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Czerniak LL, Lavieri MS, Daskin MS, Byon E, Renius K, Sweet BV, Leja J, Tupps MA. The benefits (or detriments) of adapting to demand disruptions in a hospital pharmacy with supply chain disruptions. Health Care Manag Sci 2024:10.1007/s10729-024-09686-3. [PMID: 39316321 DOI: 10.1007/s10729-024-09686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 08/14/2024] [Indexed: 09/25/2024]
Abstract
Supply chain disruptions and demand disruptions make it challenging for hospital pharmacy managers to determine how much inventory to have on-hand. Having insufficient inventory leads to drug shortages, while having excess inventory leads to drug waste. To mitigate drug shortages and waste, hospital pharmacy managers can implement inventory policies that account for supply chain disruptions and adapt these inventory policies over time to respond to demand disruptions. Demand disruptions were prevalent during the Covid-19 pandemic. However, it remains unclear how a drug's shortage-waste weighting (i.e., concern for shortages versus concern for waste) as well as the duration of and time between supply chain disruptions influence the benefits (or detriments) of adapting to demand disruptions. We develop an adaptive inventory system (i.e., inventory policies change over time) and conduct an extensive numerical analysis using real-world demand data from the University of Michigan's Central Pharmacy to address this research question. For a fixed mean duration of and mean time between supply chain disruptions, we find a drug's shortage-waste weighting dictates the magnitude of the benefits (or detriments) of adaptive inventory policies. We create a ranking procedure that provides a way of discerning which drugs are of most concern and illustrates which policies to update given that a limited number of inventory policies can be updated. When applying our framework to over 300 drugs, we find a decision-maker needs to update a very small proportion of drugs (e.g., < 5 % ) at any point in time to get the greatest benefits of adaptive inventory policies.
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Affiliation(s)
- Lauren L Czerniak
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA.
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA
| | - Mark S Daskin
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA
| | - Eunshin Byon
- Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave, Ann Arbor, MI, 48109, USA
| | - Karl Renius
- Michigan Medicine; Department of Pharmacy Services, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Burgunda V Sweet
- College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, USA
| | - Jennifer Leja
- Michigan Medicine; Department of Pharmacy Services, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Matthew A Tupps
- Michigan Medicine; Department of Pharmacy Services, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Wai MC. Drug Shortage and Ethical Issues: Integrating Multidisciplinary Perspectives with a Shared Ethical Framework. PHARMACY 2024; 12:136. [PMID: 39311127 PMCID: PMC11417769 DOI: 10.3390/pharmacy12050136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024] Open
Abstract
Drug shortages can cause ethical dilemmas when no systematic, equitable allocation, or utilization schema is in place. During the COVID-19 pandemic, an ethical framework outlining moral values was proposed as way to approach allocating limited resources to patients. In addition to an ethical perspective, it is prudent to consider costs. Examining existing economic frameworks and combining them with an ethical perspective may provide a practical, systematic process for decision makers when allocating drugs in short supply. Drug shortages continue to impact multiple areas across different subspecialties of medicine due to multiple factors, including limited manufacturers, regulatory issues, and costs. All of these factors make it difficult to anticipate and manage drug shortages effectively, but developing a combined framework may reduce some of the ethical and equitable ambiguity with regards to patient care.
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Affiliation(s)
- Maya C Wai
- College of Pharmacy, Department of Pharmacy Practice, Northwest Regional Campus, University of Arkansas for Medical Sciences, 1125 N. College Ave., Fayetteville, AR 72703, USA
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3
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Gentile T, Snee I, Heinrichs D, Hockstein MA, Mazer-Amirshahi M, Fox ER. The empty code cart: Drug shortages over time. Am J Health Syst Pharm 2024; 81:e543-e547. [PMID: 38800925 DOI: 10.1093/ajhp/zxae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE In high-acuity situations such as cardiac arrest, clinicians rely on prepared medications stocked in code carts to provide timely and accurate pharmacotherapy. We examined shortage trends for medications commonly used in code carts. METHODS Drug shortage data from 2001 to 2022 were retrieved from the University of Utah Drug Information Service (UUDIS) to characterize shortages reported for commonly used code cart medications. Data extracted included the number of shortages, shortage duration, drug characteristics, and reason for the shortage. RESULTS From 2001 to 2022, 71 drug shortages for code cart medications were reported. The number of new shortages peaked in 2010, and the number of total shortages peaked in 2010. At the end of the study period, 61 (84.7%) shortages had been resolved. For resolved shortages, the mean shortage duration was 18.2 months. The drug with the greatest number of reported shortages was dextrose (10 total), the drug with the longest resolved shortage was calcium chloride injection (116 months), and the drug with the longest active shortage was atropine injection (165 months at the end of the study period). Throughout the entire study period, only 2 suppliers provided commercially available prefilled syringes of dextrose for stocking on code carts. The most common reason for shortages, when reported, was manufacturing delays. CONCLUSION Medications commonly used in code carts were frequently impacted by drug shortages, which have the potential to impact patient care. Institutional protocols for mitigation and larger efforts to promote a more resilient drug supply chain are critical to ensure patient safety and quality care.
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Affiliation(s)
- Tyler Gentile
- Georgetown University School of Medicine, Washington, DC, USA
| | - Isabel Snee
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Max A Hockstein
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Maryann Mazer-Amirshahi
- Georgetown University School of Medicine, Washington, DC
- National Capital Poison Center, Washington, DC, USA
| | - Erin R Fox
- Shared Services, University of Utah Health, Salt Lake City, UT, USA
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Majumdar JR, Grbic J, Carlsson S, Barreiro D, Marte M, Laudone V, Assel MJ, Masson G. Impact of Replacing Fentanyl With Hydromorphone as the First-Line Postoperative Opioid Among Patients Undergoing Outpatient Cancer Surgery. J Perianesth Nurs 2024; 39:638-644.e1. [PMID: 38493405 PMCID: PMC11297671 DOI: 10.1016/j.jopan.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE In response to a nationwide fentanyl shortage, our institution assessed whether changing our first-line postoperative intravenous opioid from fentanyl to hydromorphone impacted patient outcomes. The primary research aim was to evaluate the association between first-line opioid and rapidity of recovery. DESIGN The study team retrospectively obtained data on all consecutive patients extracted from the electronic medical record. The rapidity of recovery was defined as the time from entry into the postanesthesia care unit to the transition to Phase 2 for ambulatory extended recovery patients and as the length of total postanesthesia care unit stay for outpatients. METHODS Following intent-to-treat-principles, we tested the association between study period and rapidity of recovery (a priori clinically meaningful difference: 20 minutes) using multivariable linear regression, adjusting for anesthesia type (general vs monitored anesthesia care), American Society of Anesthesiologst physical status (ASA) score (1-2 vs 3-4), age, service, robotic procedure, and surgery start time. FINDINGS Ambulatory extended recovery patients treated in the hydromorphone period had, on average, a 0.25 minute (95% confidence interval [CI] -6.5, 7.0), nonstatistically significant (P > .9) longer time to transition. For outpatient procedures, those who received hydromorphone had, on average, 8.5-minute longer stays (95% CI 3.7-13, P < .001). Although we saw statistical evidence of an increased risk of resurgery associated with receiving hydromorphone (0.5%; 95% CI -0.1%, 1.0%; P = .039 on univariate analysis), the size of the estimate is clinically and biologically implausible and is most likely a chance finding related either to multiple testing or confounding. CONCLUSIONS The multidisciplinary team concluded that the increase in postoperative length of stay associated with hydromorphone was not clinically significant and the decrease waste of prefilled syringes outweighed the small potential increased risk of resurgery compared to the shorter-acting fentanyl. We will therefore use hydromorphone moving forward.
