However, when we calculated by total number of hospital levels and by each hospital level, the total number of drug items used in 2018 and 2019 was higher than in 2017, leading to a ratio between the number of DD items under Circular 10 and the total number of pharmaceutical items in 2018 and 2019 was lower than in 2017 in all hospitals at different levels and at each hospital level, and this difference was not statistically significant (p>0.05) 19 (Table 3.8).