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ABC-VEN matrix analysis of pharmaceutical inventory management in Tikur

Anbessa Specialized Hospital for the years 2009 to 2013, Addis Ababa, Ethiopia

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 Indian Journal of Basic and Applied Medical Research; March 2016: Vol.-5, Issue- 2, P. 734-743

Original article
ABC-VEN matrix analysis of pharmaceutical inventory management in Tikur Anbessa
Specialized Hospital for the years 2009 to 2013, Addis Ababa, Ethiopia
Sefinew Migbaru a ,Mahlet Yigeremu b, Berhanemeskel Woldegerimac, Workineh Shibeshi d*

aOncology Pharmacy case team , Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, P.O. Box 1176,
Addis Ababa, Ethiopia.
bDepartment of Gynecology and Obstetrics, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia.
c School of Pharmacy, College of Medical and Health Science, University of Gondar, Ethiopia. Email: aberhaneth@gmail.com
d Department of Pharmacology and Clinical pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box
1176, Addis Ababa, Ethiopia
*Corresponding author : Berhanemeskel Woldegerimac

Abstract
Introduction: Effective drug supply management ensures uninterrupted availability of quality approved, safe and effective pharmaceuticals.
This can be achieved through proper selection, quantification, procurement, distribution and use of drugs based on consumption and morbidity
pattern of the catchment area by using a system like ABC-VEN matrix analysis. The objective of the study was to assess pharmaceutical
inventory management of Tikur Anbessa Specialized Hospital (TASH) for fiscal years 2009-2013.
Methods: This research was retrospective facility based cross sectional study in which ABC, VEN and ABC-VEN matrix analysis techniques
were utilized to assess the 5 years (2009-2013) pharmaceutical inventory management system at TASH. The study was conducted from January
- May 2014.The list of drugs with corresponding prices was retrieved from goods receiving vouchers, GRV (models 19).
Observations and results: Out of the five years pharmaceutical ABC analysis; Insulin /NPH/, examination glove, gauze bandage, surgical
gloves, vicryl and normal saline 1000 ml had exist through five years by covering huge amount of money. From ABC-VEN matrix analysis,
majority of items were Category I. Most of the Category I pharmaceuticals in turn were Class A and V items which require great attention for
their control and availability.
Conclusion: The study findings indicated that there are huge pharmaceuticals in TASH, which need proper control and supervision at different
levels of management. The results indicate the need for routine application of scientific pharmaceutical inventory management tools such as
ABC-VEN matrix analysis to improve efficiency of resource use and patient care.
Key words: ABC analysis, VEN analysis, ABC-VEN matrix, Class I, Class II, Class III Pharmaceuticals

Introduction procurement, distribution and use of drugs based on

In different countries majority of health facilities budget is consumption and morbidity pattern of the catchment area.[3]
spent for pharmaceuticals utilization. Spending on Thus, the need for planning, designing and organizing the
pharmaceuticals accounted for more than 17% of all health pharmacy in a manner that results in efficient clinical and
expenditure on average across Organization for Economic administrative services becomes the most pertinent.[4] The
Cooperation and Development (OECD) countries in 2011.[1] goal of the hospital supply system is to ensure that there is
Effective management on availability and accessibility of adequate stock of the required items so that an uninterrupted
essential drugs as well as alternative drugs with information supply of all essential items is maintained.[5] There are
particularly in pharmacy profession are found to be crucial various tools involved for inventory management but
[2]
for optimal and rational pharmacotherapy. This could be commonly used are: Always, Better, and Control (ABC)
achieved through proper selection, quantification,

