Retrospective analysis of financial loss on expired medicines at Kamuzu Central Hospital in Lilongwe, Malawi

Limited research studies have been conducted to find out how much money is lost on expired medicines in public health facilities, especially in low-income countries. This study aimed to analyse the financial loss due to expired medicines at Kamuzu Central Hospital in Lilongwe, Malawi from 2018 to 2023. We used a descriptive cross-sectional research design where retrospective data of medicines that were recorded as expired during the 2018/2019 to 2022/2023 financial year was extracted using a data extraction tool. The total cost for each year was calculated using the unit costs from invoices that were available for the specified period. For donated medicine, the price which the donors indicated was used, and in cases where this information was unavailable, the International Medical Products Price Guide was used. Utilizing a formula for calculating the average rate of change, statistical analysis was done to calculate the average annual rise in revenue loss across the analysis period. To calculate the percentage of financial loss, the entire cost of all expired medicines in each year was expressed as a percentage of the overall pharmaceutical budget expenditure. During the five-year review period, Kamuzu Central Hospital incurred financial losses amounting to 2,374,750.36 USD on expired medicines. The financial year 2019/2020 contributed the highest (40.76%) to the total value, followed by 2021/2022 (20.04%), and 2022/2023 (8.99%). Out of the total monetary value, hospital-purchased medicines contributed 71.15%, and donated medicines contributed 28.85%. Based on the total budget for the five years, the hospital lost 9.28% of its pharmaceutical budget to expired medicines. The year 2019/2020 presented the highest financial loss of 1,141,155.12 USD (27.34%) from the total annual drug allocation of 3,919,976.48 USD. The top classes of wasted medicines through expiry in terms of monetary value were anti-infective, anti-cancers, and medicines used in the cardiovascular system. Kamuzu Central Hospital incurred significant financial losses amounting over a five-year period due to expired medicines. Hospital-purchased medicines accounted for the majority of the financial losses due to expiry, compared to donated medicines. Anti-infective, anti-cancer, and cardiovascular medicines were identified as the top classes of wasted medicines in terms of monetary value. This suggests a need for targeted interventions to improve inventory management practices, potentially focusing on these specific medication categories to reduce wastage.