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Aronson JK, Heneghan C, Ferner RE. Drug shortages. Part 1. Definitions and harms. Br J Clin Pharmacol 2023; 89:2950-2956. [PMID: 37455356 DOI: 10.1111/bcp.15842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Drug shortages are repeatedly in the news. The earliest drug shortages were reported during the First World War, but the numbers of shortages have increased in recent years. In the first part of this two-part review, we discuss definitions of drug shortages and so-called stockouts, which are localized shortages, and the harms that they can cause. Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations, but we lack an adequate definition. The problems are too complicated to be encompassed in a brief intensional dictionary-style definition, and that is reflected in the many different attempts at definition that have been proposed. We therefore propose an extensional operational definition that incorporates the processes by which products are manufactured, the causes of shortages and the contributory factors. A definition of this sort allows one to identify the main causes of a particular drug shortage and therefore the remedies that might prevent, mitigate or manage it. In the second part of the review we discuss the causes and solutions in more detail. Adverse drug reactions and medication errors attributable to shortages occur but are not often reported. Adverse reactions to substitute medicines are possible, and errors can occur because of unfamiliarity or unnecessary treatment with replacement medicines. Other harmful outcomes include withdrawal reactions, undertreatment, treatment delays and cancellations, failure of alternatives and disruption of clinical trials.
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Affiliation(s)
- Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Song Y, Li J, Zhao F, Jin P. Drug shortages in China: a cross-sectional study. BMC Health Serv Res 2023; 23:438. [PMID: 37143100 PMCID: PMC10159680 DOI: 10.1186/s12913-023-09295-w] [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: 09/23/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Drug shortages significantly threaten public health and medical service provision worldwide. Research evidence on the complete picture of drug shortages is currently scant in China. This study aimed to provide a descriptive overview and a reference for alleviating of drug shortages in China. METHODS National and provincial lists of drug shortages issued in China from 2018 to 2021 were collected and summarized. The information on essential medicines, medical insurance drugs, emergency drugs, and volume-based purchasing drugs was then matched with a drug shortage list to analyse the characteristics, proportion and incidence of drug shortage on each list based on the analysis of information such as dosage form, shortage frequency, and Anatomical Therapeutic Chemical (ATC) classification of the drugs in shortage. RESULTS A total of 24 provinces issued drug shortages lists involving 408 drugs from 2018 to 2021. All 58 drugs in the national drug list were included on the provincial drug shortage list. Among all the drugs in shortage, the most significant shortage involved injections, accounting for 45.3% (185/408). Ninety-five drugs (23.3%) were in shortage 5 times (annual shortage > 1 time) or more in the provincial lists, and 199 drugs (48.8%) were on the shortage list only once. In terms of therapeutic property, nearly all categories of drugs had been reported in shortage, among which cardiovascular drugs, nervous system drugs, anti-tumor and immunomodulatory drugs, and blood and hematopoietic organ drugs accounted for more than 10%. There is no significant difference in drug shortage among economic regions. Comparing drugs in shortage and various lists, 81.9% (334/408), 51.0% (208/408) and 67.9% (277/408) fell on the National Medical Insurance Drug List, National Essential Medicines List, and WHO Model List of Essential Medicines, respectively, while the volume-based purchasing drugs accounted for 3.4% (14 drugs). The incidence of drug shortages on NEML, WHO Model List of Essential Medicines and medical insurance category A was significantly higher than that of medical insurance category B and volume-based purchasing drugs (P < 0.05). Of the Emergency Drugs List, 72.0% (36/50) also experienced shortages, significantly higher than all the above categories (P < 0.05). CONCLUSIONS In China, drug shortages were severe and complicated. Drug shortages vary among economic regions but are not significant. In comparison, the national procurement pattern of volume-based drug purchasing may be conducive to alleviating the drug shortage problem. Collaboration of all partners was recommended to ensure the supply of clinically necessary drugs.
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Affiliation(s)
- Yinyin Song
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Jianchun Li
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China
| | - Pengfei Jin
- Department of Pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), No. 1 Dahua Road, Dongcheng district, Beijing, 100730, P.R. China.
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Understanding public procurement within the health sector: a priority in a post-COVID-19 world. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:172-185. [PMID: 35894208 DOI: 10.1017/s1744133122000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Every year, over 250,000 public authorities in the European Union (EU) spend about 14% of GDP on the purchase of services, works and supplies. Many are in the health sector, a sector in which public authorities are the main buyers in many countries. When these purchases exceed threshold values, EU public procurement rules apply. Public procurement is increasingly being promoted as a tool for improving efficiency and contributing to better health outcomes, and as a policy lever for achieving other government goals, such as innovation, the development of small and medium-sized enterprises, sustainable green growth and social objectives like public health and greater inclusiveness. In this paper, we describe the challenges that arise within health care systems with public procurement and identify potential solutions to them. We examined the tendering of pharmaceuticals, health technology, and e-health. In each case we identify a series of challenges relating to the complexity of the procurement process, imbalances in power on either side of transactions and the role of procurement in promoting broader public policy objectives. Finally, we recommend several actions that could stimulate better procurement, and suggest a few areas where further EU cooperation can be pursued.