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and Vital, essential and Desirable/ Non essential (VED/N) and low therapeutic advantage. These items are important to
[6,4,7]
and Stock card & Bin card. patients; however, patients will not die or face a traumatic
ABC analysis is a method of classifying items according to condition due to the absence of these drugs/ reagents. So
[8]
their cost. It is also known as the V.Pareto principle they are not essential.[11,15]
[16]
“separating the vital few from the trivial many” because, for The pervious ABC-VEN analysis done in TASH has
any group of things that contribute to a common effect, a certain limitations; the data was only three years, lacks
relatively few contributors account for a majority of the matrix analysis and it was done by mixing Aid & Budget
effects. The analysis classifies the items into three pharmaceuticals. For this reason, expensive Aid
categories: the first 10-20% of the items account for pharmaceuticals make dominancy over some Budgets which
approximately 70-80% of cumulative value (cost) (category might be class A item if it was done separately. Moreover,
A), 10-20% are category B items that account for a further study is needed which indicates current pharmaceutical
15-20% of the cumulative value and the remaining 60-80% managerial activities. Aims & Aims & Objectives
are category C items, amounting for a mere 5-10% of the The objectives of this study was to analyze TASH
[9,10,11,12]
total value. pharmaceuticals inventories from 2009 - 2013 by using
The limitation of ABC analysis is that it is based only on ABC-VEN matrix, and to assess five years pharmaceuticals
monetary value and the rate of consumption of the item. In a consumption trend as well as to identify categories of
hospital, an item of low monetary value and consumption pharmaceuticals requiring stringent management control.
may be very vital or even lifesaving. Their importance Materials & Methods
cannot be overlooked simply because they do not appear in Study setting and design
category A. Therefore, another parameter of the materials is The study was carried out at Tikur Anbessa Specialized
their criticality. Hospital (TASH), Addis Ababa, Ethiopia. TASH is a
VEN analysis of pharmaceuticals is based on criticality and teaching hospital of Addis Ababa University which has more
utility for the patients. Based on their criticality, the items than 700 beds and serves more than 818 patients per day on
could be classified into three categories: vital, essential and outpatient pharmacy service. Majority of these patients
[5] 17
desirable. The categories in the original system are vital receive a prescription containing one or more drugs This
(V), essential (E), and nonessential (N) (sometimes called research was retrospective facility based cross sectional
[13,14]
VED-vital, essential, and desirable). Vital study in which ABC, VEN and ABC-VEN matrix analysis
pharmaceuticals can be given values based on their potential techniques were utilized to assess the 5 years (2009-2013)
on lifesaving, crucial for health services and if it is pharmaceutical inventory management system by using
impossible without them to safely alive and prevent death or hospital’s secondary GRV data (model 19) from January-
disability of the patient. It is mandatory 24 hours of a day, 7 May 2014.
[11]
days of a week, a quarter of a year or 12 months of a year. Inclusion and exclusion criteria
Essential pharmaceuticals are effective against less severe Pharmaceuticals i.e., drugs, laboratory reagents and
but significant illness, not vital; it is between Vital and less consumable medical supplies that are purchased by hospital
essential .They are lifesaving ; without which patient may be or donated to the hospital and recorded by good receiving
in difficulty but may be somehow substituted. It is vouchers (Model 19) from 2009 to 2013 were included
mandatory at least once a day, or at least once in a week, or (Appendix 1) All program pharmaceuticals like;
at least once in a month or once in a quarter of the year, but antiretroviral drugs, anti-tuberculosis drugs, family planning
[11]
not as highly mandatory as vitals. Non-essential/less drugs and Implantable pharmaceutical equipment were
essential pharmaceuticals are effective for minor illnesses excluded from this study.

