many of the drugs collected from these homes were totally unused.
Although aware of the availability of expiry date of the drug, 37% of the
families in Saudi Arabia indicated that they never checked the expiry date prior to
drug administration (Table 3).
A total of 12,463 drug products were found in 1554 households in Saudi
Arabia (8.0 drugs/family) with a total retail value of US$ 81,820.9. No drugs were
found in only 5 (0.32%) households, while 75.9% of the families had 5 drugs or more
and 12.6% of the families had 10 drugs or more up to 35 drugs found in 3 households.
Table 4 shows the distribution of the drugs found in homes of 1554 Saudi Arabian
families based on drug classification adopted by the Saudi National Formulary (SNF)
8
(13) according to their pharmacological action. The largest group (16.8%) was
respiratory drugs followed closely by drugs acting on the central nervous system
(CNS) (16.4%) and antimicrobial agents (14.3%). Of the CNS drugs, OTC analgesics
constituted about 50% of the total while sedatives, tranquilizers, antidepressants,
hypnotics, anxiolytics and appetite suppressants accounted for the rest. Table 4 shows
the number of drugs allocated to the 14 pharmacological classes found in homes. In
any case, there was a good agreement (Kendall's tau-b=0.75, p=0.00019, and
Spearman's rho=0.86, p<0.001) between medicines found in the households of Saudi
Arabia and Gulf States.
There was about 50% more drugs per individual in household than in Gulf
States, but the percentage of expired, unused or deteriorated medicines was
significantly lower (Table 5). There was no statistically significant difference in the
number of medicines expired per family (2.2 and 2.7 in Saudi Arabia and Gulf,
respectively).
In this study, medication waste is defined as any medication that has been
dispensed by a prescription or bought over the counter, and paid for by the individual
or the government, but not consumed by a particular family member due to expiration
or deterioration (physical or chemical) or left unused with a very slim chance of being
consumed before it reaches the expiration date. According to this definition,
medication waste (based on the number of drugs) was calculated to be 25.84% of the
drugs in the households. Most of the families in Saudi Arabia enjoy free health care
including their supply of prescription medication from governmental hospitals and
primary health care clinics (1, 6, 14). Families in these countries also supplement their
needs of drugs through purchase from community pharmacies. In Saudi Arabia, there
are more than 3,000 community pharmacies with the largest concentration of these
9
pharmacies in Riyadh and Jeddah regions. In this study, the average annual purchase
of medicines per family (out-of-pocket expenditure for medication) was calculated to
be US$ 159.4 ± 4.3. Our results also indicate that these figures represent 46% of the
families total annual needs of drugs and the rest is more likely to be covered by the
government or health insurance companies. Out-of-pocket expenditures for
medication for families have averaged 0.72%±0.02% of annual income compared
with an average of 0.48%±0.05% for Gulf States (p=0.0146, t-test). Consequently,
based on the population and the number of families in Saudi Arabia, drug expenditure
by families surveyed in this study can be extrapolated to estimate the drug expenditure
by all families in Saudi Arabia. The cost of total drug consumption by families in
Saudi Arabia was calculated to be US$ 779,673,913 [about 3.0 billion Saudi Riyals
(SR)], a figure in a very close agreement with the semi-official estimates of SR 4.0
billion of total drug expenditure. The discrepancy between the two figures may have
been originated from the fact that the present study did not take into account hospitalbased medicines such as anesthetics, chemotherapeutic agents, etc.
There was no statistically significant difference (p>0.05) with respect to cost
of medication wastage between Saudi Arabia and Gulf States (Table 5). Bearing in
mind the definition of wastage adopted by this study, the cost of medication waste as
a result of close inspection of medicines found in households was calculated to be
US$ 10.0 ± 0.6 and US$ 5.2 ± 0.6 per family in Saudi Arabia and Gulf States,
respectively. Similar to the percentage of medication waste based on the number of
expired medicines, medication waste based on the cost of medicines expired was
statistically significant (p<0.05) between Saudi Arabia (19.2%) and Gulf (25%).
Using these figures, the total dollar value of medication waste can be estimated to be
in the close vicinity of 150 million dollars a year.