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Bourneau-Martin D, Babin M, Grandvuillemin A, Mullet C, Salvo F, Singier A, Cellier M, Fresse A, de Canecaude C, Pietri T, Drablier G, Geniaux H, Lagarce L, Laroche ML, Briet M. Adverse drug reaction related to drug shortage: A retrospective study on the French National Pharmacovigilance Database. Br J Clin Pharmacol 2023; 89:1080-1088. [PMID: 36177609 DOI: 10.1111/bcp.15550] [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: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
AIM Drug shortages are a growing global health issue. The aim of the study was to evaluate the consequences of drug shortages on patient safety based on data recorded in the French National Pharmacovigilance Database. METHODS All cases involving drug shortages reported from 1985 to the end of 2019 were extracted from the database. RESULTS Following the selection process, 462 cases were included. The number of cases increased significantly from 2004 to 2019. Cases mainly involved drugs from the nervous system (22.1%, 95% confidence interval [CI] 17.5-27.0%), the cardiovascular system (16.4%, 95% CI 11.9-21.4%) and anti-infectives for systemic use (14.3%, 95% CI 9.7-19.2%) ATC classes. Most of the cases reported an adverse drug reaction (ADR) belonging to the SOC nervous system (21%, 95% CI 18-24%), skin and subcutaneous (14%, 95% CI 11-17%), general (13%, 95% CI 10-17%) and gastrointestinal (8%, 95% CI 5-11%) disorders. Disease worsening was observed in 15.9% of the cases, mostly related to a lack of efficacy of the replacement drug. Half of the cases were considered as serious. Evolution was favourable in 79.4% of the cases. Death and/or life-threatening situations were reported in 5.8% of the cases. Medication errors (MEs) were identified in 51 cases (11%), mostly occurring at the administration step and involving a human factor. CONCLUSION This study emphasizes the clinical impact of drug shortage in terms of ADRs, ME and inefficiency. These observations underline the importance of a global health policy programme to limit the occurrence of drug shortages and to reinforce the information provided to patients and health care professionals in this context to limit risk.
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Affiliation(s)
- Delphine Bourneau-Martin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Marina Babin
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | | | - Charlotte Mullet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Francesco Salvo
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,Service de Pharmacologie, CHU de Bordeaux, Bordeaux, France
| | | | - Morgane Cellier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Audrey Fresse
- CHRU de Nancy - Hôpitaux de Brabois, Centre Régional de Pharmacovigilance, Vandœuvre-lès-Nancy, France
| | - Claire de Canecaude
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur Le Médicament, Faculté de Médecine, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Tessa Pietri
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre régional de pharmacovigilance, Marseille, France
| | - Guillaume Drablier
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Hélène Geniaux
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France
| | - Marie-Laure Laroche
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France.,UR 24134 (Vie Santé: Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
| | - Marie Briet
- Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France.,Université d'Angers, Angers, France.,MitoVasc Research Institute, UMR CNRS 6214 INSERM 1083, Angers, France
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Romano S, Guerreiro JP, Teixeira Rodrigues A. Drug shortages in community pharmacies: Impact on patients and on the health system. J Am Pharm Assoc (2003) 2021; 62:791-799.e2. [DOI: 10.1016/j.japh.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
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Patients perspectives on drug shortages in six European hospital settings - a cross sectional study. BMC Health Serv Res 2021; 21:689. [PMID: 34253212 PMCID: PMC8274960 DOI: 10.1186/s12913-021-06721-9] [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: 01/28/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06721-9.
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Adade CA, Diop BB, Attjioui H, Cheikh A, Mefetah H, Bouatia M. Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding. J Oncol Pharm Pract 2021; 28:605-612. [PMID: 33847197 DOI: 10.1177/10781552211008527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. OBJECTIVE The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. MATERIALS AND METHODS This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. RESULTS In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. CONCLUSION The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.
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Affiliation(s)
- Casimir Adade Adade
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Boubacar Bf Diop
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Houda Attjioui
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Amine Cheikh
- Department of Pharmacy, Faculty of Pharmacy, Abulcasis University, Rabat, Morocco
| | - Hafid Mefetah
- Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Mustapha Bouatia
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
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Aljadeed R, AlRuthia Y, Balkhi B, Sales I, Alwhaibi M, Almohammed O, Alotaibi AJ, Alrumaih AM, Asiri Y. The Impact of COVID-19 on Essential Medicines and Personal Protective Equipment Availability and Prices in Saudi Arabia. Healthcare (Basel) 2021; 9:290. [PMID: 33800012 PMCID: PMC8001971 DOI: 10.3390/healthcare9030290] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
This was a questionnaire-based cross-sectional study that explored the impact of the COVID-19 pandemic on the availability of essential medicine and personal protective equipment (PPE) in Saudi Arabia. Purposive sampling technique was used to recruit individuals working in the supply chain departments in different healthcare sectors in Saudi Arabia. One hundred and three pharmaceutical and medical supply chain employees participated in the study. Most of the participants (58.3%) were aged ≥35 years, male (65%), and pharmacists (92.2%). The majority of participants had at least two years of experience in supply chain (77.6%), worked in public hospitals (95.15%), and were mostly working at healthcare institutions located in Riyadh province (59.2%). Approximately 51% of the participants reported shortages of 10 or more essential drugs. Tocilizumab, hydroxychloroquine, lopinavir/ritonavir, ribavirin, dexamethasone, enoxaparin, interferon beta-1b, cisatracurium besylate, prednisolone, hydrocortisone, methimazole, and methylprednisolone were reported to be in shortage by at least 8% of the participants. Almost 70% of the participants reported that the pandemic did not significantly impact the prices of prescription drugs in shortage (e.g., ≥25%). Moreover, about 70% of the participants reported direct purchasing or procurement of drugs in shortage. Surgical masks, face shields, medical gowns, and N95 respirators were reported to be in short supply by 33% or more of the participants. Approximately 53% of the participants reported the prices of PPE in shortage had seen an increase by at least 25% during the pandemic. Although the COVID-19 pandemic has caused a significant disruption in the global pharmaceutical supply chain, its impact was largely manageable in Saudi healthcare institutions. This can be attributable to multiple reasons such as the effective exchange programs between hospitals and the drastic increase in public healthcare spending to ameliorate the negative impact of the pandemic on the healthcare sector.
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Affiliation(s)
- Rana Aljadeed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
| | - Omar Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
| | - Abdulaziz J. Alotaibi
- Saudi Medical Supply Chain Assembly, Saudi Pharmaceutical Society, Riyadh 11451, Saudi Arabia;
| | - Ali M. Alrumaih
- Pharmaceutical Care Department, Medical Services for Armed Forces, Ministry of Defense, Riyadh 11451, Saudi Arabia;
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.A.); (B.B.); (I.S.); (M.A.); (O.A.); (Y.A.)