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Affiliation(s)
- Jennifer R Majumdar
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY; Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY.
| | - John Grbic
- Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sigrid Carlsson
- Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY; Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Donna Barreiro
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marie Marte
- Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vincent Laudone
- Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa J Assel
- Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Geema Masson
- Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY
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Lan Y, Meng C, Sun L, Huang Z. Coping with drug shortages: A study of government-enterprise option cooperation stockpiling strategies for drugs in shortage considering API surrogate stockpiling subsidies. PLoS One 2024; 19:e0305383. [PMID: 38954737 PMCID: PMC11218969 DOI: 10.1371/journal.pone.0305383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Drug shortage is a global problem, and the development of government-enterprise cooperative stockpiles of drugs in shortage, combining physical and production capacity, has become one of the most important means of coping with drug shortages. However, existing studies have tended to overlook the fact that shortages of Active Pharmaceutical Ingredients (APIs) have become an important constraint on production capacity stockpiling and that the lack of incentives and provisions for coordination of benefits have led to a double marginal effect of joint stockpiling by government and enterprises of drugs in shortage. Accordingly, this study introduced the option contract to the drug supply system composed of government and pharmaceutical enterprises and used the subsidy of API storage in lieu as an important initiative to incentivize the reserve of APIs, to construct a model of shortage drug reserve under the government's leadership. This study aims to improve the effect of government-enterprise joint stockpiling of drugs in shortage, which is of great theoretical and practical significance. According to the classification of production license types of pharmaceutical enterprises, this study established a three-level supply chain decentralized decision-making model consisting of the government, formulation enterprises, and API enterprises, and a two-level supply chain centralized decision-making model consisting of the government and API Formulation (API-F) integrated enterprises, respectively. By solving the inverse order derivation, the government-enterprise option cooperation conditions and optimal decision-making strategy were derived. The study results showed that: (i) The addition of enterprise API stockpiling mode can help the government conventional reserves, and enterprise production capacity reserves, broaden the way of drug reserves, and improve the effect of government-enterprise option cooperation; (ii) when the probability of drug shortages is high, the government should prefer the cooperation of API-F integrated enterprises, which is conducive to reducing intermediate links and government costs and improving the supply responsiveness to shortages of medicines; (iii) Setting appropriate government subsidies for API storage can incentivize enterprises to stockpile APIs and improve drug production capacity and physical supply response capability. This study took the problem of socialized stockpiling of drugs in shortage as an entry point and explored the problems and solution strategies in the government-enterprise cooperative stockpiling of drugs in shortage, which not only made some theoretical contributions to the application of options contract in the government-enterprise cooperative stockpiling of drugs in shortage but also provided new ideas and theoretical basis for the improvement of the stockpiling work of drugs in shortage.
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Affiliation(s)
- Yipeng Lan
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Chenlu Meng
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
- Institute of Drug Regulatory Science, Shenyang Pharmaceutical University, Shenyang, China
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Vann Yaroson E, Quinn G, Breen L. Medicines Shortages Reporting Systems (MSRS): An exploratory review of access and sustainability. Res Social Adm Pharm 2024; 20:72-83. [PMID: 38458895 DOI: 10.1016/j.sapharm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The efficacy of medicines depends on their accessibility and availability. Dedicated medicine shortage reporting systems (MSRS) have been set up in different countries, either mandatory or voluntary, following the recommendations of the World Health Organisation to ensure these. OBJECTIVES To explore how the Medicine Shortages Reporting System (MSRS) can tackle medicine shortages through improved access and sustainability. METHODS Personnel directly involved in the reporting mechanisms for medicine shortages in eight (8) countries participated in semi-structured interviews. An interview protocol based on the Dynamic Capabilities View and Organisational Information Processing Theory (OIPT) was developed. It contained questions related to participant's views on the process involved in MSRS and how it was used to tackle shortages. Data were thematically analysed. RESULTS Three core elements were identified to influence MSRS's ability to tackle shortages and ensure sustainability; (1) the ability to identify what information requirements the reporting system needs, (2) identify information processing capabilities, and (3) the ability to match requirements and information processing capabilities through a dynamic capability decision-making process. The dynamic decision-making process involves reiteratively sensing shortages by understanding and validating information received. CONCLUSION Building MSRS to tackle shortages for accessibility and sustainability is a systemic process that entails understanding the various elements and processes of MSRS. It includes defining medicine shortages, reconfiguring resources, defining accessibility and ensuring the system's sustainability. Our study provides insights into MSRS developed for mitigating medicine shortages and provides a framework for a sustainable MSRS. The findings extend the literature on medicine shortage management by identifying the various elements required to set up an MSRS. It also provides practical implications for countries that seek to establish MSRS to mitigate medicine shortages. Further studies could extend the number of participating countries to provide a clearer picture of the MSRS and how it can reduce medicine shortages.
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Affiliation(s)
- Emilia Vann Yaroson
- University of Huddersfield Business School, Charles Sykes Building, Queensgate, HD1 3DH, UK.
| | - Gemma Quinn
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
| | - Liz Breen
- University of Bradford School of Pharmacy and Medical Sciences, Richmond Building, Richmond Road, Bradford, BD7 1DP, UK.