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Data collection and analysis Provision of care in tertiary care hospitals is sensitive to the
The data was collected from model 19 by trained timely availability of facilities, including drugs. In case of
pharmacists. The training focused on pharmaceuticals with drugs, besides the criticality factor, the cost factor must also
same name but with different strength and dosage. Each be taken into consideration, as can be seen from our study,
pharmaceutical was recorded on the data abstraction form. where (9.60, 14.89, 17.06, 19.45 & 12.17 %) of the
The data analysis had three phases; the first was ABC pharmaceuticals consumed about (81.20, 79.00, 75.00, 79.23
analysis which had nine steps (Appendix 2). VEN analysis & 76.15 %) of ADE of the pharmacy in TASH from 2009 to
was the second phase which needed only reconciliation 2013 respectively (Table 1). These are items requiring
hence it was done based on the hospital drug list which greater monitoring as it has fewer drugs consuming most of
included VEN analysis. The final but crucial step was ABC- the budget expenditure.
VEN matrix analysis after reconciliation. The ABC-VEN The study result (Figure 1) showed that all five years
matrix was formulated by cross-tabulating the ABC and pharmaceuticals ABC analysis was compatible under the V.
VEN analysis. From this combination, three categories were Pareto curve. From this figure in 2009 class A
created (I, II and III). Category I was constituted by drugs pharmaceuticals took the maximum of budget percentage
belonging to AV, AE, AN, BV and CV subcategories. The range (70-80%) than other years. But on 2011 class A items
BE, CE and BN subcategories constituted category II, and took lower portion of budget range and maximum of items
the remaining drugs in the CN subcategory constituted proportion (10-20%). There was some similarity on the
category III. In these subcategories the first alphabet refers availability of class A, B & C items on 2010, 2012 and
to its place in ABC analysis, while the second alphabet 2013.
18,19,15,4
stands for its place in the VEN analysis. VEN analysis
Observations & results For VEN classification in current study, Tikur Anbessa
ABC analysis Specialized Hospital drug list VEN classification which was
The five years ABC analysis of pharmaceuticals in TASH is published in 2012 was used. From TASH drug list, most of
summarized in Table 1. The ABC analysis of Tikur Anbessa pharmaceuticals were Vital. There was no almost non-
Specialized Hospital showed that a total of 250 items were essential item in pharmaceutical VEN analysis (Figure 2). .
stored during the year 2009 which increased in successive As shown in figure 2, the VEN classification for 2009
years. Out of these pharmaceuticals, 24 items (9.60%) revealed that out of 250 pharmaceuticals stored, 168
consumed 81.20% of annual drug expenditure comprising items(67.2%) were considered ‘Vital’; 55 items (22%) were
group ‘A’ items. Fifty one items (20.40%) consumed ‘Essential’, 1 item (0.4%) were considered ‘Nonessential
13.30% of annual drug expenditure forming group ‘B’ items. and the rest 26 items (10.4%) were out of hospital drug list .
The rest 175 items (70.00%) consumed only 5.50% of total In 2010 out of 282 pharmaceuticals stored, 179 items
budget, classified as group ‘C’ items. In 2013, 263 items (59.7%) were considered ‘Vital’; 54 items (20.5%) were
were analyzed out of which 32 items (12.17%) consumed ‘Essential’ and 2 item (0.5 %) were considered
76.15% (18, 466, 329.04 Birr) of annual pharmaceuticals ‘Nonessential’. In 2011 out of 299 pharmaceuticals stored,
expenditure comprising group ‘A’ items and 47 items 220 items(73.5%) were considered ‘Vital’; 61 items (20.4%)
(17.87%) consumed 15.63% (3,779, 223.45 Birr) of annual were ‘Essential’, and there is no ‘Nonessential items , but
drug expenditure forming group ‘B’ items. The rest 184 two drugs; Nitrofurazone 0.2 %, 30gm ointment and white
items (69.96%) consumed only 8.26% (2,003,355.33 Birr) of petrolatum ointment 1kg both of them were class C which
total budget, classified as group ‘C’ items. were out of hospital drug list.