10
DISCUSSIONS
Saudi Arabia, like many other countries around the world, has turned its public
focus onto health care system, with drug expenditures and wastage drawing particular
attention. This study attempted to quantify drug use and wastage in Saudi Arabia and
compare the results with the corresponding figures obtained from four other Gulf
States, namely, Kuwait, UAE, Qatar and Oman. The data were extrapolated to
estimate the total annual cost of medication waste on a national scale especially in
Saudi Arabia. One of the strength points is the prospective nature of the study where
medicines were seen and their condition examined and recorded on site. Extensive
literature search proved that this is the first study of its kind in this part of the world.
The population in Saudi Arabia, like other populations in the Gulf region, is
characterized by a high degree of cultural homogeneity and by an equally high degree
of social stratification which rested in the diffusion of values and attitudes
exemplified in the family. Saudi Arabian families tend to be patriarchal where the
father in the family appearing to assume an authoritarian role at the top of the
hierarchy. Drug culture in these families is almost identical from one individual in the
family to another and from one family to another. In this regard, meeting with the
father is most likely to reflect the point of view of the rest of the family members. The
preponderance of drug products in these homes was clearly manifested in this study
where there was, at least, one drug per individual in the family. Although most of the
fathers in our sample of families are well educated, the educational level had no
significant effect (p>0.05) on number of drugs found or on the amount of medication
waste observed in these homes. Most of them were not aware of the proper storage
conditions of their inventory of drugs and only 49.7% know the medical condition for
11
which each drug was originally prescribed. In addition, 37% in Saudi Arabia and
33.3% in Gulf States do not check the expiry date prior to drug administration.
The results of overstocking medication and the abundance of expired, unused
or deteriorated drugs (about 26% in Saudi Arabia and 41% in Gulf countries) as well
as the absence of proper labeling or clear instructions for use may have contributed to
the drug poisoning accidents observed in 6.4% and 5.7% of the families in Saudi
Arabia and Gulf States, respectively. One can be almost sure that, at least, 80% of
these episodes occurred in young children below the age of 5 years. It can be
emphasized that more than 50% of the population are below the age of 18 years. In
Saudi Arabia, family out-of-pocket expenditures for medication have averaged 0.7%
of annual income compared with an average of 0.48% for Gulf States combined.
Personal out-of-pocket expenditures for medication in the United States (15) have
ranged from 0.8% to 1% of consumer unit income since 1985, a figure not
significantly different from that of Saudi Arabia. Almost 50% of the families in Saudi
Arabia and Gulf States have, at least, one chronic condition for which a drug must be
consumed. The effect of the existence of a chronic condition in the family on out-ofpocket expenditures for medication was examined. Estimates based on findings of the
present study suggest a strong relationship between out-of-pocket expenditures and
the existence of chronic conditions. The out-of-pocket expenditures for those families
with chronic conditions averaged 0.78% of the income vs. 0.67% for those with no
chronic conditions (p=0.0149, t-test) in Saudi Arabia. Similarly, out-of-pocket
expenditures for families with a hereditary disease averaged 0.85% vs. 0.67% for
those with no hereditary disease (p=0.00184, t-test). Surprisingly, there were no
statistically significant differences in out-of-pocket expenditures for medications
between families with either a chronic condition or hereditary disease and families
12
without them in the Gulf States. Out-of-pocket expenditure trends indicate that drugs
do not represent a large portion of the overall health care picture for families in the
Gulf region. However, consumers in Saudi Arabia feel these costs more personally
because large portions of outpatient drugs are purchased with out-of-pocket funds.
This is may be due to the fact that citizens in the Gulf States are more dependent on
their governments in supplying them with prescription and OTC medication than in
Saudi Arabia. Data from the present study revealed that families in Saudi Arabia
spend 16.3% more than Gulf families for out-of-pocket medications. We were
cognizant that that the differences in drug expenditures may not arise from the
differences in volume consumption, but from differences in drug prices in these
countries. Therefore, a price comparison was carried out confirm the uniformity of
drug prices in the countries of the Gulf region. It also worth mentioning that the
governments of these countries through their Council of Ministers of Health resort to
group tenders rather than individual direct purchase of drugs for all countries.
