1. INCREASING HERBAL PRODUCT CONSUMPTION IN THAILAND DURING THE PERIOD 2001- 2003 Assoc Prof Dr Arthorn Riewpaiboon Department of Pharmaceutical Botany Faculty of Pharmacy Mahidol University Bangkok 10400 Thailand Email address: pyarp@mahidol.ac.th

2. Increasing Herbal Product Consumption in Thailand During the Period 2001- 2003 Riewpaiboon A Faculty of Pharmacy, Mahidol University, Bangkok 10400 Thailand. Problem Statement: Herbal products have increased importance in both health care and business. Studies on consumption of herbal products are pivotal in public health planning. There has never been such a study collecting data at drugstore level and covering the whole country in Thailand. Objectives: To investigate expenditures and categories of herbal product consumption in drugstores in Thailand. Design: Cross-sectional descriptive research Setting: Registered drugstores. Study Population: Drugs and foods produced from herbs sold in all registered drugstores in Thailand. Methods: The country was first divided into 13 regions. One province was selected from each region by convenience sampling. Drugstores in each province were categorized into 3 types based on their registration status: Type 1 (eligible to sell all drugs), Type 2 (eligible to sell ready-packed modern and traditional drugs), and Type 3 (eligible to sell traditional drugs). Finally, drugstores were included at a proportion of 1% of the population in each type by a convenience sampling method. Purchasing documents for herbal products sold in the drugstores were collected for two consecutive months during September-December 2001 and March-April 2003. All items of these products were classified into groups by their indications. Purchase prices (wholesale prices) were used to calculate the values of herbal products obtained in each store per study period. The medians were converted to annual values for each type of store, then derived estimates for the whole country. Results: The sample included 129 and 121 drugstores in 2001 and 2003, respectively. Total consumption was 27 million US$ in the year 2001(1 US $ = 40 Thai baht), or amounts of US$13 million, $8 million, and $6 million from type 1, 2, and 3 drugstores respectively. The total consumption increased to 32 million US$ in 2003. At constant prices, this represented an increase of 11%. Focusing on type of drugstores, the changes were +32%, +24% and -52% for type 1, type 2 and type 3 respectively. Based on retail prices (78% mark-up), the five top-ranked categories of products used in 2003 were haematonics (valued at US$14.4 million; 26% of total value), post delivery drugs ($5.3 million; 10%), anti-constipation ($5.1 million; 9%), anti-cough ($4.9 million ; 9%) and Yahom or cardiotonics ($4.1 million; 7%). Conclusions: Herbal product consumption increased by 11% from 2001 to 2003. A decrease in consumption in type 3 drugstores might be explained by their decreased popularity. To cover the full range of consumption of herbal products, further studies should include other outlets e.g. hospital and direct sales. Due to high and increasing sales volume, drug use evaluation of herbal products should be conducted. Study Funding: The National Research Council of Thailand

3. PROBLEM STATEMENT Popularity of herbal utilization has dramatically increased in Thailand during the past decade. Herbs were always promoted based on their values of both health and economic aspects. A number of herbal drugs have been incorporated into the national essential drug list. Similarly, herbal products have been promoted as a part of national economy development. To achieve these policies, in terms of planning, information on utilization or consumption is pivotal. There are some reports on herbal product consumption e.g. from surveys and manufacturing reports to the Food and Drug Administration, but they are not consistent. There has never been such a study collecting data at drugstore level and covering the whole country. So, we do not know real situation of consumption. This is a basic problem to further studies on interventions pursuing cost-effective use of herbal products.

4. OBJECTIVE The study was designed to investigate expenditure and categories of herbal product consumption in drugstores in Thailand. STUDY DESIGN Cross-sectional descriptive research. SETTING Registered drugstores. STUDY POPULATION All drugstores in Thailand (13,105 stores in 2002). METHODS Scope: Herbal products in this study cover drugs and foods produced from herbs i.e. traditional drugs (produced based on knowledge of traditional medicine), herbal drugs (produced based on integration of traditional and simple modern knowledge and technology), food supplement and herbal beverage.

5. METHODS (Continued) Sample size and sampling techniques: The country was first divided into 13 regions. One province was selected from each region by convenience sampling method. Drugstores in each province were categorized into 3 types based on registration i.e. type 1 (eligible to sell all drugs), type 2 (eligible to sell ready- packed modern and traditional drugs) and type 3 (eligible to sell traditional drugs). Finally, the drugstores were included at a proportion of 1% of the population in each type by convenience sampling method (Figure 1). Data collecting: Purchasing documents for herbal products sold in the drugstores were collected for two consecutive months during September-December 2001 and March-April 2003. Analysis: All items of the products were classified into groups by their indications. Purchasing prices (wholesale prices) were used to calculate the values of herbal products obtained in each store per study period. The median values were converted to annual values. Finally, the annual values of drug store types were used to derive estimates for the whole country. Percentage mark-up was employed in estimation of expenditure at retail prices (Figure 2).