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Wäneskog M, Rasmussen TB, Jensen ED. A strategy for successful dual-species protein expression of genes with non-optimal codon usage destined for bacterial and yeast cell factories. Biotechnol Prog 2024:e3482. [PMID: 38757558 DOI: 10.1002/btpr.3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Recombinant protein expression on an industrial scale traditionally utilizes one of two microbial workhorses: Escherichia coli or Saccharomyces cerevisiae. Additionally, random protein engineering of enzymes and proteins aimed for expression in S. cerevisiae are often mutagenized and pre-screened in E. coli before expression in yeast. This introduces artificial bottlenecks as the bacterial expression vector needs to be substituted for a yeast expression vector via sub-cloning, and the new library re-evaluated before a final screening in yeast. Here, we put forward a protein expression and engineering strategy that involves the use of a dual-host shuttle vector (pYB-Dual) designed with both a strong inducible yeast promoter (pGAL1), and a strong inducible bacterial promoter (pT7-RNAP), which allows for inducible protein expression in both species. Additionally, we demonstrate that by transforming the pYB-Dual vector into the E. coli strain Rosetta 2, which has elevated levels of 7 rare tRNAs, we can achieve high-level protein expression in both yeast and bacteria, even when using a mNeonGreen gene codon optimized for yeast. This dual expression vector is expected to remove bottlenecks during protein engineering of commercially important enzymes destined for high-titer expression in yeast.
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Affiliation(s)
- Marcus Wäneskog
- Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Trine Bertram Rasmussen
- Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Emil D Jensen
- Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
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Vogler S. Tackling medicine shortages during and after the COVID-19 pandemic: Compilation of governmental policy measures and developments in 38 countries. Health Policy 2024; 143:105030. [PMID: 38484475 DOI: 10.1016/j.healthpol.2024.105030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
In response to increasing shortages of medicines, governments have implemented legislative and non-legislative policy measures. This study aimed to map these policies across high-income countries in Europe and beyond as of 2023 and to analyse developments in governmental approaches since the beginning of the pandemic. Information was collated from 38 countries (33 European countries, Australia, Brazil, Canada, Israel and Saudi Arabia) based on a survey conducted with public authorities involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network in 2023. 34 countries requested pharmaceutical companies to notify national registers of upcoming shortages and 20 countries obliged manufacturers and/or wholesalers to stock supply reserves of critically needed medicines. Further common measures included export bans for defined medicines (18 countries), regulatory measures to facilitate import and use of alternative medicines (35 countries) and multi-stakeholder coordination (28 countries). While the legislation of 26 countries allows imposing sanctions, particularly for non-compliance to reporting requirements, fines were rather rarely imposed. Since 2022, at least 18 countries provided financial incentives, usually in the form of price increases of some off-patent medicines. Overall, several policies to address medicine shortages were taken in recent years, in some countries as part of a comprehensive package (e.g., Australia, Germany). Further initiatives to secure medicine supply in a sustainable manner were being prepared or discussed.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian National Public Health Institute), Stubenring 6, 1010 Vienna, Austria; Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.
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9
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Bourneau-Martin D, Grandvuillemin A, Babin M, Mullet C, Said H, Cellier M, Geniaux H, Gautier S, Beurrier M, Veyrac G, Lagarce L, Laroche ML, Briet M. Adverse drug effect in the context of drug shortage: the CIRUPT prospective study from the French pharmacovigilance network. Eur J Hosp Pharm 2024:ejhpharm-2023-004047. [PMID: 38621957 DOI: 10.1136/ejhpharm-2023-004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Drug shortages are of increasing concern to worldwide public health. The consequences of drug shortages for patient safety have been little studied, especially from a pharmacovigilance point of view. In this context, the network of French pharmacovigilance centres conducted the CIRUPT study (Conséquences Iatrogènes des RUPTures de stock/iatrogenic consequences of drug shortages) based on a prospective campaign of adverse effects occurring in the context of drug shortage notifications. METHODS All notifications involving a shortage drug submitted to the French pharmacovigilance centres between 1 January 2020 and 30 June 2021 were collected and registered in the French national pharmacovigilance database with the standardised high level term 'product supply and availability issues' and with predefined keywords in the narrative section. RESULTS 224 cases were included, involving mainly adverse drug reactions (ADRs) (n=131/224, 59%) and medication errors (n=51/224, 23%); 29% of the cases were serious. The most represented classes of shortage drugs were: vaccines (n=78/224, 35%); drugs for acid-related disorders (H2-receptor antagonists) (n=27/224, 12%); antineoplastic agents (n=17/224, 8%); and antiepileptics (n=15/224, 7%). In 82% of cases, the involved shortage drug was the subject of information delivered to health professionals by the National Agency for the Safety of Medicines and Health Products. Drug shortages were associated with an ADR related to replacement drugs in 59% (n=131/224) of the cases, drug inefficacy in 18% (n=41/224), and/or an aggravation of the underlying disease in 11% (n=25/224). CONCLUSIONS From a pharmacovigilance point of view, a large diversity of anatomical therapeutic classes is involved and the risk related to drug shortages is not limited to drugs registered on 'major therapeutic interest or essential drug' lists. Information from health agencies is not sufficient to avoid the risks, and further strategies should be developed.
