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Bolcato M, Jommi C. Shortage of plasma-derived medicinal products: what is next? narrative literature review on its causes and counteracting policies in Italy. Front Pharmacol 2024; 15:1375891. [PMID: 38769998 PMCID: PMC11102971 DOI: 10.3389/fphar.2024.1375891] [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: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction: This paper describes the peculiarities of the plasma-derived medicinal product (PDMP) market and illustrates the results of a review of the literature on policies aimed at counteracting the shortage of PDMPs. Characteristics of PDMPs: Plasma is primarily used for the industrial production of blood products (80%). The demand for PDMPs, particularly immunoglobulins (IGs), is increasing. However, the production of PDMPs is complex, long (7-12 months), and expensive, accounting, according to US estimates, for 57% of the total costs of PDMPs compared to 14% for small molecules. PDMP market: Unexpected increases in clinical need cannot be addressed in the short term. Once the demand for some diseases is satisfied, the collection and fractionation of plasma will only be used to supply some specific patients. Hence, the full weight of the marginal costs, which remain constant, are borne by a few products. According to last liter economics, the industry stops producing when the marginal revenue equals the marginal cost, thereby reducing the convenience of producing the most commonly used PDMPs (albumin and IG). The imbalance between the demand and supply of PDMPs was exacerbated by the COVID-19 pandemic, which further increased the cost of plasma collection. Shortage issue and possible solutions: Policies to counteract this imbalance have also been discussed. If the demand is inappropriate, it should be reduced. If the demand is appropriate and supply cannot be increased, the demand should be prioritized for patients for whom PDMPs are the only available treatment. If the shortage depends on insufficient supply and technical and allocative efficiency, both production and supply should be improved, together with incentives for all stakeholders involved in the PDMP market to increase the sustainability of production/supply. The paper is focused on this second issue, that is supply-driven unbalance.
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Affiliation(s)
- Matteo Bolcato
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Harmon M, Riazi K, Callum J, Arnold DM, Barty R, Sidhu D, Heddle NM, MacLeod L, Li N. Immunoglobulin utilization in Canada: a comparative analysis of provincial guidelines and a scoping review of the literature. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:85. [PMID: 37717038 PMCID: PMC10504792 DOI: 10.1186/s13223-023-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Canada has high immunoglobulin (IG) product utilization, raising concerns about appropriate utilization, cost and risk of shortages. Currently, there is no national set of standardized IG guidelines, and considerable variations exist among the existing provincial guidelines. The aims of this study were: (1) to compare the existing Canadian provincial guidelines on the use of IG products to identify their consistencies and differences and (2) to examine the existing research in Canada on IG supply and utilization following the establishment of IG guidelines to understand the scope of research and pinpoint the gaps. METHODS A comparative analysis accounted for the differences across provincial IG guidelines. We highlighted similarities and differences in recommendations for medical conditions. A scoping review of citations from MEDLINE, PubMed, Scopus and Embase databases was conducted for studies published from January 01, 2014, to April 12, 2023. RESULTS While provincial guidelines represented a considerable overlap in the medical conditions delineated and relatively uniform dose calculations, numerous differences were observed, including in recommendation categories, provision of pediatric dosing, and divergent recommendations for identical conditions based on patient demographics. The scoping review identified 29 studies that focused on the use of IG in Canada. The themes of the studies included: IVIG utilization and audits, the switch from IVIG to SCIG, patient satisfaction with IVIG and/or SCIG, the economic impact of self-administered SCIG versus clinically administered IVIG therapy, and the efficacy and cost-effectiveness of alternative medications to IG treatment. CONCLUSION The differences in guidelines across provinces and the factors influencing IVIG/SCIG use, patient satisfaction, and cost savings are highlighted. Future research may focus on clarifying costs and comparative effectiveness, exploring factors influencing guideline adherence, and evaluating the impact of updated guidelines on IG use and patient outcomes.
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Affiliation(s)
- Megan Harmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kiarash Riazi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rebecca Barty
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Davinder Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nancy M Heddle
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - Laurie MacLeod
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Na Li
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
- Department of Computing and Software, McMaster University, Hamilton, ON, Canada.