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Mangundu M, Roets L, Janse van Rensberg E. Accessibility of healthcare in rural Zimbabwe: The perspective of nurses and healthcare users. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 32501024 PMCID: PMC7284155 DOI: 10.4102/phcfm.v12i1.2245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/17/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Accessibility of healthcare in rural areas is globally impeded by physical, material, human, financial and managerial resources and societal barriers in the healthcare system. Developing countries like Zimbabwe are significantly affected. Aim The aim of this article was to share the perspectives of nurses and healthcare users (HCUs) in the rural areas of Zimbabwe with regard to the accessibility of healthcare. Setting The study was conducted at 45 rural health facilities in Chegutu district, Mashonaland West province and Masvingo district in Masvingo province, Zimbabwe. Methods A self-administered questionnaire (for professional nurses) and a structured interview questionnaire (for HCUs) were utilised to gather data in a cross-sectional survey. Two districts were randomly sampled from 59 districts. All nurses working in 45 public health facilities in the selected two districts, who were willing and available to participate, were included. Ninety nurses participated in the study. The HCUs were selected through a multistage sampling technique. The sample size for HCUs was calculated by using Dobson’s formula, and 445 HCUs were included via convenience sampling. Results Nurses reported challenges such as work overload because of staffing shortages (55%) and the supply of necessary medical drugs that lacked consistency in both the quantity and type ordered(46.7%). The challenges faced by HCUs included long distances from villages to health facilities (86%), unaffordability of transport costs and lack of access to medical drugs (59.95%), causing them to seek assistance from traditional healers (43%). Conclusion Both the nurses and HCUs perceived grave challenges regarding access to health facilities, health workers and medical drugs, all of which are bound to have an impact on the health of communities in rural Zimbabwe.
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Affiliation(s)
- Manenji Mangundu
- Department of Health Studies, School of Social Sciences, University of South Africa, Pretoria.
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Miljković N, Godman B, Kovačević M, Polidori P, Tzimis L, Hoppe-Tichy T, Saar M, Antofie I, Horvath L, De Rijdt T, Vida RG, Kkolou E, Preece D, Tubić B, Peppard J, Martinez A, Yubero CG, Haddad R, Rajinac D, Zelić P, Jenzer H, Tartar F, Gitler G, Jeske M, Davidescu M, Beraud G, Kuruc-Poje D, Haag KS, Fischer H, Sviestina I, Ljubojević G, Markestad A, Vujić-Aleksić V, Nežić L, Crkvenčić A, Linnolahti J, Ašanin B, Duborija-Kovačević N, Bochenek T, Huys I, Miljković B. Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications. Front Pharmacol 2020; 11:357. [PMID: 32273845 PMCID: PMC7114887 DOI: 10.3389/fphar.2020.00357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe.
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Affiliation(s)
- Nenad Miljković
- Institute of Orthopaedic Surgery "Banjica", University of Belgrade, Belgrade, Serbia
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Piera Polidori
- Department of Clinical Pharmacy, IRCCS, ISMETT, Palermo, Italy
| | - Leonidas Tzimis
- Hospital Pharmacy Department, Chania General Hospital, Crete, Greece
| | | | - Marika Saar
- Pharmacy Department, Tartu University Hospital, Tartu, Estonia
| | - Ioan Antofie
- Hospital Pharmacy Department, Spitalul Clinic C. F. Cluj-Napoca, Cluj-Napoca, Romania
| | - Laszlo Horvath
- Department of Pharmaceutical Surveillance and Economics, University of Debrecen, Debrecen, Hungary
| | - Thomas De Rijdt
- Pharmacy Department, University Hospitals Leuven, UZ Herestraat, Leuven, Belgium
| | - Róbert György Vida
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Elena Kkolou
- Hospital Pharmacy Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - David Preece
- Leeds Medicines Advisory Service, The Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, United Kingdom
| | - Biljana Tubić
- Sector for Medicinal Products, Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina.,Faculty of Medicine-Department of Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Joan Peppard
- Hospital Pharmacy Department, Midland Regional Hospital, Tullamore, Ireland
| | - Alicia Martinez
- Servicio de Farmacia, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Ratiba Haddad
- Hospital Pharmacy Department, Hôpital Antoine Béclère, Clamart, France
| | - Dragana Rajinac
- Hospital Pharmacy Department, Clinical Centre of Serbia, Belgrade, Serbia
| | - Pavle Zelić
- International Cooperation and Public Relation Department, Medicines and Medical Device Agency of Serbia, Belgrade, Serbia
| | - Helena Jenzer
- Health Division, Berner Fachhochschule Health Professions Ernährung und Diätetik, Bern, Switzerland
| | - Franci Tartar
- Department of Hospital Pharmacy, General Hospital Celje, Celje, Slovenia
| | - Gunda Gitler
- Hospital Pharmacy Department, Apotheke der Barmherzigen Brüdere. U., Linz, Austria
| | - Martina Jeske
- Pharmacy Department, University Clinic-State Hospital of Innsbruck, Innsbruck, Austria
| | - Michal Davidescu
- Faculty of Social Sciences, The Graduate School of Business Administration, Tel Aviv, Israel
| | - Guillaume Beraud
- Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France.,Department of Public Health, Université Droit et Santé Lille 2, Lille, France
| | - Darija Kuruc-Poje
- Hospital Pharmacy Department, General hospital "dr. Tomislav Bardek", Koprivnica, Croatia
| | | | - Hanne Fischer
- Strategic Procurement and Supply of Pharmaceuticals, Amgros I/S, Copenhagen, Denmark
| | - Inese Sviestina
- Hospital Pharmacy Department, Children's Clinical University Hospital, Riga, Latvia
| | - Gordana Ljubojević
- Department of Physical Medicine and Rehabilitation "Dr Miroslav Zotović", Banja Luka, Bosnia and Herzegovina
| | - Anne Markestad
- National Center for Medicine Shortages in Hospitals, Oslo universitetssykehus HF, Nydalen, Norway
| | - Vesna Vujić-Aleksić
- Certification Department, The Republic of Srpska Agency for Certification, Accreditation and Quality Improvement in Health Care, Banja Luka, Bosnia and Herzegovina.,Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Lana Nežić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Anica Crkvenčić
- Community Pharmacy Department, Pharmacy "Biljana", Banja Luka, Bosnia and Herzegovina
| | | | - Bogdan Ašanin
- Department of Surgery, Department of Medical Ethics, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Nataša Duborija-Kovačević
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
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11
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Modisakeng C, Matlala M, Godman B, Meyer JC. Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications. BMC Health Serv Res 2020; 20:234. [PMID: 32192481 PMCID: PMC7082963 DOI: 10.1186/s12913-020-05080-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. METHOD Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. RESULTS The 'Procurement process' emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. CONCLUSIONS Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.