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Affiliation(s)
- Delphine Bourneau-Martin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Aurelie Grandvuillemin
- Centre Regional de Pharmacovigilance, University Hospital Centre Dijon Bourgogne, Dijon, Bourgogne-Franche-Comté, France
| | - Marina Babin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Charlotte Mullet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Hillary Said
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Morgane Cellier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Helene Geniaux
- Centre Regional de Pharmacovigilance, University Hospital Centre of Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Sophie Gautier
- Centre Régional de Pharmacovigilance, Lille University Hospital, Lille, Hauts-de-France, France
| | - Mathilde Beurrier
- Centre Régional de Pharmacovigilance, Nancy University Hospital Center, Nancy, Grand Est, France
| | - Gwenaelle Veyrac
- Centre Regional de Pharmacovigilance, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Marie-Laure Laroche
- Centre Régional de Pharmacovigilance, University Hospital Centre of Limoges, Limoges, Nouvelle-Aquitaine, France
| | - Marie Briet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital Centre Angers, Angers, Pays de la Loire, France
- UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, SFR ICAT, University of Angers, Angers, Pays de la Loire, France
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Fırat O, Çakan M, Demirkan K, Dericioğlu N. Seizure control and complications in patients switching from clobazam to clonazepam due to drug shortage. Epilepsy Behav 2024; 153:109690. [PMID: 38382407 DOI: 10.1016/j.yebeh.2024.109690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Antiseizure medication (ASM) shortages are a global problem that have a negative impact on outcomes such as seizure control in patients with epilepsy (PWE). In the case of clobazam (CLB) shortage, there is no study regarding the management strategy. This study aims to investigate the alteration in seizure frequency and the occurrence of side effects in PWE undergoing an abrupt switch from clobazam (CLB) to clonazepam (CLZ), during CLB shortage. MATERIAL AND METHODS A retrospective study was conducted from electronic health records at our neurology outpatient clinic from January to July 2022. Change in seizure frequency and percentage of CLZ-associated side effects were determined as primary and secondary outcomes, respectively. Potential drug-drug interactions (Level C and above) were evaluated by using Lexicomp Drug Interaction Checker. RESULTS The analysis included a total of 29 adult patients (15F, median age: 29). The switching ratio was 10 mg CLB for every 1 mg CLZ (10:1). Seizure frequency was higher during the CLZ period compared to the CLB period (p < 0.05), but no status epilepticus cases were observed. All patients exhibited potential drug-drug interactions, leading to reduced CLZ levels in 12 cases. A total of 36 CLZ-associated side effects were identified, with fatigue (19.4 %), drowsiness (16.6 %), and somnolence (13.8 %) being the most prevalent. A positive and strong correlation was found between CLZ dose and the number of side effects (r: 0.556; p: 0.002). CONCLUSION The abrupt switch from CLB to CLZ was observed to increase seizure frequency without leading to status epilepticus in PWE. CLZ-associated side effects were found to be tolerable despite the abrupt switch. Future studies may explore the effect of alternative switching ratios.
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Affiliation(s)
- Oğuzhan Fırat
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey.
| | - Melike Çakan
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey
| | - Neşe Dericioğlu
- Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
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Amico A, Verginer L, Casiraghi G, Vaccario G, Schweitzer F. Adapting to disruptions: Managing supply chain resilience through product rerouting. SCIENCE ADVANCES 2024; 10:eadj1194. [PMID: 38232157 DOI: 10.1126/sciadv.adj1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024]
Abstract
Supply chain disruptions may cause shortages of essential goods, affecting millions of individuals. We propose a perspective to address this problem via reroute flexibility. This is the ability to substitute and reroute products along existing pathways, hence without requiring the creation of new connections. To showcase the potential of this approach, we examine the US opioid distribution system. We reconstruct over 40 billion distribution routes and quantify the effectiveness of reroute flexibility in mitigating shortages. We demonstrate that flexibility (i) reduces the severity of shortages and (ii) delays the time until they become critical. Moreover, our findings reveal that while increased flexibility alleviates shortages, it comes at the cost of increased complexity: We demonstrate that reroute flexibility increases alternative path usage and slows down the distribution system. Our method enhances decision-makers' ability to manage the resilience of supply chains.
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Affiliation(s)
- Ambra Amico
- Chair of Systems Design, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland
| | - Luca Verginer
- Chair of Systems Design, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland
| | - Giona Casiraghi
- Chair of Systems Design, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland
| | - Giacomo Vaccario
- Chair of Systems Design, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland
| | - Frank Schweitzer
- Chair of Systems Design, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland
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12
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Santhireswaran A, Chu C, Kim KC, Gaudette É, Burry L, Clement F, Suda K, Tadrous M. Early observations of Tier-3 drug shortages on purchasing trends across Canada: A cross-sectional analysis of 3 case-example drugs. PLoS One 2023; 18:e0293497. [PMID: 38127996 PMCID: PMC10734939 DOI: 10.1371/journal.pone.0293497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND To curb the growing impact of drug shortages, Health Canada developed the Tiered Notification and Communication Framework which assigns potential shortages a corresponding tiered status. Tier-3 is assigned to shortages with the greatest potential impact on the healthcare system. This study aims to describe drug purchasing trends in response to Tier-3 shortages using three case-examples. METHODS We conducted a time-series analysis of monthly purchasing data for three out of 17 Tier-3 drug shortages (hydralazine, sarilumab, and medroxyprogesterone acetate) with publicly available reports in July 2021 and available IQVIA MIDAS data from January 2016 to December 2021. We assessed percent changes in purchasing at 1-, 3-, and 6-months after the onset of each Tier-3 drug shortage and interventional ARIMA modelling was used to assess the statistical significance. RESULTS Medroxyprogesterone acetate experienced a significant shift (p = 0.0370) in purchasing following its shortage, and the 1-, 3-, and 6-month percent changes were +14.9%, +6.8% and -3.1%, respectively. Hydralazine and sarilumab did not show a significant shift. The 1-, 3-, and 6-month percent changes for hydralazine were +15.5%, +10.2%, and +9.6% respectively and +25.2%, +45.1% and +39.2 for sarilumab. CONCLUSIONS These results indicate that drugs assigned a Tier-3 status may not show declines in purchasing in the months following status assignment, which may be due to policy responses following the assignment. However, more insight is needed into the mechanisms through which these policy measures impact shortages and whether they are functioning as intended.
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Affiliation(s)
| | - Cherry Chu
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Katherine Callaway Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Division of General Internal Medicine, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA, United States of America
| | - Étienne Gaudette
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Katie Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Division of General Internal Medicine, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA, United States of America
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Women’s College Hospital, Toronto, Ontario, Canada
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13
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Wong WP, Saw PS, Jomthanachai S, Wang LS, Ong HF, Lim CP. Digitalization enhancement in the pharmaceutical supply network using a supply chain risk management approach. Sci Rep 2023; 13:22287. [PMID: 38097696 PMCID: PMC10721629 DOI: 10.1038/s41598-023-49606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
One major issue in pharmaceutical supply chain management is the supply shortage, and determining the root causes of medicine shortages necessitates an in-depth investigation. The concept of risk management is proposed in this study to identify significant risk factors in the pharmaceutical supply chain. Fuzzy failure mode and effect analysis and data envelopment analysis were used to evaluate the risks of the pharmaceutical supply chain. Based on a case study on the Malaysian pharmaceutical supply chain, it reveals that the pharmacy node is the riskiest link. The unavailability of medicine due to unexpected demand, as well as the scarcity of specialty or substitute drugs, pose the most significant risk factors. These risks could be mitigated by digital technology. We propose an appropriate digital technology platform consisting of big data analytics and blockchain technologies to undertake these challenges of supply shortage. By addressing risk factors through the implementation of a digitalized supply chain, organizations can fortify their supply networks, fostering resilience and efficiency, and thereby playing a pivotal role in advancing the Pharma 4.0 era.