6. Thailand 13 areas; 12 Public health regions and Capital city (Bangkok) Classify drugstores in each province into type 1, type 2, type 3 1 32 samples from all 3 types in 13 provinces 1% by convenience sampling Stratified sampling Convenience sampling 13 provinces; one province from each area Figure 1 Diagram of sampling methods.

7. Items and their values of individual store for 2 months Grouping by indications Percentage calcu- lation by indica- tion groups Medians of total values by drugstore groups; Bangkok -type1 - type2 - type3 Provincial -type1 -type2 - type3 Volume at wholesale prices per drugstore per year Country volume at wholesale prices per year Country volume at retail prices per year Country volume per year by indication groups Proportion adjusting to 1 year Mark-up adjusting Number of stores adjusting to the country Figure 2 Analysis chart.

8. RESULTS The sample included 129 and 121 drugstores in 2001 and 2003, respectively. Total consumption was 27 million US$ in the year 2001(1 US $ = 40 Thai baht), or amounts of US$13 million, $8 million, and $6 million from type 1, 2, and 3 drugstores respectively. The total consumption increased to 32 million US$ in 2003. At constant prices, this represented an increase of 11%. Focusing on type of drugstores, the changes were +32%, +24% and -52% for type 1, type 2 and type 3 respectively (Table 1, Figure 3). Market structure classified based on location and drugstore types is composed of type 1, type 2 and type 3 drugstores in Bangkok, and type 1, type 2 and type 3 drugstores in provincials. Sale volumes in 2003 were 4.2, 1.4 and 0.6 million US$ in Bangkok drugstores, and 13.7, 9.2 and 2.4 million US$ in provincial drugstores respectively (Table 2, Figure 4). Consumption in Bangkok (19%) was accounted for one-fifth of the total amount. This was corresponding to the population proportion. In terms of drugstore types, in 2001, consumptions in type 1, type 2 and type 3 were 48%, 30% and 22% respectively. The market structure changed in 2003, consumptions in type 1, type 2 and type 3 were 57%, 34% and 9% respectively.

9. RESULTS (Continued) Based on retail prices (78% mark-up), the five top-ranked categories of products used in 2003 were haematonics (valued at US$14.4 million; 26% of total value), post delivery drugs ($5.3 million; 10%), anti-constipation ($5.1 million; 9%), anti-cough ($4.9 million ; 9%) and Yahom or cardiotonics ($4.1 million; 7%) (Table three, Figure 5). These major indication groups were accounted for approximately 60% of the total consumption. DISCUSSION It is essential to keep in mind that the herbal product consumption in drugstores is just one part of the total amount. Another outlet of consumption is direct sales. This is expected to be huge. But there is no specific study on consumption via this channel. Based on magnitude of consumption by indication groups, generally, it implies to types of illnesses. However, in case of herbal drugs, indication classification system is based on the concept of holistic medicine. Each drug may have more than one different indications.

10. Table 1 Increasing consumption during the period 2001-2003 at constant price calculated based on wholesale price. Drug store Consumption in 2001 (US$) Consumption in 2003 (US$)*Change Type1 12,780,455 16,931,11332% Type 2 8,055,356 10,010,48324% Type 3 5,922,445 2,838,816-52% Total 26,758,256 29,780,41211% * Producer Price Index in 2001 and 2003 = 102.5 and108.4, respectively. Based year is 2000. Figure 3 Graphically demonstration of table one.

11. Table 2 Total herbal consumption at wholesale prices in the year 2003. Outlet Wholesale (US$, 1$=40 Baht)Percent Bangkok; Type1 4,207,38013% Bangkok; Type2 1,371,7124% Bangkok; Type3 613,5822% Provincials; Type 1 13,698,30443% Provincials; Type 2 9,214,98429% Provincials; Type 3 2,388,6398% Whole country 31,494,601100% Figure 4 Graphically demonstration of table two.

12. Table 3 Top five rank of highest amount of products in 2003. Drug groupAmount (US$)Percent 1 Haematonics ( ยาบำรุงโลหิต ) 14,407,52826% 2 Post delivery drugs ( ยาสตรี ยาหลังคลอด ) 5,337,30410% 3 Anti-constipation ( ยาแก้ ท้องผูก ) 5,093,2669% 4 Anti-cough ( ยาแก้ไอ ) 4,901,3189% 5 Cardiotonics ( ยาหอม แก้ วิงเวียน ) 4,056,3497% 6Miscellaneous 22,195,33739% Figure 5 Graphically demonstration of table three.

13. DISCUSSION (Continued) In this study, the drugs were classified based on only the first indication stated. While overall consumption was increased, the decreased consumption in type 3 drugstores might be explained as a decrease in popularity of such drugstore. Type 3 drugstores legally provide services by traditional registered pharmacist and provide a limited goods. While in type 2 and 3 provide more goods. So, customers can have what they need in one stop. CONCLUSIONS Herbal product consumption increased by 11% from 2001 to 2003. A decrease in consumption in type 3 drugstores might be explained by their decreased popularity. To cover the full range of consumption of herbal products, further studies should include other outlets e.g. hospital and direct sales. Due to high and increasing sales volume, drug use evaluation of herbal products should be conducted.