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In 2012 and 2013 in similar way there was no any money. X-ray film of different size and Adriamycin 500 mg
nonessential item and out of 293 pharmaceuticals stored in injection also existed in top ten Class I items for four
2012, 176 items (60%) were considered ‘Vital’; 44 items subsequent years. The rest Vincristine sulphate 1mg,
(15%) were ‘Essential’ but chlorpheniramine maleate + dextrose in water 1000 ml , catheter different size,
betamethasone combined drug(class C) were out of hospital ceftriaxone 1g injection, catgut different size, Merisilk
drug list. In 2013 out of 263 items stored 184 items (70%) different size and shape and surgical blade different size
were considered ‘Vital’; 52 items (19.7%) were ‘Essential. were also recorded in Class I in the five years at least once.
Respiridone 1 and 2 mg and Niclosamide 500 mg (class C) Discussion
were found out of hospital drug list. The present study reports Tikur Anbessa Specialized
From the total utilized items, more than 230 same Hospital (TASH) pharmaceuticals inventories from 2009-
pharmaceuticals had been purchased every year. From these 2013 by using ABC-VEN matrix analysis. The findings
on 2011 there was some improvement by supplying newer indicate that the majority of pharmaceuticals were either
items relative to the rest four years because in 2011, there vital or expensive, and need a management with greatest
were 37 newer items than 2009 and 2010. Majority of these attention (Table 2).
newer items were laboratory pharmaceuticals. In 2013 there The principle of management by exception should be
were some newer vital drugs added. From these; practiced by top management for such items to which would
Dexamethasone 0.5mg tab, Ergometrine malate 0.25mg/ml, help in keeping a check on the annual budget and their
Etoposide 20mg/ml injection, Ifosfamide 1000mg inj, availability. The consumption and its effect on the stock
Imipramine 25mg tablet and Mesna 100mg/ml in 4ml level should be monitored continuously, and the safety stock
injection are vital drugs and their sustainability had great must be kept low to reduce carrying cost.
impact on health service improvement. The pharmaceuticals shortage was a considerable issue for
ABC-VEN matrix analysis TASH. There were more than 20 main pharmaceuticals
Table 2 shows ABC-VEN matrix analysis of categories in TASH Drug/VEN list based on hospital’s
Pharmaceuticals from 2009 – 2013. Category I items which diagnosis and treatment units. But majority of
consumed 12481901.8, 11053651.6, 16073428.2, pharmaceuticals were not delivered to each unit and these
18200820.7, 21807548.7 ETB, respectively were either vital units only had an average of 20% of their need in 2013 as
or expensive drugs which needs the practice of the principle compared to the hospital drug list. Based on TASH drug list
of management by exception. Category II which consumed data 51.54%, 43.87% & 4.66% of pharmaceuticals under
407346.58, 507010.31, 595578.04, 431649.2, 1060044.03 inclusion were V, E & N respectively.[17] Even though
ETB, from 2009 - 2013 respectively consists of drugs that pharmaceuticals delivered in five years showed 59.7 to
were essential. Category III only for 2009 and 2010 73.5% items were Vital, availability of pharmaceuticals
accounted for 2149.15, and 5317 ETB, the rest years have relative to the hospital drug list was very low.
no any Category III item, consists of drugs that were Even though some pharmaceutical supplies were provided
nonessential and inexpensive which were the lowest in the by donation, majority of drugs are still on hand of Budget
hierarchy of priority. From top ten Class I pharmaceutical; pharmaceuticals supply management. There is huge gap on
Insulin /NPH/ 100u/ml in 10ml, Examination glove, Gauze lifesaving drugs availability implementation. The purchasing
Bandage, Surgical Gloves Sterile latex number 7.5 of 50 system might always follow similar ways of procurement
pairs, Vicryl (Polyglycoliq) different size and shape, and since there were no more new drugs seen relative to
Normal Saline (Sodium chloride 0.9% ) injection of 1000 ml hospital’s drug list.
existed through five years by covering huge amount of