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Affiliation(s)
- Cynthia Modisakeng
- Department of Pharmacy, Dr George Mukhari Academic Hospital, Private Bag, Pretoria, South Africa.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Moliehi Matlala
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow, UK
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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12
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Abstract
PURPOSE Drug shortages have become a constant challenge in patient care over the past two decades. In 2018, there was a shortage of etoposide injection in the United States. The purpose of this study was to analyze the impact of the etoposide injection shortage. METHODS This single-center, retrospective chart review included patients prescribed an etoposide-containing chemotherapy regimen between January 2018 and August 2018. The primary objective was to determine the percentage of patients who required a change in treatment due to the etoposide injection drug shortage. For the secondary objectives, the following was compared between patients who received etoposide injection versus alternative etoposide formulations (etopophos injection or oral etoposide): adverse events, medication errors, treatment delays, disease progression, and drug costs. RESULTS Twenty-two patients were included in this study. Overall, seven (32%) patients required a change in treatment due to the etoposide injection shortage. Of the seven patients, six required the use of an alternative etoposide formulation and one patient had etoposide omitted in at least one treatment cycle. There were no significant differences in adverse events, medication errors, treatment delays, or disease progression when comparing patients who received etoposide injection versus alternative etoposide formulations. The average drug cost per cycle was significantly higher in the patients who required a change in treatment. CONCLUSIONS To our knowledge, this is the first study to characterize the clinical impact of the etoposide injection shortage. Results from this study highlight the direct impact that drug shortages have on patient care.
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Affiliation(s)
- Hualy Li
- Department of Pharmacy, Pennsylvania Hospital, Philadelphia, USA
| | - Sarah K Cimino
- Department of Pharmacy, Pennsylvania Hospital, Philadelphia, USA
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13
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Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine Shortages: Gaps Between Countries and Global Perspectives. Front Pharmacol 2019; 10:763. [PMID: 31379565 PMCID: PMC6658884 DOI: 10.3389/fphar.2019.00763] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Over the last decade, global health policies and different research areas have focused on the relevance and impact of medicine shortages. Published studies suggest there have been difficulties with access to medicines since the beginning of the 20th century, and there have been advances in our understanding and management of the problem since then. However, in view of global and regional health care concerns with shortages, we believe this phenomenon needs to be characterized and described more fully regarding the types of medicines affected, possible causes, and potential strategies to address these. The aim of this scoping review was to identify, compare if possible, and characterize the recent literature regarding the situation of medicines shortages between countries, and provide different perspectives, including a global context and national approaches. Methodology: A scoping study presented as a narrative review of the situation and findings principally based on published articles. Results: Based on the reported cases in the literature, a typology of medicines shortage and supply interruption episodes and their causes were proposed; national approaches to notify and manage the medicines shortages cases were described and classified by update frequency; principal differences between market and supply chain management perspectives of the situation were identified and global and countries’ perspectives were described. Conclusion: Policy makers require solutions that prevent those cases in which the population’s health is affected by episodes of medicine shortages and/or interruption in the supply chain. There is also a need to generate a glossary related to logistics management and the availability of medicines which will be useful to understand and overcome shortages. In addition, recognize that potential solutions are not only related with actions linked to research, development and innovation, but much wider. Overall, we believe this article can act as a basis for future discussions in this important area.
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Affiliation(s)
- Angela Acosta
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,RAM Group, National University of Colombia, Bogotá, Colombia
| | - Egdda Patricia Vanegas
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,SEPRO Research Group, National University of Colombia, Bogotá, Colombia
| | - Joan Rovira
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Andalusian School of Public Health, Granada, Spain
| | - Brian Godman
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Tomasz Bochenek
- ISAGS, South American Institute of Government in Health, UNASUR, Rio de Janeiro, Brazil.,Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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14
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Poulsen JH, Rishøj RM, Fischer H, Kart T, Nørgaard LS, Sevel C, Dieckmann P, Clemmensen MH. Drug change: 'a hassle like no other'. An in-depth investigation using the Danish patient safety database and focus group interviews with Danish hospital personnel. Ther Adv Drug Saf 2019; 10:2042098619859995. [PMID: 31321023 PMCID: PMC6628512 DOI: 10.1177/2042098619859995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Drug change (DC) is a common challenge in Danish hospitals. It affects the
work of hospital personnel and has potentially serious patient safety
consequences. Focus on medication safety is becoming increasingly important
in the prevention of adverse events. The aim of this study is to identify
and describe patient safety challenges related to DCs, and to explore
potential facilitators to improve patient safety in the medication process
in Danish hospital setting. Method: Two qualitative methods were combined. Data were obtained from the Danish
Patient Safety Database (DPSD) containing incidents reports of adverse
events related to DCs. Additionally, five semi-structured focus group
interviews with hospital personnel (doctors, nurses, pharmacists and
pharmacy technicians) from the five regions of Denmark were held. Results: The DPSD search identified 88 incidents related to DCs due to tender or drug
shortage. The incidents were linked to prescribing errors, incorrect dose
being dispensed/administered, and delayed/omitted treatment. Four themes
from the interviews emerged: (1) challenges related to the drug itself; (2)
situational challenges; (3) challenges related to the organization/IT
systems/personnel; (4) facilitators/measures to ensure patient safety. Conclusion: DC is as a complex challenge, especially related to drug shortage. The
results allow for a deeper understanding of the challenges and possible
facilitators of DCs on the individual and organizational level. Pharmacy
personnel were identified to play a key role in ensuring patient safety of
DCs in hospitals. Indeed, this emphasizes that pharmacy personnel should be
engaged in developing patient safety strategies and support hospital
personnel around drug changes.
