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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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Li Y, Zhang M, Xu Y, Li X, Lu T. Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China. Int J Clin Pharm 2024; 46:694-703. [PMID: 38472597 DOI: 10.1007/s11096-024-01706-0] [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: 12/04/2023] [Accepted: 01/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent. AIM To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement. METHOD An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province. RESULTS Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging. CONCLUSION Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.
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Affiliation(s)
- Yue Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China
| | - Mengdie Zhang
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi Xu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, People's Republic of China
| | - Xin Li
- Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Tao Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People's Republic of China.
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Fatani M, Shamayleh A, Alshraideh H. Assessing the Disruption Impact on Healthcare Delivery. J Prim Care Community Health 2024; 15:21501319241260351. [PMID: 38907592 PMCID: PMC11193933 DOI: 10.1177/21501319241260351] [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: 03/23/2023] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024] Open
Abstract
Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.
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Affiliation(s)
- Maymunah Fatani
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
| | - Abdulrahim Shamayleh
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
| | - Hussam Alshraideh
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
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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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Stocker KJ, Tiemann A, Brunk KM, Agegnehu B, Buhlinger K, Amerine L, Roberts MC, McLaughlin JE, Clark SM, Rose R, Mekonnen B, Bhakta N, Fentie AM, Alexander TB, Ozawa S, Chargualaf M, Muluneh B. Processes and perceptions of chemotherapy supply chain in Ethiopia: A mixed-method study. J Oncol Pharm Pract 2023; 29:1555-1564. [PMID: 36303425 DOI: 10.1177/10781552221134254] [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] [Indexed: 10/28/2023]
Abstract
BACKGROUND The impact and downstream effects of the chemotherapy supply chain in Ethiopia are not well understood. The purpose of this study was to identify perceived gaps in supply chain and characterize their impact on patient care. METHODS A concurrent mixed-method study was conducted at a large academic cancer center in Ethiopia. In-depth interviews (IDIs) and surveys were completed in collaboration with external stakeholders with knowledge about chemotherapy supply chain in Ethiopia. Thematic coding was used for qualitative analysis of IDI and descriptive statistics were used to summarize quantitative survey data. RESULTS Six stakeholders participated in the IDIs and seven completed surveys. IDIs revealed that most chemotherapeutic agents are purchased by the Ethiopian Pharmaceutical Supply Agency (EPSA) and are distributed to cancer treatment centers. A free-market purchasing option also exists, but for chemotherapy obtained outside of government-subsidized channels, the potential for substandard or falsified chemotherapy was a concern. Participants expressed confidence that the correct treatment was administered to patients, but viewpoints on reliability and consistency of medication supply were variable. Quantitative data from the survey showed that participants were not confident that medications are prepared safely and correctly. Improper storage and manipulation of high-risk medications remain a significant risk to staff. CONCLUSIONS This study provides insight from a healthcare staff perspective on how gaps in the chemotherapy supply chain process impact patient care in a low-income country. Inventory management, disruptions in supply chain, and product integrity were perceived as the largest gaps in the current chemotherapy supply chain structure.
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Affiliation(s)
- Kurtis J Stocker
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Andrew Tiemann
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Kelly M Brunk
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Bemnat Agegnehu
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Kaitlyn Buhlinger
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Lindsey Amerine
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Megan C Roberts
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Stephen M Clark
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Robert Rose
- Department of pharmacy, University of Kentucky HealthCare, Lexington, KY, USA
| | | | | | - Atalay Mulu Fentie
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Tikur Anbesa Specialized Hospital, Oncology Unit, Addis Ababa, Ethiopia
| | - Thomas B Alexander
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Michael Chargualaf
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Benyam Muluneh
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Soares AQ, Melo MA, Silva PID, Chagas VO, Provin MP, Silva MMD, Vila VDSC, Amaral RG. "A lack of information keeps us from medicine, well-being, harmony…": a mixed method study with plaintiffs requesting medicines in administrative cases. CIENCIA & SAUDE COLETIVA 2022; 27:1205-1221. [PMID: 35293456 DOI: 10.1590/1413-81232022273.04122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
The need to request public health managers to ensure the right of access to medicines characterizes an administrative case and the method to do so is called the administrative route. This mixed method study aimed to analyze the perceptions of plaintiffs requesting medications by the administrative route about barriers to access medicines in the Brazilian public health sector. Data were gathered through focus groups and questionnaires. The results point to the interdependence of pharmaceutical services with the interfacing areas to ensure access. The barriers related to individuals reflect the commitment to develop citizenship, justifying the cost of the medicine to motivate the demand. Barriers to service provision include irregular availability of medicines, insufficient resources, and unsatisfactory quality of services. The difficulty in obtaining medical consultations and prescriptions originating in the public sector are barriers to the health sector. The barriers above the health sector are compliance with administrative procedures, corruption, and clientelism. The administrative route intensifies inequities in access to healthcare in Brazil.
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Affiliation(s)
- Amanda Queiroz Soares
- Hospital das Clínicas, Universidade Federal de Goiás. Setor de Farmácia Hospitalar, 1ª Avenida s/n, Setor Leste Universitário, 74605-020. Goiânia GO Brasil.
| | | | - Pedro Ivo da Silva
- Hospital Municipal de Aparecida, Secretaria Municipal de Aparecida de Goiânia. Aparecida de Goiânia GO Brasil
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Rizk HI, Elkholy MM, Barakat AA, Elsayed RMM, Abd El Fatah SAM. Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level. J Egypt Public Health Assoc 2021; 96:1. [PMID: 33439381 PMCID: PMC7806678 DOI: 10.1186/s42506-020-00062-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.
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Affiliation(s)
- Hoda Ibrahim Rizk
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, 12 Manial Street, Cairo, Egypt
| | - Monira Mahmoud Elkholy
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, 12 Manial Street, Cairo, Egypt
| | - Abeer Abdou Barakat
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, 12 Manial Street, Cairo, Egypt
| | | | - Shaimaa A M Abd El Fatah
- Public Health and Community Medicine, Faculty of Medicine, Cairo University, 12 Manial Street, Cairo, Egypt.
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Zaprutko T, Kopciuch D, Bronisz M, Michalak M, Kus K, Nowakowska E. Drug shortages as a result of parallel export in Poland - Pharmacists' opinions. Health Policy 2020; 124:563-567. [PMID: 32199618 DOI: 10.1016/j.healthpol.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Drug shortages are recognized as a global problem. However, studies concerning drug shortages in Europe are scarce. Therefore, the main aim of the study was to conduct an analysis concerning drug shortages in Polish pharmacies and to collect pharmacists' opinions about parallel trade and 'reverse traffic' of medicines. METHODS The study was conducted between October 2015 and July 2016 using a specially designed anonymous questionnaire consisting of 10 questions. The tool was delivered to pharmacists. From over 1800 distributed sheets, 435 were included. RESULTS According to Polish pharmacists' opinions, shortages are most frequently associated with anticoagulants and antidiabetics and are an increasing problem in Poland. In respondents' opinion, fines for 'reverse traffic' should be high and restrictive and manufacturers should be obliged to build stocks for a certain period. CONCLUSIONS Drug shortages concern several groups of medicines, often without generics. Solutions incorporated in Poland and aimed to reduce shortages seem to be ineffective. Reduction of drug shortages should be a priority of all stakeholders, because it is not only a Polish problem, but it is a common European issue.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland.
| | - Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Maria Bronisz
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60806 Poznań, Poland
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