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There could be serious functional dislocation of patient care had been done in USA on oncology medication availability
when vital drugs are not available even for a short period. indicates that oncology drug shortages occurred frequently
Therefore, these should always be stocked in sufficient in the first half of 2011.[26]
quantity to ensure their constant availability. The shortage of Lack of essential medicines is still one of the most serious
essential drugs can be tolerated for a short period. If these public health problems. About 30% of the world’s
essential drugs (like antibiotics, antineoplastic) are not population lacks the medicines they need. The situation is
available beyond a few days or a week, the functioning of worse in the poorest parts of Africa and Asia where the
the hospital can be adversely affected. These drugs should figure rises to over 50 % .[27] Study on Indian Armed Forces
also be controlled and monitored carefully. The shortage of revealed that out of 1536 items in their drug list considered
non-essential drugs would not adversely affect patient care for the study, only 400 drugs of the total inventory
or hospital functioning even if shortage is prolonged and consuming approximately 90.00% of the operating budget of
there were no more non-essential items. the hospital towards expendable medical stores, the
Similar studies also showed essential drug shortage and remaining 1136 (73.95%) drugs consuming only 10% of the
irregular accessibility is common in different region of total expenditure.[28]
Ethiopia. Research done by Jimma University on availability Similar study carried out by Gupta et al (2007) in a tertiary
and affordability of essential drugs in public health center in care hospital in India showed that 14.4% items consumed
south western Ethiopia showed the shortage on essential 70% of annual drug expenditure comprising the A group
drugs availability which forced patients to purchase drugs while group C constituted 63.7% items which consumed
from private pharmacies, go to informal sector or forgo 10% of annual drug expenditure of the hospital. Another
[20]
treatment. Study done in Gondar town, North West part study done in Thailand also showed that from 336
of Ethiopia also showed; even though average availability medicines, 26 items (7.74%) consumed 70.84% of annual
of essential medicines in the public health centers in value and classified into class A, 37 items (11.01%)
Gondar town was good, rural health centers were stock out consumed 19.23% of annual value classified into class B,
for significant percent of essential medicines over the six and 273 items (81.25%) of annual value consumed only
[21]
months period. Though TASH has diverse and super- 9.93% forming class C.[15]
specialized services availability than hospitals in Ethiopia Since ABC categorization follows V. Pareto way of
where ABC-VEN studies were done including Dilla classifying the percentage of class A, B and C items, results
[22] [23]
University Hospital , Debire Markos Hospital , there done in different hospitals may show related percentage of
were similarity on pharmaceuticals which had higher budget. items. But magnitude of total budget show difference since
This may be due to common supply by governmental there may be different representative pharmaceuticals and
pharmaceuticals supplier, pharmaceuticals fund supply budget in each health setting. This study also showed that
agency (PFSA). the total number of items analyzed annually in TASH was
The hospital has to ensure the availability of various drugs lower than Kenya. For example MSH Pharmaceuticals
round the clock as these are essential and vital for patient consumption report on the Aga Khan University Hospital of
care. The Pharmacy Departments are often charged with Kenya , the drug therapeutic committee did an ABC analysis
responsibility for managing drug and delivery system of 793 medicines for 2005 and found that the top four
[24]
costs. For improvement of therapeutic outcome of hospital products were antimicrobials that accounts 10% of total
[25] [11]
activity, availability of pharmaceuticals has a great role. budget This may implies TASH being a university
But in real situation, pharmaceutical supplies interruption is hospital which mobilize lower number of pharmaceuticals.
very common even in developed countries. A survey which

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Some pharmaceuticals which were Vital in TASH may be and such functions can be delegated to lower level
essential in other Hospitals. So it may be difficult to make an managers.
association based on number of vital, essential and desirable Conclusion
items. In Debre Markos Referral Hospital VEN study in The study finding indicated that there are huge
Ethiopia, the pharmaceuticals were classified as 67.4 % pharmaceuticals in TASH which need proper management
[23]
vital, 28.9% essential and 5.02% non-essential. VEN and supervision. Even if budget utilization shows increment
analysis study done in Goa Medical College Hospital of from 2009 to 2013, there was an asymmetric trend on
India showed that, around 12.36% of the drugs were pharmaceutical availability. Relative to TASH drug list there
classified as vital, 47.12 % as essential, and the remaining is a gap on pharmaceuticals availability. Majority of
[18]
40.50% as desirable. Sassoon Indian General Hospital pharmaceuticals were found vital items. From these;
also showed 148 (50.9%), 117(40.2%) and 26 (8.9%) items Category I pharmaceuticals took higher proportion than
were found to be V, E and D category items, Category II & III and most of Category I pharmaceuticals
[29]
respectively. Relative to other related study findings, were also Class A and V items that need great attention of
Tikur Anbessa Specialized Hospital VEN result contained top management for annual budget allocation and their
more Vital items and lower non-essentials. Generally the availability.
drugs belonging to category A requires strict managerial Acknowledgments
control, accurate data driven forecasting of demand, close This study is partly supported by office of Vice president for
check on budgetary control, minimum safety stock, frequent Research and Technology transfer of Addis Ababa
stock taking and judicious purchasing, stocking, issue and University. The authors thank the pharmacy staffs of TASH:
inspection policy. Category B drugs require moderate Mr Birhanu Abera and Tiya Bacha for their cooperation in
control by middle level managers whereas category C the data collection process. We also would like to extend our
requires minimum control measures for order and purchase gratitude to Mr Ayalew Adinew and Mr Dejenu Sahilea
(from MSH SIAPS) for their help in statistical analysis.