Self medication was prevalent in Saudi Arabia and Gulf States where 20% and
40% of the families took drugs prescribed for their friends or bought drugs based on
their advice, respectively. In most of the Gulf countries, governmental health facilities
may have played a part in medication wastage, as through them, drugs can be
obtained free of charge for citizens of these countries. Many patients still entertain the
idea that the outcome of their visit to the hospital or physician's clinic must be a
prescription. Many other societies used to have the same impression (11). In addition,
80% of the families sought the advice of pharmacist in prescribing drugs for them.
Among community pharmacy staff, profit is likely to be the important factor in
product recommendation. In other Arab countries, over 50% of supplies of drugs from
community pharmacies are without either a prescription or advice of the pharmacist
13
(16). In Saudi Arabia, most medicines (e.g., antimicrobials, bronchodilators,
antihypertensives) that require a prescription in the United States may be purchased
over the counter (2). The misuse of OTC medicines was also reported in many other
countries (17, 18).
The extent of medication wastage in Saudi Arabia and Gulf countries proved
to be large relative to their GNP. For the first time in this part of the world, the extent
of medication waste was estimated through the current cross-sectional study. Saudi
Arabia loses from the budget allocated to health care about US$ 150 million each
year. There are no accurate figures estimating the extent of medication wastage in
leading countries such as the United States. In a relatively small state like Oklahoma,
it is estimated that between US$ 3–10 million a year in unused prescription drugs
from nursing homes are destroyed. Extrapolating these figures to the continental
United States, the amount of wastage will be enormous. If the amount of drug wastage
in Saudi households was extrapolated to the United States based on population ratio
between the two countries, the total dollar value of drug wastage would have
surpassed US$ 2 billion. The frequency of drugs found at homes in Saudi Arabia and
Gulf States give an indication of the level of prescribing of drugs in these countries,
whereas the high percentage of expired, unused or deteriorated drugs (25.8% for
Saudi Arabia and 41.3% for Gulf States) gives a clear-cut indication of the level of
noncompliance among the families.
There are no immediate solutions for this problem. It is recommended that
generic drug products can play a positive role in minimizing the amount of wastage as
their prices are lower than those of innovative drug products. Thus the governments of
Gulf countries should promote the use of generic alternatives which can have a costeffective impact in reducing expenditure on drugs. Also, these countries should
14
sponsor drug collection programs of unused medicines for redistribution to patients
who need but cannot afford them, or for donation to the humanitarian agencies. The
accumulation of unwanted medicines as proven by the present study is not only an
economic burden, but also can be a significant source of poisoning, particularly for
young children. The safety aspects of drug consumption in these countries should be
monitored through national pharmacovigilance systems to collect and disseminate
data on drug utilization, including consumption and prescribing patterns.
15
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Saudi Arabia. Am J Hosp Pharm 1992; 49:2252-4.
3. Boivin M. The cost of medication waste. Can Pharm J 1997; 130(4): 32-9.
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problem. Can Med Assoc J 1996; 155:1596-98
5. Potter M. Medication compliance, a factor in the drug wastage problem. Nurs
Times 1981; 77(6):Suppl 5:17-20
6. Al-Nasser AN. Prescribing patterns in primary healthcare in Saudi Arabia. DICP.
The Annals of Pharmacotherapy 1991; 25:91-3.
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Potential for drug misuse in the eastern province of Saudi Arabia. Annals Saudi
Med 1987; 7:301-5.
8. All-Party Pharmacy Group. Concordance & Wasted Medicines. A report to Health
Ministers. Royal Pharmaceutical Society of Great Britain. July 2002.
9. Skinner RF, Shave JHL, Harris JM, Peattie JR, Talman FAJ. A survey of
medicines in patients' homes. British Pharmaceutical Conference, Coventry,
UK,1978.
10. Anonymous. Huge waste of medicines claimed. Pharm J 2000; 264:238.
11. Yosselman S, Superstine E. Drug utilization patterns in Israel. Drug Intell Clin
Pharm 1977; 11:678-80.
12. Bezzaoucha A. Drug consumption in Algeria according to a survey of families.
Therapie 1993; 48(5): 503-8.