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Solís-Díez G, Turu-Pedrola M, Roig-Izquierdo M, Zara C, Vallano A, Pontes C. Dealing With Immunoglobulin Shortages: A Rationalization Plan From Evidence-Based and Data Collection. Front Public Health 2022; 10:893770. [PMID: 35664094 PMCID: PMC9160570 DOI: 10.3389/fpubh.2022.893770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The demand and consumption of immunoglobulins (IgGs) are growing, and there are many difficulties in obtaining supplies. The aim of the study was to analyze the evolution of IgG consumption and cost over a decade, describe the measures implemented for clinical management in the context of regional public health system, and evaluate the initial impact of these measures. Methods We performed a retrospective longitudinal study including patients of all public health systems in Catalonia. First, we analyzed data on consumption and cost of IgGs during a period between 1 January, 2010 and 31 December 2021. Second, we analyzed the impact of a set of regional measures in terms of annual consumption and cost of IgGs. Regional measures were based on rational evidence-based measures and computer registries. We compared the data of year before applying intervention measures (1 January and 31 December 2020) with data of year after applying clinical management interventions (1 January and 31 December 2021). In addition, detailed information on clinical indications of IgG use between 1 January and 31 December 2021 was collected. Results Overall, in terms of population, the consumption of IgGs (g/1,000 inhabitants) increased from 40.4 in 2010 to 94.6 in 2021. The mean cost per patient increased from €10,930 in 2010 to €15,595 in 2021. After implementing the measures, the mean annual estimated consumption per patient in 2021 was statistically lower than the mean annual estimated consumption per patient in 2020 (mean difference −47 g, 95% CI −62.28 g, −31.72 g, p = 0.03). The mean annual estimated cost per patient in 2021 was also lower than the mean annual estimated cost per patient in 2020 (the mean difference was –€1,492, 95% CI –€2,132.12, –€851.88; p = 0.027). In 2021, according to evidence-based classification, 75.66% treatments were prescribed for a demonstrated therapeutic evidence-based indication, 12.17% for a developed therapeutic evidence-based indication, 4.66% for non-evidence-based therapeutic role indication, and 8.1% could not be classified because of lack of information. Conclusion The annual consumption and cost of IgGs have grown steadily over the last decade in our regional public health system. After implementing a set of regional measures, the annual consumption of IgGs per patient and annual cost per patient decreased. However, the decrease has occurred in the context of the coronavirus disease 2019 (COVID-19) pandemic, which may have influenced their clinical use. Managing the use of IgGs through a rational plan with strategies including evidence-based and data collection may be useful in a shortage situation with growing demand. Registries play a key role in collection of systematic data to analyze, synthesize, and obtain valuable information for decision support. The action developed needs close monitoring in order to verify its effectiveness.
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Affiliation(s)
- Gerard Solís-Díez
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Marta Turu-Pedrola
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Marta Roig-Izquierdo
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Corinne Zara
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Antoni Vallano
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
- *Correspondence: Antoni Vallano
| | - Caridad Pontes
- Gerència del Medicament, Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Unitat Docent Parc Taulí, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Stanworth SJ, New HV, Apelseth TO, Brunskill S, Cardigan R, Doree C, Germain M, Goldman M, Massey E, Prati D, Shehata N, So-Osman C, Thachil J. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematol 2020; 7:e756-e764. [PMID: 32628911 PMCID: PMC7333996 DOI: 10.1016/s2352-3026(20)30186-1] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain-from donor, through collection and processing, to patients-to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.
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Affiliation(s)
- Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; Radcliffe Department of Medicine and NIHR Oxford Biomedical Research Centre-Haematology Theme, University of Oxford, Oxford, UK.
| | - Helen V New
- NHS Blood and Transplant, London, UK; Department of Haematology, Imperial College London, London, UK
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; Norwegian Armed Forces Medical Services, Oslo, Norway
| | - Susan Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Rebecca Cardigan
- NHS Blood and Transplant, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Québec, QC, Canada
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | | | - Daniele Prati
- Department of Transfusion Medicine and Hematology, IRCCS Ca 'Granda Hospital Maggiore Policlinico Foundation, Milan, Italy
| | - Nadine Shehata
- Department of Medicine, Division of Haematology, Mount Sinai Hospital, ON, Canada; Department of Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; University Health Network, Department of Medicine, Division of Medical Oncology and Haematology, Toronto, ON, Canada
| | - Cynthia So-Osman
- Department of Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, Netherlands; Department of Haematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jecko Thachil
- Manchester University NHS Foundation Trust, Manchester, UK
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