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Affiliation(s)
- Joo Hanne Poulsen
- Social and Clinical Pharmacy, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark
| | - Rikke Mie Rishøj
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Hanne Fischer
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Trine Kart
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Lotte Stig Nørgaard
- Social and Clinical Pharmacy, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christian Sevel
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Herlev Hospital, Herlev, Denmark
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15
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The impacts of medication shortages on patient outcomes: A scoping review. PLoS One 2019; 14:e0215837. [PMID: 31050671 PMCID: PMC6499468 DOI: 10.1371/journal.pone.0215837] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background In recent years, medication shortages have become a growing worldwide issue. This scoping review aimed to systematically synthesise the literature to report on the economic, clinical, and humanistic impacts of medication shortages on patient outcomes. Methods Medline, Embase, Global Health, PsycINFO and International Pharmaceutical Abstracts were searched using the two key concepts of medicine shortage and patient outcomes. Articles were limited to the English language, human studies and there were no limits to the year of publication. Manuscripts included contained information regarding the shortage of a scheduled medication and had gathered data regarding the economic, clinical, and/or humanistic outcomes of drug shortages on human patients. Findings We found that drug shortages were predominantly reported to have adverse economic, clinical and humanistic outcomes to patients. Patients were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage. There were also reports of equivalent and improved patient outcomes in some cases. Conclusions The results of this review provide valuable insights into the impact drug shortages have on patient outcomes. The majority of studies reported medication shortages resulted in negative patient clinical, economic and humanistic outcomes.
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16
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Nonzee NJ, Luu TH. The Drug Shortage Crisis in the United States: Impact on Cancer Pharmaceutical Safety. Cancer Treat Res 2019; 171:75-92. [PMID: 30552658 DOI: 10.1007/978-3-319-43896-2_6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug shortages pose a significant public health concern in the United States, and cancer drugs are among those most affected. Shortages present serious safety risks for patients and substantial burden on providers and the healthcare system. Multifaceted drivers of this complex problem include manufacturing disruptions, raw material shortages, regulatory issues, market dynamics, and limited financial incentives that reward quality and production of off-patent drugs. Oncology drugs in short supply have resulted in substitution of less effective or more toxic alternatives, medication errors, and treatment delays, and are especially concerning for medications with no adequate substitute. Consequently, patient outcomes such as disease progression and survival have been adversely affected. Furthermore, emerging gray markets have contributed to cost-prohibitive markups and introduction of counterfeit products that compromise patient safety. The Food and Drug Administration plays a key role in preventing and managing pharmaceutical shortages, largely through regulations requiring early notification of manufacturing interruptions. Other proposed strategies similarly target upstream causes and center on reducing regulatory hurdles for manufacturers and increasing incentives for market entry and quality improvement. Despite progress in preventing supply disruptions, continued exploration of underlying systemic drivers remains critical to informing long-term solutions and alleviating the clinical and economic impact of drug shortages.
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Affiliation(s)
- Narissa J Nonzee
- Department of Health Policy and Management, University of California, Los Angeles, CA, USA.
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17
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Fittler A, Vida RG, Rádics V, Botz L. A challenge for healthcare but just another opportunity for illegitimate online sellers: Dubious market of shortage oncology drugs. PLoS One 2018; 13:e0203185. [PMID: 30153304 PMCID: PMC6112670 DOI: 10.1371/journal.pone.0203185] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/20/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Drug shortages mean a challenge to healthcare systems. Exposed patients or health care providers may seek alternative resources for these products online. The purpose of our study was to analyze the online availability of oncology shortage drugs at national and at international levels in 2014 and 2016. Methods We tested the online accessibility of oncology shortage drugs by simulating the Internet search method of patients. Search results were evaluated according to operational, distributional, and patient safety characteristics. Results In 2014 and 2016 all (100%) antineoplastic agents affected by shortages were available on the Internet without medical prescription. The number of relevant websites among search engine results has decreased from 112 to 98, while online vendors actually offering oncology shortage drugs for sale has risen from 66.1% to 80.6% within relevant websites in the two evaluated years. None of the online sellers were classified as legitimate or accredited by LegitScript and VIPPS online pharmacy verification databases. Conclusion According to our findings shortage oncology drugs are widely available online. To manage shortages and illegal Internet trade national and international standardized shortage reporting and information systems, regularly updated Internet pharmacy verification databases are needed. As well, institutional procurement and medication use review policies are required.