13. Al-Salamah S, et al. (Eds.). Saudi National Formulary. Second Edition. Saudi
Pharmaceutical Society, Riyadh, 1995.
14. Alkhawajah AM, Eferakeya AE. The role of pharmacists in patients' education on
medication. Public Health 1992; 106:231-7.
15. Lee JA, McKercher PL. Statistical comparison of consumer drug expenditure and
discretionary purchases to assess drug affordability. Clin Ther 2002; 24(6):100316.
16
16. Benjamin H, Motawi A, Smith F. Community pharmacists and primary health
care in Alexandria. J Soc Admin Pharm 1995; 12(1):3-11.
17. Pates R, McBride AJ, Li S, Ramadan R. Misuse of over-the-counter medicines: a
survey of community pharmacies in a South Wales health authority. Pharm J
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17
Table 1:
Comparison between 1554 families in Saudi Arabia and 87 families in other Gulf States with respect to Demographic and
Socioeconomic Characteristics. Results are expressed as Mean  SEM.
KSA
Kuwait
UAE
Qatar
Oman
Family Size
6.6  0.09
6.0  0.87
8.2  0.66
8.9  0.64
7.8  0.51
Children under 5 years
0.97  0.03
1.06  0.31
0.4  0.16
0.35  0.2
0.75  0.13
Children 5-15 years
1.3  0.03
1.0  0.3
1.4  0.4
1.05  0.2
1.35  0.18
Children over 12 years
2.0  0.06
1.41  0.55
2.9  0.46
5.6  0.59
3.3  0.6
Hospital visits per year
7.9  0.2
6.9  0.46
6.6  0.81
6.6  0.4
6.7  0.32
Annual Income (US $)
32753  525
45835  4945
36000  4000
36640  4685
28920  3518
Health expenses per year (US $)
587.1  19.9
341  152
640  187
420  197
230  40
Percentage of health expenses of
the annual income.
2.62  0.17
0.63  0.20
1.99  0.77
1.87  0.42
0.96  0.14
18
Table 2:
Comparison between 1369 Saudi families and 185 expatriate families in Saudi Arabia with respect to
Demographic and Socioeconomic Characteristics. Results are expressed as Mean  SEM.
Saudis
Non-Saudis
p (Sig)
Family Size
6.79  0.1
4.89  0.13
<0.0001 (S)
Children under 5 years
1.0  0.03
.7  0.06
<0.0001 (S)
Children 5-15 years
1.27  0.04
1.0  0.07
0.0069 (S)
Children over 12 years
2.12  0.07
1.1  0.1
<0.0001 (S)
Hospital visits per year
8.0  0.40
6.0  0.55
0.0044 (S)
Annual Income (US $)
33728  562
25643  1445
<0.0001 (S)
Health expenses per year (US $)
589.4  21.4
573.3  56.3
0.7896 (NS)
2.45  020
3.64  0.43
0.0316 (S)
Percentage of health expenses of the
annual income.
19
Table 3: Comparison between 1369 Saudi families and 185 Non-Saudi families in Saudi Arabia and 87 families in other Gulf States
with respect to their attitudes toward self medication and storage of medicines. Results are expressed as Mean  SEM.
Ask pharmacist to prescribe OTC
Take medicines from relatives or friends
Buy medicines upon advice of a relative or friend
Drug poisoning episodes
Storage of Medicines:
- Special Cabinet:
- Room
- Kitchen
- Bathroom
- Others
Condition of Medicines:
- In its original package
- No package but known
- No package and unknown
Check expiration dates before administration
Expired medicines disposal:
- Keep all
- Get rid of all
- Keep if not expired
Saudi
n (%)
1106 (80.8)
282 (20.6%)
601 (43.9%)
85 (6.2%)
Non-Saudi
n (%)
147 (79.4%)
35 (18.9%)
70 (37.9%)
15 (8.1%)
Gulf
n (%)
73 (83.9%)
26 (29.8%)
43 (49.4%)
5 (5.7%)
597 (42.3%)
186 (13.6%)
416 (30.4%)
35 (2.6%)
153 (11.2%)
108 (58.7%)
18 (9.8%)
46 (25%)
2 (1.1%)
11 (5.9%)
37 (37%)
10 (10%)
25 (28.7%)
15 (17.2%)
1072 (78.3%)
280 (20.5%)
17 (1.2%)
863 (63%)
158 (85.4%)
27 (14.6%)
148 (80%)
62 (71.3%)
25 (28.7%)
0.1474 (NS)
58 (66.7%)
0.0251 (S)
162 (11.9%)
448 (32.8%)
757 (55.4%)
19 (10.3%)
41 (22.2%)
125 (67.7%)
8 (9.2%)
28 (32.2%)
51 (58.6%)
0.7958 (NS)
20
p(Sig)
0.8691 (NS)
0.1936 (NS)
0.2711 (NS)
0.3684 (NS)
0.4769 (NS)
Table 4:
Medicines* found in homes of 1641 families (1554 families in Saudi
Arabia and 87 families in other Gulf Countries).