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Affiliation(s)
- Wai Peng Wong
- School of Information Technology, Monash University Malaysia, 47500, Selangor, Malaysia.
| | - Pui San Saw
- School of Pharmacy, Monash University Malaysia, 47500, Selangor, Malaysia
| | - Suriyan Jomthanachai
- Faculty of Management Sciences, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Leong Seng Wang
- School of Pharmacy, Monash University Malaysia, 47500, Selangor, Malaysia
| | - Huey Fang Ong
- School of Information Technology, Monash University Malaysia, 47500, Selangor, Malaysia
| | - Chee Peng Lim
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Australia
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14
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Yu SR, Lee JH. Price increase negotiations to address drug shortages in South Korea's national health insurance. Front Pharmacol 2023; 14:1307462. [PMID: 38111380 PMCID: PMC10725904 DOI: 10.3389/fphar.2023.1307462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
South Korea has adopted a unique approach to address drug shortages by increasing reimbursement prices within its National Health Insurance Service. This study aims to analyze the characteristics, increase rates, affecting factors, and budget impacts of products that have increased price through the negotiation system. Between 2007 and 2022, there were price increase negotiations over 244 items. Of these, price increase negotiations were successful for 217 items, resulting in an agreement rate of 89%. The average rate of price increase for the agreed-upon products was 37.8%, and the overall budget increase for drugs with price increases (n = 217) was approximately 24.5%. Budget impact of each variable of the negotiated agreements showed that the number of negotiated agreement items was smaller after 2015 than before 2015, but each total budget impact (initial budget, increased budget, and final budget) and the average budget impact were higher. Although domestic companies accounted for a larger overall budget, the average budget per item was larger for multinational companies. The correlation analysis of the ratio of price increase and budget impact variables showed that the ratio of price increase was positively and significantly correlated with the increased budget, while it was negatively but not significantly correlated with the initial and final budgets. The South Korean model of increasing reimbursement prices in public insurance for drugs at risk of shortages serves as an exemplary case for not only securing patient access but also considering budget management.
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Affiliation(s)
- Seung Rae Yu
- College of Pharmacy, Dong-Duk Women’s University, Seoul, Republic of Korea
| | - Jong Hyuk Lee
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
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15
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Liebman E, Lawler EC, Dunn A, Ridley DB. Consequences of a shortage and rationing: Evidence from a pediatric vaccine. JOURNAL OF HEALTH ECONOMICS 2023; 92:102819. [PMID: 37857116 DOI: 10.1016/j.jhealeco.2023.102819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
Shortages and rationing are common in health care, yet we know little about the consequences. We examine an 18-month shortage of the pediatric Haemophilus Influenzae Type B (Hib) vaccine. Using insurance claims data and variation in shortage exposure across birth cohorts, we find that the shortage reduced uptake of high-value primary doses by 4 percentage points and low-value booster doses by 26 percentage points. This suggests providers largely complied with rationing recommendations. In the long-run, catch-up vaccination occurred but was incomplete: shortage-exposed cohorts were 4 percentage points less likely to have received the ir booster dose years later. We also find that the shortage and rationing caused provider switches, extra provider visits, and negative spillovers to other care.
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Affiliation(s)
- Eli Liebman
- University of Georgia, 620 South Lumpkin Street, Athens, GA 30602, United States.
| | - Emily C Lawler
- University of Georgia and National Bureau of Economic Research, 355 South Jackson Street, Athens, GA 30602, United States.
| | - Abe Dunn
- Bureau of Economic Analysis, 1441 L Street NW, Washington, DC 20230, United States.
| | - David B Ridley
- Duke University, Fuqua School of Business, Durham, NC 27708, United States.
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16
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Poulsen JH, Jensen SR, Clemmensen MH, Holck MV, Uldal N, Kart T, Nielsen GS, Armandi H, Hansen OLM. Evaluation of the establishment of a national task force - A systematic measure to manage critical drug shortages in hospitals. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100322. [PMID: 37694165 PMCID: PMC10485142 DOI: 10.1016/j.rcsop.2023.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Drug shortages (DSs) have become a well-known challenge in health care, and serious patient safety consequences, such as medication errors and adverse patient outcomes are reported. To meet these challenges, a national task force was established to manage and minimize the impact of critical DSs' on hospitals in Denmark. Objective To evaluate the establishment of the National Task Force for Critical Drug Shortages (NTF) in terms of quality, patient safety, and resources from different actor perspectives related to critical DS management in Danish hospitals. Methods Five online focus group interviews were held with participants representing different actor perspectives, all of whom were involved in managing DSs. They represent actors from 1) the NTF; 2) hospital pharmacists not involved in the NTF but who manage DSs locally and/or regionally; 3) the procurement departments of hospital pharmacies; 4) pharmacy technicians performing clinical pharmacy services at a patient level, and 5) the procurement and supply unit at Amgros. Results The thematic analysis revealed four major themes: 1) centralized management of critical DSs is predominantly considered to be positive, 2) collaboration and professional discussion across actors and actor levels, 3) mixed attitudes toward the current communication platforms and format, and 4) short supply of time. Conclusion The NTF ensures a consistent and qualified management of critical DSs. The NTF ensures the evaluation of different patient safety aspects related to identification of a suitable alternative. Challenges with the communication platform and transparency of the process from the NTF toward hospital pharmacy were mentioned but overall, the NTF contributes to a successful use of resources in health care.