Table 1: Pharmaceuticals ABC analysis result of Tikur Anbessa Specialized Hospital (2009-2013)

Year Quantity Class % of total budget % of total

consumed or ADE Items
2009 24 A 81.20 9.60
51 B 13.30 20.40
175 C 5.50 70.00
2010 42 A 79.00 14.89
59 B 15.20 21.00
181 C 5.70 64.20
2011 51 A 75.00 17.06
47 B 15.00 15.77
201 C 10.00 67.23
2012 57 A 79.23 19.45
60 B 9.80 20.48
176 C 5.50 60.00
2013 32 A 76.15 12.17

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47 B 15.63 17.87
184 C 8.26 69.96

ADE = Annual Drug Expenditure

Table 2 :AC-VEN matrix analysis of pharmaceuticals at Tikur Anbesa Specialized Hospital (2009-2013)
ABC

A B C Total
VEN ADE %ADE Qun ADE %AD Qun ADE %ADE Qun ADE %Qun Qun
E
V 10084722.7 75.66 18 1547085.8 11.61 43 434640.3 3.26 107 12066448.85 67.2 168
E 415452.9 3.12 3 276967.18 2.08 7 130379.4 0.98 45 822799.48 22.0 55
N/D 0 0.00 0 0 0.00 0 2149.15 0.02 1 2149.15 0.4 1
NA 328379.4 2.46 3 28800 0.22 1 80920.47 0.61 22 438099.87 10.4 26
2009

Total 10828555 81.24 24 1852853 13.90 51 648089.32 4.86 175 13329497.35 89.6 250
V 8854734.69 70.36 36 1331814.2 10.72 44 446108.3 6.91 99 10632657.19 63.5 179
E 420994.36 3.31 5 378156.61 2.49 13 128853.7 2.18 36 928004.67 19.1 54
N/D 0 0.00 0 0 0.00 0 5317 0.04 2 5317 0.7 2
NA 63036 0.97 1 74647 1.18 2 116409.5 1.84 44 254092.5 16.7 47
Total 9338765.05 74.64 67 1784588.0 28.97 54 696689.3 10.97 273 11820042.36 100.0 282
2010

1
V 10936873 64.44 44 2123057 12.51 40 1306804 7.70 137 14366734 73.58 220
E 1706694.18 10.06 6 301510.34 1.78 5 294067.7 1.73 51 2302272.22 20.74 62
N/D 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0
NA 112963.5 0.67 1 106640 0.63 2 83607.6 0.49 14 303211.1 5.69 17
Total 12756530.7 75.16 51 2531207.3 14.91 47 1684479.3 9.92 202 16972217.32 100.0 299
2011

0
V 15288678 72.93 44 1384079 6.60 37 776457 3.70 95 17449214 60.07 176
E 751606.7 3.59 5 266695.8 1.27 8 164953.4 0.79 30 1183255.9 14.68 43
N/D 0 0.00 0 0 0.00 0 0.00 0 0 0.00 0
NA 1502404 7.17 9 532908 2.54 15 295322.8 1.41 50 2330634.8 25.26 74
Total 17542688.7 83.68 58 2183682.8 10.42 60 1236733.2 5.90 175 20963104.7 100.0 293
2012

0
V 16719063 68.95 28 2954400 12.18 35 1471120 6.07 120 21144583 69.58 183
E 662965.74 2.73 3 703983.63 2.90 10 356060.4 1.47 39 1723009.77 19.77 52
N/D 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0
NA 1084300 4.47 1 120840 0.50 2 176175.4 0.73 25 1381315.4 10.65 28
2013

Total 18466328.7 76.15 32 3779223.6 15.59 47 2003355.8 8.26 184 24248908.17 100.0 263

ADE=Annual Drug Expenditure in Ethiopian birr, % refers to percentage of ADE, Qun = quantity of item per year ,
%Qun = percentage of items , NA = items that were not available in VEN classification

740
740
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Figure 1:Tikur Anbessa specialized hospital pharmaceuticals ABC cumulative curve (2009-2013)

ADE = Annual Drug Expenditure in Ethiopian Birr

VEN catagory of Pharmaceuticals

100% 0.44 0.85 0 0 0

90% 22.98 21.71 20.00 22.03

24.44
80%
N
, 70%
E
,
V 60%
f
o N- non essential
eg 50%
at E- Essential
ne 40% 75.11 76.17 78.29 80.00 77.97
cr V- Vital
e 30%
P
20%
10%
0%
2009 2010 2011 2012 2013

Year

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