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Affiliation(s)
- András Fittler
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- * E-mail:
| | - Róbert György Vida
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Valter Rádics
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Lajos Botz
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
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18
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Frosch ZAK, Cronin AM, Gagne JJ, Teschke MP, Gray SW, Abel GA. Cancer drug shortages: Awareness and perspectives from a representative sample of the US population. Cancer 2018; 124:2205-2211. [DOI: 10.1002/cncr.31246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Zachary A. K. Frosch
- Dana-Farber Cancer Institute; Boston Massachusetts
- Brigham and Women's Hospital; Boston Massachusetts
| | | | | | | | | | - Gregory A. Abel
- Dana-Farber Cancer Institute; Boston Massachusetts
- Brigham and Women's Hospital; Boston Massachusetts
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19
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Claus B, Bauters T, Laureys G. Drug shortages in a pediatric stem cell transplantation ward: Challenges and implications. A 5-year bilan. J Oncol Pharm Pract 2018; 25:841-846. [PMID: 29592767 DOI: 10.1177/1078155218765627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the implications of shortages of pharmaceutical products used in conditioning and supportive care regimens of pediatric patients undergoing a hematopoietic stem cell transplantation in a tertiary care hospital. Between July 2011 and July 2016, a total of 84 individual shortages, affecting 22 different drugs (79.8% supportive care drugs; 20.2% chemotherapeutics) were detected with a mean duration of 85 days (SD 138) per individual drug shortage. Eighteen shortages were critical and very urgent. Sulfamethoxazol/trimethoprim, piperacillin/tazobactam, ranitidine, benzylpenicillin, ondansetron (supportive care) and methotrexate, melphalan (chemotherapeutics) had the longest supply disruptions. A variety of solutions could be identified including the purchase of a generic alternative (36.9%) for both oral and parenteral treatments (in a ratio 3:2). Urgent import from another (European) country was performed in 14 cases (16.7%). High impact solutions such as cohorting of patients and change of ongoing treatments (2.4%) were used for parenteral treatments only. Pharmaceutical modification was sometimes applied for oral treatments (2.4%). Due to persistent occurrence of these shortages, an efficient pharmacy workflow (electronic follow-up by end of 2016) and a multidisciplinary approach were needed.
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Affiliation(s)
- B Claus
- 1 Pharmacy Department, Ghent University Hospital, Ghent, Belgium.,2 Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - T Bauters
- 1 Pharmacy Department, Ghent University Hospital, Ghent, Belgium.,3 Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - G Laureys
- 3 Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
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20
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Bochenek T, Abilova V, Alkan A, Asanin B, de Miguel Beriain I, Besovic Z, Vella Bonanno P, Bucsics A, Davidescu M, De Weerdt E, Duborija-Kovacevic N, Fürst J, Gaga M, Gailīte E, Gulbinovič J, Gürpınar EU, Hankó B, Hargaden V, Hotvedt TA, Hoxha I, Huys I, Inotai A, Jakupi A, Jenzer H, Joppi R, Laius O, Lenormand MC, Makridaki D, Malaj A, Margus K, Marković-Peković V, Miljković N, de Miranda JL, Primožič S, Rajinac D, Schwartz DG, Šebesta R, Simoens S, Slaby J, Sović-Brkičić L, Tesar T, Tzimis L, Warmińska E, Godman B. Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries. Front Pharmacol 2018; 8:942. [PMID: 29403372 PMCID: PMC5779072 DOI: 10.3389/fphar.2017.00942] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022] Open
Abstract
Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.
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Affiliation(s)
- Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vafa Abilova
- Analytical Expertise Centre, Ministry of Health, Baku, Azerbaijan
| | - Ali Alkan
- Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Bogdan Asanin
- Department of Surgery, Department of Medical Ethics, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | | | - Zeljka Besovic
- Montenegrin Agency for Drugs and Medical Devices, Sector for Drugs and Medical Devices, Podgorica, Montenegro
| | - Patricia Vella Bonanno
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products, Brussels, Belgium
| | | | - Elfi De Weerdt
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Natasa Duborija-Kovacevic
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty of the University of Montenegro, Podgorica, Montenegro
| | - Jurij Fürst
- Department of Medicines, Health Insurance Institute, Ljubljana, Slovenia
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | | | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Vilnius, Lithuania.,State Medicine Control Agency, Vilnius, Lithuania
| | - Emre U Gürpınar
- Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Balázs Hankó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Vincent Hargaden
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | | | - Iris Hoxha
- Department of Pharmacy, University of Medicine, Tirana, Albania
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Andras Inotai
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy and Health Economics, Institute of Economics, Eötvös Loránd University, Budapest, Hungary
| | - Arianit Jakupi
- Department of Drug Management, Faculty of Pharmacy, UBT (Kosovo), Prishtina, Albania
| | - Helena Jenzer
- Health Department, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry Zurich (PUK), Zurich, Switzerland
| | - Roberta Joppi
- Local Health Unit of Verona-Veneto Region, Verona, Italy
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Despina Makridaki
- Panhellenic Association of Hospital Pharmacists, Athens, Greece.,National Organization for Medicines, Athens, Greece
| | - Admir Malaj
- Department of Pharmacy, University of Medicine, Tirana, Albania
| | - Kertu Margus
- Estonian State Agency of Medicines, Tartu, Estonia
| | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.,Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka (Republic of Srpska), Banja Luka, Bosnia and Herzegovina
| | | | - João L de Miranda
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Portalegre, Portalegre, Portugal.,Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Stanislav Primožič
- Agency for Medicinal Products and Medicinal Devices, Ljubljana, Slovenia
| | | | - David G Schwartz
- Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Juraj Slaby
- State Institute for Drug Control, Prague, Czechia
| | | | - Tomas Tesar
- Department of Organisation and Management in Pharmacy, Pharmaceutical Faculty, Comenius University, Bratislava, Slovakia
| | | | - Ewa Warmińska
- Dentons Europe Dąbrowski i Wspólnicy sp. k., Warszawa, Poland
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Clinical Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom
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Panzitta M, Ponti M, Bruno G, Cois G, D'Arpino A, Minghetti P, Mendicino FR, Perioli L, Ricci M. The strategic relevance of manufacturing technology: An overall quality concept to promote innovation preventing drug shortage. Int J Pharm 2016; 516:144-157. [PMID: 27838294 DOI: 10.1016/j.ijpharm.2016.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 11/25/2022]
Abstract
Manufacturing is the bridge between research and patient: without product, there is no clinical outcome. Shortage has a variety of causes, in this paper we analyse only causes related to manufacturing technology and we use shortage as a paradigm highliting the relevance of Pharmaceutical Technology. Product and process complexity and capacity issues are the main challenge for the Pharmaceutical Industry Supply chain. Manufacturing Technology should be acknowledged as a R&D step and as a very important matter during University degree in Pharmacy and related disciplines, promoting collaboration between Academia and Industry, measured during HTA step and rewarded in terms of price and reimbursement. The above elements are not yet properly recognised, and manufacturing technology is taken in to consideration only when a shortage is in place. In a previous work, Panzitta et al. proposed to perform a full technology assessment at the Health Technological Assessment stage, evaluating three main technical aspects of a medicine: manufacturing process, physicochemical properties, and formulation characteristics. In this paper, we develop the concept of manufacturing appraisal, providing a technical overview of upcoming challenges, a risk based approach and an economic picture of shortage costs. We develop also an overall quality concept, not limited to GMP factors but broaden to all elements leading to a robust supply and promoting technical innovation.