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Affiliation(s)
- Joo Hanne Poulsen
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
| | - Stine Raaby Jensen
- The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, S, Denmark
| | - Marianne Hald Clemmensen
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
| | | | | | | | | | - Helle Armandi
- Medicines Information Center, The Hospital Pharmacy, Capital Region of Denmark, Copenhagen, NV, Denmark
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Alowairdhi MA, Alhussain FH, Alomran MI, Almadani OA, Alkhammash NA, Alyabes SF, Alharbi SA, Almudaiheem EA, Alhaider RA, Alhassan SA, Almuallem ZA, Algain N, Alshehri AO, Alshammari TM, Althunian TA. The association between drug pricing and drug shortage in Saudi Arabia: a retrospective database analysis. J Pharm Policy Pract 2023; 16:91. [PMID: 37464406 DOI: 10.1186/s40545-023-00591-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Previous studies have suggested that drug pricing could contribute to drug shortages; however, there is limited quantitative assessment of this potential causal association. This retrospective database analysis aimed to investigate the association between drug prices and drug shortage incidents in Saudi Arabia. METHODS This was a retrospective database analysis study. Drugs with shortage notifications sent to the Saudi Food and Drug Authority (SFDA) between January 2017 and December 2020 were included. Each drug's foreign-to-Saudi price ratio (FTSPR) was calculated by dividing the mean international price by the Saudi price. Drugs were categorized into three groups based on their FTSPR: Group 1 (FTSPR > 1), Group 2 (FTSPR = 1), and Group 3 (FTSPR < 1). The primary outcome was the ratio of mean counts (mCR) between the three groups, with Group 3 serving as the control group. The analysis was adjusted for the measured confounders using a negative binomial regression model. RESULTS A total of 900 drugs were included in the study, with 348 in Group 1, 345 in Group 2, and 209 in Group 3. The mean count in Group 1 was higher compared to Group 3 (mCR: 1.88; 95% confidence interval [CI] 1.24 to 2.83), while the mean counts between Group 2 and Group 3 were comparable (mCR: 1.39; 95% CI 0.92 to 2.09). CONCLUSIONS Our findings indicate an association between drug shortage incidents and higher prices of drugs outside Saudi Arabia. Further studies are needed to explore this causal relationship in different contexts.
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Affiliation(s)
- Mohammad A Alowairdhi
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Fatimah H Alhussain
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Maha I Alomran
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Ohoud A Almadani
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Norah A Alkhammash
- Drug Availability and Tracking Center, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Shayma F Alyabes
- Drug Availability and Tracking Center, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Sultan A Alharbi
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Esraa A Almudaiheem
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Reem A Alhaider
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Sara A Alhassan
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Zainab A Almuallem
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Nuha Algain
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Abdulaziz O Alshehri
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Turki A Althunian
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Postma DJ, Notenboom K, De Smet PAGM, Leufkens HGM, Mantel-Teeuwisse AK. Medicine shortages: impact behind numbers. J Pharm Policy Pract 2023; 16:44. [PMID: 36918981 PMCID: PMC10013985 DOI: 10.1186/s40545-023-00548-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Current research to assess the impact that medicine shortages have on patients is limited to general aspects, such as the prevalence of shortages and product characteristics. The aim of this study is to assess the overall impact that medicine shortages have on economic, clinical, and humanistic outcomes. METHODS A cohort of all known products in shortage in the Netherlands between 2012 and 2015 were characterized by their route of administration, anatomical therapeutic chemical class, and whether they were originator or generic products. A representative sample of 324 shortages (18% of all shortages) was rated as having low, medium, or high impact on the five elements that determine the impact of shortages on patients: availability of an alternative product, underlying disease, susceptibility of the patient, costs (for patients and society at large), and number of patients affected. Ratings were converted into numerical scores per element and multiplied to obtain an overall impact score. RESULTS Two elements were most frequently rated as having a high impact: disease (29%) and costs (20%). Nearly half of the shortages (47%) rated high on at least one element, while nearly 10% rated high on multiple elements. Thirty percent of the shortages rated high on direct impact, which is represented by these elements: alternative product and disease. An additional 17% of the shortages rated high on indirect impact, which is represented by these elements: costs, susceptibility, and number of patients. High impact scores could not significantly be attributed to characteristics of the products in shortage. CONCLUSIONS An assessment of the medicine shortages' impact using a framework based on economic, clinical, and economic outcomes showed that all three outcomes affect the overall impact that medicine shortages have on patients.
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Affiliation(s)
- Doerine J Postma
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.,Royal Dutch Pharmacists Association, The Hague, The Netherlands
| | - Kim Notenboom
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Peter A G M De Smet
- Departments of IQ Health Care and of Clinical Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
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Francas D, Mohr S, Hoberg K. On the drivers of drug shortages: empirical evidence from Germany. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2023. [DOI: 10.1108/ijopm-09-2022-0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PurposeDisruptions and shortages of drugs have become severe problems in recent years, which has triggered strong media and public interest in the topic. However, little is known about the factors that can be associated with the increased frequency of shortages. In this paper, the authors analyze the drivers of drug shortages using empirical data for Germany, the fourth largest pharmaceutical market.Design/methodology/approachThe authors use a dataset provided by the German Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte [BfArM]) with 425 reported shortages for drug substances (DSs) in the 24-month period between May 2017 and April 2019 and enrich the data with information from additional sources. Using logistic and negative binomial regression models, the authors analyze the impact of (1) market characteristics, (2) drug substance characteristics and (3) regulatory characteristics on the likelihood of a shortage.FindingsThe authors find that factors like market concentration, patent situation, manufacturing processes or dosage form are significantly associated with the odds of a shortage. The authors discuss the implications of these findings to reduce the frequency and severity of shortages.Originality/valueThe authors contribute to the empirical research on drug shortages by analyzing the impact of market characteristics, DS characteristics and regulatory characteristics on the reported shortages. The authors’ analysis provides a starting point for better prioritizing efforts to strengthen drug supply as it is currently intensely discussed healthcare authorities.
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Izutsu KI, Abe Y, Kurita M, Yoshida H. [Shortages of Prescription Drugs Due to Compliance and Quality Issues in Japan]. YAKUGAKU ZASSHI 2023; 143:139-152. [PMID: 36418079 DOI: 10.1248/yakushi.22-00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Several good manufacturing practice (GMP) compliance issues and their associated quality problems that have been revealed since 2020 have led to large-scale recalls and supply suspensions of drug products in Japan. This paper provides an overview of the causes and countermeasures for supply disruptions of low-molecular-weight chemical pharmaceutical agents, focusing on quality-related issues. A recent increase in the use of generic drugs emphasized the importance of strengthening active pharmaceutical ingredient (API) supply chains and ensuring GMP compliance among drug manufacturers. In addition, increasing recalls in the drug products of certain marketing authorization holders due to storage stability problems strongly suggests the need to improve their development process considerably. Other measures to stabilize the supply of pharmaceuticals, including increasing stockpiles of APIs, were also discussed.