Pharmacological Class
Respiratory
Saudi Arabia
n (%)
2095 (16.8%)
Other Gulf Countries
n (%)
94 (15.3 %)
Central Nervous System
2050 (16.4%)
84 (13.6 %)
Antibiotics
1779 (14.3 %)
111 (18 %)
Gastrointestinal
1382 (11.1 %)
60 (9.7 %)
Miscellaneous
847 (6.8 %)
57 (9.4 %)
Nutrition and Blood
823 (6.6 %)
24 (3.9 %)
Musculoskeletal/Joints
790 (6.3 %)
52 (8.4 %)
Skin
735 (5.9 %)
33 (5.4 %)
Ear-Nose-Throat
553 (4.4 %)
26 (4.2 %)
Cardiovascular
465 (3.7 %)
60 (9.7 %)
Eye
398 (3.2 %)
25 (4.1 %)
Endocrine
375 (3.0 %)
16 (2.6 %)
Ob/Gyn-Urinary
140 (1.1 %)
12 (1.9 %)
Cytotoxic
31 (0.2 %)
0 (0 %)
12463 (100 %)
616 (100 %)
Total
* Classified according to pharmacological classes of the Saudi National Formulary (SNF) (Ref. 13).
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Table 5
Pharmacoeconomic implication of medicines (total and expired) found in 1554 households in Saudi Arabia and
87 households in four other Gulf States. Results are expressed as Mean  SEM.
Number of medicines per family
KSA
8.00  0.11
Kuwait
4.94  0.57
UAE
9.0  0.54
Qatar
4.70  0.28
Oman
7.70  0.52
Gulf *
6.6 0.33
p (sig)**
0.003 (S)
Number of medicines per individual
1.53  0.03
0.99  0.71
1.2  0.17
0.62  0.09
1.16  0.11
1.01  0.07
0.0001 (S)
Percentage of expired/unusable
medicines based on total number
25.8  0.7
24.8  8.6
33.3  2.6
36.1  5.8
52.9 3.7
41.3  3.0
<0.0001(S)
Total cost of medicines per family
(US $)
51.0  2.5
28.7  5.3
72.3  14.5
31.6  10.6
28.0  2.1
34.1  3.5
0.1086 (NS)
Total cost of
individual (US $)
per
10.0  0.6
5.7 1.3
10.6  3.2
4.0  1.2
1.0  0.15
5.2  0.6
0.0591 (NS) ¥
Cost of expired/unusable medicines
per family (US $)
9.3  0.4
6.5  2.6
19.7  5.3
5.3  1.5
6.5  0.8
7.7  1.3
0.3895 (NS)
Cost of expired/unusable medicines
per individual (US $)
1.9  0.12
1.7  1.0
3.0  1.4
0.75  0.2
1.01  0.15
1.32  0.3
0.2589 (NS)
Percentage of expired/unusable
medicines based on total cost.
19.2  0.6
24.5  8.9
22.1  4.6
27.1  5.9
24.8  2.7
25.0  2.5
0.0222 (S)
*
**
¥
medicines
Average for Kuwait, UAE, Qatar and Oman combined.
t-test between KSA and Gulf, S=Significant, NS=Not Significant
Significant using Mann-Whitney U test (p<0.0001), see data analysis section.
22