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Affiliation(s)
- Michele Panzitta
- Department of Pharmaceutical Sciences Università degli Studi di Perugia, Via del Liceo 1, 06123 Perugia, Italy; AFI, Study Group on Pharmaceutical Economy, Viale Ranzoni 1 20041 Milano, Italy
| | - Mauro Ponti
- AFI, Study Group on Pharmaceutical Economy, Viale Ranzoni 1 20041 Milano, Italy; Sanofi-Genzyme, Viale Luigi Bodio 37/b, 20158 Milano, Italy
| | - Giorgio Bruno
- AFI-Associazione Farmaceutici dell'Industria, viale Ranzoni 1, 20041 Milano, Italy; Recipharm AB, Via Filippo Serpero, 2, Masate (MI), Italy
| | - Giancarlo Cois
- AFI, Study Group on Pharmaceutical Economy, Viale Ranzoni 1 20041 Milano, Italy; Chiesi Via San Leonardo, 96A, 43122 Parma, Italy
| | - Alessandro D'Arpino
- AFI, Study Group on Pharmaceutical Economy, Viale Ranzoni 1 20041 Milano, Italy; Perugia Hospital, Pharmacy Department, 06132 Sant'Andrea delle Fratte, Perugia, Italy
| | - Paola Minghetti
- AFI-Associazione Farmaceutici dell'Industria, viale Ranzoni 1, 20041 Milano, Italy; School of Hospital Pharmacy, Pharmaceutical Sciences Department, Università degli Studi di Milano, Via Festa del Perdono 7 - Milano, Italy
| | | | - Luana Perioli
- Department of Pharmaceutical Sciences Università degli Studi di Perugia, Via del Liceo 1, 06123 Perugia, Italy
| | - Maurizio Ricci
- Department of Pharmaceutical Sciences Università degli Studi di Perugia, Via del Liceo 1, 06123 Perugia, Italy; AFI, Study Group on Pharmaceutical Economy, Viale Ranzoni 1 20041 Milano, Italy; School of Hospital Pharmacy, Università degli Studi di Perugia, Via del Liceo 1, 06123 Perugia, Italy.
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22
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Tan YX, Moles RJ, Chaar BB. Medicine shortages in Australia: causes, impact and management strategies in the community setting. Int J Clin Pharm 2016; 38:1133-41. [PMID: 27383246 DOI: 10.1007/s11096-016-0342-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
Background Medicine shortages are an ongoing global problem. The Therapeutic Goods Administration (TGA) dedicated a website for monitoring of medicine shortages in Australia in May 2014, as part of the Medicine Shortage Information Initiative. This study aimed to explore the views of pharmacists regarding medicine shortages in the community setting and the impact of the TGA website in Australia. Setting Community pharmacies in New South Wales, Australia. Method Twenty semi-structured interviews were conducted with community pharmacists. Data collected were analysed thematically utilising the framework analysis method. Main outcome measure Qualitative analysis conducted using the framework approach. Results Findings clearly indicated that medicine shortages were experienced on a regular basis, but most participants were unaware of the TGA website. Medicine shortages reportedly impacted both pharmacists and consumers; and various workarounds were undertaken to manage the issue. The "price disclosure policy" was found to be a prominent contributing factor in emerging shortages. Suggestions were made for ways to improve the growing occurrence of shortages. Conclusion Overall, the study found that there was a lack of familiarity with the TGA website, despite experiencing regular shortages of medicines in practice. Also highlighted, was the importance of pharmacists prioritising patient care over business decisions. To reduce prescribing of out-of-stock medicines notifying doctors about shortages was also considered important, to allow for early action to be taken at higher levels of the supply chain. Findings of this study may help direct future policy-making around the world, as medicine shortages is a problem shared by healthcare providers in most countries around the world.
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Affiliation(s)
- Yee Xi Tan
- Faculty of Pharmacy, The University of Sydney, A15 Pharmacy and Bank Building, Sydney, NSW, 2006, Australia
| | - Rebekah J Moles
- Faculty of Pharmacy, The University of Sydney, A15 Pharmacy and Bank Building, Sydney, NSW, 2006, Australia
| | - Betty B Chaar
- Faculty of Pharmacy, The University of Sydney, A15 Pharmacy and Bank Building, Sydney, NSW, 2006, Australia.