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Affiliation(s)
| | - Yasuhiro Abe
- Division of Drugs, National Institute of Health Sciences
| | - Mari Kurita
- Division of Drugs, National Institute of Health Sciences
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21
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Part I: Interactive case: Management of urgent drug shortages. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Sabogal De La Pava ML, Tucker EL. Drug shortages in low- and middle-income countries: Colombia as a case study. J Pharm Policy Pract 2022; 15:42. [PMID: 35698240 PMCID: PMC9189796 DOI: 10.1186/s40545-022-00439-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Drug shortages are a global problem. Analyzing shortages worldwide is important to identify possible relationships between drug shortages across countries, determine strategies that reduce drug shortages, and reduce the inequality in access to medicines between countries. In contrast to well-documented shortages in high-income countries, there are few studies that consider low- and middle-income economies. We evaluate drug shortages in one middle-income country, Colombia. Methods We collected data from INVIMA, the institution responsible for managing medicine shortage alerts in Colombia. We classified the data using the Anatomical Therapeutic Chemical (ATC) classification system and analyzed them using descriptive statistics. We considered a study period from 2015 to 2021 (vital medicines) and from 2010 to 2020 (non-vital medicines). Results In total, 173 unique ATC codes were in shortage. These included antidotes, alimentary tract and metabolism products, anesthetics, cardiac stimulants and antithrombotic agents. The major causes were manufacturing problems and few suppliers. Drug shortages substantially increased from 2020 to May 2021 due to the COVID-19 pandemic. Among resolved shortages, the average duration was 1.6 years with a standard deviation of 1.9 years. The longest, naloxone tablets, were in shortage for almost 10 years. Conclusions Drug shortages are a persistent problem in Colombia. Government institutions have made progress in implementing systems and procedures to report them. However, the approaches implemented need to be maintained and refined. This study lays the groundwork for the analysis of drug shortages in other LMICs. We highlight the necessity of addressing drug shortages in their global context and reducing the inequality in access to medicines between countries.
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Affiliation(s)
| | - Emily L Tucker
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA.,School of Health Research, Clemson University, Clemson, SC, USA
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Postoperative Respiratory Events in Surgical Patients Exposed to Opioid Analgesic Shortages Compared to Fully Matched Patients Non-exposed to Shortages. Drug Saf 2022; 45:359-367. [PMID: 35298825 DOI: 10.1007/s40264-022-01171-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Shortages of opioid analgesics critically disrupt clinical practice and are detrimental to patient safety. There is a dearth of studies assessing the safety implications of drug shortages. OBJECTIVE We aimed to assess perioperative opioid analgesic use and related postoperative hypoxemia (oxygen saturation less than 90%) in surgical patients exposed to prescription opioid shortages compared to propensity score-matched patients non-exposed to opioid shortages. METHODS We conducted a retrospective study including adult patients who underwent elective surgery at The University of California San Francisco in the period August 2018-December 2019. We conducted a Gamma log-link generalized linear model to assess the effect of shortages on perioperative use of opioids and a weighted logistic regression to assess the likelihood of experiencing postoperative hypoxemia. RESULTS There were 1119 patients exposed to opioid shortages and 2787 matched non-exposed patients. After full matching, patients exposed to shortages used a greater mean of morphine milligram equivalents/day (146.94; 95% confidence interval 123.96-174.16) than non-exposed patients (117.92; 95% confidence interval 100.48-138.38; p = 0.0001). The estimated effect was a 1.25 (95% confidence interval 1.12-1.40; p = 0.0001) times greater use of opioids in patients exposed to opioid shortages than non-exposed patients. After full matching, a greater proportion of patients exposed to shortages (19.06%) experienced hypoxemia compared with non-exposed patients (16.91%). In addition, a greater proportion of patients exposed to opioid shortages (1.20%) experienced hypoxemia reversed by intravenous naloxone administration compared with non-exposed patients (0.44%). CONCLUSIONS Given the shortage prevalence, reliance on opioid medications, and related risk of respiratory depression, harm prevention measures remain critical to prevent postoperative complications that may compromise patients' safety.
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Community Pharmacy Staff Knowledge, Opinion and Practice toward Drug Shortages in Saudi Arabia. Saudi Pharm J 2022; 29:1383-1391. [PMID: 35002375 PMCID: PMC8720696 DOI: 10.1016/j.jsps.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022] Open
Abstract
Drug shortages continue to pose a significant threat to public health and safety. Drug shortages not only worsen patient outcomes, but also significantly burden healthcare systems with additional costs. This study aimed to assess community pharmacy staff knowledge, opinion, and practice toward drug shortages in Saudi Arabia from November 2019 to March 2020. This was a cross-sectional study carried out among 1,008 community pharmacists from Saudi Arabia using a validated, self-administered and Internet-based survey. Analysis was done using chi square and fisher exact tests. Most participants were males (97.2%), less than 30 years old (48.1%), and non-Saudi citizens (94.4%), and 72.0% had good knowledge of drug shortages (score = 4–5). Around 36.0% reported that it takes 1–3 days to receive a response to the shortage report. There was a statistically significant association between the professional level of the community pharmacists and their opinion about reporting drug shortages (P < .05). Most community pharmacies (56.2%) did not receive any notification about drug shortages. In conclusion, most community pharmacists are knowledgeable and have good practice regarding drug shortages, but their opinions about drug shortages differ according to each pharmacy reporting policy.
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25
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Koizumi R, Kusama Y, Asai Y, Yoshiaki G, Muraki Y, Ohmagari N. Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials. BMC Health Serv Res 2021; 21:1118. [PMID: 34663315 PMCID: PMC8523201 DOI: 10.1186/s12913-021-07139-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/05/2021] [Indexed: 01/01/2023] Open
Abstract
Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07139-z.
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Affiliation(s)
- Ryuji Koizumi
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. .,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
| | - Yusuke Asai
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gu Yoshiaki
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.,Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
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Atif M, Sehar A, Malik I, Mushtaq I, Ahmad N, Babar ZUD. What impact does medicines shortages have on patients? A qualitative study exploring patients' experience and views of healthcare professionals. BMC Health Serv Res 2021; 21:827. [PMID: 34404420 PMCID: PMC8369330 DOI: 10.1186/s12913-021-06812-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background The shortage of medicines represents a complex global phenomenon that triggers patient care and safety issues. The study was undertaken to explore the impact of medicines shortages on patients in Pakistan. The study also identified barriers which hinder the solutions of medicines shortages issue. Methods A qualitative study design was adopted and the data was collected in stages between July and September 2019using an in-depth interview approach. The purposive and convenient sampling strategy was used to recruit the study participants. Sample size was limited by using the saturation point criteria. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 35 stakeholders including 13 physicians, 12 pharmacists and 10 patients participated in the study. The findings of the study were classified into five key themes and seven subthemes. The five themes included, ‘impact of medicine shortages on patients’, ‘patients’ practices in response to medicine shortages’, ‘influence of medicines shortages on medical practice or pharmaceutical business’, ‘barriers to solutions for medicines shortages’, and ‘suggestions to assuage the impact of medicine shortages.’This study showed that the medicine shortages had significant clinical and financial impact on patients. Patients’ opted for a number of risk-prone practices to avoid treatment disruption during shortages. An array of pharmaceutical market, medicines quality and patient related factors refrain physicians to switch from brand name medicine to generics and lead to ineffective management of medicines shortages. Promotion of generic prescription, implementation of punitive policies and proper patient consultation was advised to assuage the impact of medicine shortages on patients. Conclusion The adverse clinical, economic and humanistic impact affirmed in this study demand the introduction of risk-management strategies for medicines shortages in hospital and community settings in accordance with the international standards. Promotion of effective patient counselling by the healthcare professionals to deter risk-prone practices associated with medicines shortages is mandatory. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06812-7.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Azka Sehar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Ammar MA, Tran LJ, McGill B, Ammar AA, Huynh P, Amin N, Guerra M, Rouse GE, Lemieux D, McManus D, Topal JE, Davis MW, Miller L, Yazdi M, Leber MB, Pulk RA. Pharmacists leadership in a medication shortage response: Illustrative examples from a health system response to the COVID-19 crisis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021; 4:1134-1143. [PMID: 34230910 PMCID: PMC8250559 DOI: 10.1002/jac5.1443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
As medication experts, clinical pharmacists play an active and dynamic role in a medication shortage response. Supplementing existing guidelines with an actionable framework of discrete activities to support effective medication shortage responses can expand the scope of pharmacy practice and improve patient care. Dissemination of best practices and illustrative, networked examples from health systems can support the adoption of innovative solutions. In this descriptive report, we document the translation of published shortage mitigation guidelines into system success through broad pharmacist engagement and the adaption and implementation of targeted strategies. The profound, wide‐reaching medication shortages that accompanied the coronavirus disease 2019 (COVID‐19) pandemic are used to highlight coordinated but distinct practices and how they have been combined to expand the influence of the pharmacy enterprise.
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Affiliation(s)
- Mahmoud A Ammar
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Lydia J Tran
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Bryan McGill
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Abdalla A Ammar
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Phu Huynh
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | - Nilesh Amin
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Michael Guerra
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Ginger E Rouse
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Diana Lemieux
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Dayna McManus
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Jeffrey E Topal
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - Matthew W Davis
- Department of Pharmacy Services Yale-New Haven Hospital New Haven Connecticut USA
| | - LeeAnn Miller
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | - Marina Yazdi
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
| | | | - Rebecca A Pulk
- Corporate Pharmacy Services Yale New Haven Health New Haven Connecticut USA
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28
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Hantel A, Peppercorn J, Abel GA. Model solutions for ethical allocation during cancer medicine shortages. Lancet Haematol 2021; 8:e246-e248. [PMID: 33770477 PMCID: PMC10975648 DOI: 10.1016/s2352-3026(21)00055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Andrew Hantel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Inpatient Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Harvard Medical School Center for Bioethics, Boston, MA, USA
| | - Jeff Peppercorn
- Division of Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory A Abel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Harvard Medical School Center for Bioethics, Boston, MA, USA.
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29
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Rodriguez-Monguio R, Naveed M, Seoane-Vazquez E. Predictors of shortages of opioid analgesics in the US: Are the characteristics of the drug company the missing puzzle piece? PLoS One 2021; 16:e0249274. [PMID: 33788898 PMCID: PMC8011730 DOI: 10.1371/journal.pone.0249274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Shortages of opioid analgesics are increasingly common, interfere with patient care and increase healthcare cost. This study characterized the incidence of shortages of opioid analgesics in the period 2015–2019 and evaluated potential predictors to forecast the risk of shortages. Methods This was an observational retrospective study using the US Food and Drug Administration (FDA) drug shortages data. All FDA approved opioids were included in the study. Opioid analgesics were identified using the FDA National Drug Codes (NDC) and classified according to the Drug Enforcement Administration (DEA) schedule. We conducted Least Absolute Shrinkage and Selection Operator logistic regression analysis to assess direction of the association between risk of shortage and potential predictors. We used multivariable penalized logistic regression analysis to model predictors of shortages. We split the dataset into training and validation sets to evaluate the performance of the model. Findings The FDA approved 8,207 unique NDCs for opioid analgesics; 3,017 (36.8%) were in the market as of April 30, 2019 and 91(3.0%) of them were listed as in shortage by the FDA. All NDCs in shortage were schedule II opioids; 86 (94.5%) were injectable and 84 (92.3%) generics. There were 418 companies with at least one opioid NDC listed by the FDA. Three companies accounted for more than 4 in 5 of the schedule II active injectable opioids. For each unit increase in the number of prior instances of shortages of a company, the likelihood of an NDC shortage for that company increased by 3.4%. For each unit increase in number of NDCs marketed by a company, the odds of an NDC shortage for that company decreased by 1%. Conclusions In the period 2015–2019, shortages of opioid analgesics disproportionally impacted schedule II and injectable opioids. The risk of shortage of opioid analgesics significantly increased with the incidence of previous instances of shortages of a manufacturing company and decreased with the number of NDCs marketed by a company. The characteristics of the manufacturing company, rather than the number of companies, might be the missing piece to the complex puzzle of drug shortages in the US.
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Affiliation(s)
- Rosa Rodriguez-Monguio
- Department of Clinical Pharmacy, University of California San Francisco (UCSF), San Francisco, California, United States of America.,Medication Outcomes Center, University of California San Francisco (UCSF), San Francisco, California, United States of America.,Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mahim Naveed
- Medication Outcomes Center, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Enrique Seoane-Vazquez
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California, United States of America.,Economics Science Institute, Argyros School of Business and Economics, Chapman University, Irvine, California, United States of America
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30
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Miller FA, Young SB, Dobrow M, Shojania KG. Vulnerability of the medical product supply chain: the wake-up call of COVID-19. BMJ Qual Saf 2020; 30:331-335. [PMID: 33139342 DOI: 10.1136/bmjqs-2020-012133] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Steven B Young
- School of Environment, Enterprise and Development, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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