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23
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Nurgat Z, Faris D, Mominah M, Vibar A, Al-Jazairi A, Ewing S, Ashour M, Qaisi SK, Balhareth S, Al-Jedai A. A three-year study of a first-generation chemotherapy-compounding robot. Am J Health Syst Pharm 2016; 72:1036-45. [PMID: 26025995 DOI: 10.2146/ajhp140256] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a performance evaluation of an automated system for compounding antineoplastic preparations are reported. METHODS Three years after the pharmacy department of a hospital in Saudi Arabia installed an i.v.-compounding robot (CytoCare, Health Robotics), data captured by the pharmacy information system and the machine's integrated software were analyzed to assess the performance of the robot in terms of compounding accuracy, days of operation, and downtime. RESULTS The robot was used to prepare 3.82%, 10.80%, and 13.79% of selected antineoplastics compounded in 2010, 2011, and 2012, respectively. The robot failed to meet the specified dose accuracy range of ±5% in compounding 3 of 337 chemotherapy preparations (0.9%) in 2010, 349 of 1516 preparations (23%) in 2011, and 460 of 2993 preparations (15%) in 2012. The robot was operational on 40%, 39%, and 61% of available workdays in 2010, 2011, and 2012, respectively. Robot throughput relative to the pharmacy's manual compounding process was low, with substantial medication waste resulting from dose preparation failures. Implementation challenges included workflow disruptions due to robot downtime, mechanical issues (e.g., robot arm-clamping failures), difficulty obtaining gravimetric data for some drugs, and the need to recalibrate the device to accept i.v. bags, syringes, and medication vials incompatible with manufacturer specifications. CONCLUSION The introduction of a chemotherapy-compounding robot for preparation of patient-specific i.v. antineoplastic drugs had a limited efficiency impact in practice. This solution, with its numerous limitations and technical difficulties, is not yet mature enough for universal adoption.
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Affiliation(s)
- Zubeir Nurgat
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Dima Faris
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Maher Mominah
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Arris Vibar
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Abdulrazaq Al-Jazairi
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Sheena Ewing
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Mohammed Ashour
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Shrouq Kamel Qaisi
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Sakra Balhareth
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC
| | - Ahmed Al-Jedai
- Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
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Parsons HM, Schmidt S, Karnad AB, Liang Y, Pugh MJ, Fox ER. Association Between the Number of Suppliers for Critical Antineoplastics and Drug Shortages: Implications for Future Drug Shortages and Treatment. J Oncol Pract 2016; 12:e289-98, 249-50. [PMID: 26837565 DOI: 10.1200/jop.2015.007237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Congress has identified the critical need to evaluate contributors to ongoing cancer drug shortages. Because increased competition may reduce drug shortages, we investigated the association between the number of suppliers for first-line breast, colon, and lung antineoplastics and drug shortages. DATA AND METHODS Using the 2003 to 2014 Red Book and national drug shortage data from the University of Utah's Drug Information Service, we used exploratory analysis to quantify time trends in first-line drug suppliers and shortages by cancer site. Generalized mixed models were used to examine the association between the number of suppliers for individual drugs and resulting drug shortages. RESULTS Among 35 antineoplastic drugs approved for first-line treatment of breast, colon, and lung cancer, the number of unique suppliers varied greatly (range, 1 to 19). In 2003, 12.5%,33.3%, and 0%of breast, colon, and lung cancer drugs, respectively, experienced shortages, which increased overall by 2014, to 40.0%, 37.5%, and 54.5%, respectively. Having as mall number of drug suppliers more than doubled the odds of shortages compared with a large number of suppliers (≥5), although the results were only statistically significant with three to four suppliers (odds ratio = 2.6, P = .049) but not with one to two suppliers (odds ratio = 3.49, P = .105). One of the strongest risk factors for drug shortages was the age of the drug, with older drugs significantly more likely to experience shortages (P<.001). CONCLUSION Cancer drugs with a small number of suppliers had a higher risk of drug shortages than did those with$5 suppliers, but the relationship was nonlinear. Because the age of the drug is the strongest risk factor, future studies should explore underlying causes of shortages in older drugs.
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Affiliation(s)
- Helen M Parsons
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
| | - Susanne Schmidt
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
| | - Anand B Karnad
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
| | - Yuanyuan Liang
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
| | - Mary Jo Pugh
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
| | - Erin R Fox
- University of Texas Health Science Center at San Antonio, San Antonio, TX; and University of Utah College of Pharmacy, Salt Lake City, UT
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25
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Duan F, Wang EQ, Lam MGEH, Abdelmaksoud MHK, Louie JD, Hwang GL, Kothary N, Kuo WT, Hofmann LV, Sze DY. Superselective Chemoembolization of HCC: Comparison of Short-term Safety and Efficacy between Drug-eluting LC Beads, QuadraSpheres, and Conventional Ethiodized Oil Emulsion. Radiology 2016; 278:612-621. [DOI: 10.1148/radiol.2015141417] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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26
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Unguru Y, Fernandez CV, Bernhardt B, Berg S, Pyke-Grimm K, Woodman C, Joffe S. An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer. J Natl Cancer Inst 2016; 108:djv392. [PMID: 26825103 DOI: 10.1093/jnci/djv392] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/20/2015] [Indexed: 12/15/2022] Open
Abstract
Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework provides reasoning for explicit decision-making in the face of an actual drug shortage. Moreover, it minimizes bias that might occur when individual clinicians or institutions are forced to make bedside rationing and prioritization decisions and addresses the challenge that individual clinicians face when confronted with bedside decisions regarding allocation. Whenever possible, allocation decisions should be supported by evidence-based recommendations. "Curability," prognosis, and the incremental importance of a particular drug to a given patient's outcome are the critical factors to consider when deciding how to allocate scarce life-saving cancer drugs.
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Affiliation(s)
- Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ).
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Brooke Bernhardt
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Stacey Berg
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Kim Pyke-Grimm
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Catherine Woodman
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
| | - Steven Joffe
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD (YU); Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD (YU); IWK Health Centre, Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada (CVF); Texas Children's Hospital, Houston, TX (BB); Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (SB); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Lucile Packard Children's Hospital, Stanford Palo Alto, CA (KPG); University of Iowa, Iowa City, IA (CW); Department of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (SJ)
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27
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Bauters T, Claus BO, Norga K, Huys I, Simoens S, Laureys G. Chemotherapy drug shortages in paediatric oncology: A 14-year single-centre experience in Belgium. J Oncol Pharm Pract 2015; 22:766-770. [PMID: 26447099 DOI: 10.1177/1078155215610915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shortages of chemotherapy are a growing challenge for the healthcare system. We present the burden of drug shortages of chemotherapeutics in the paediatric hemato-oncology unit of a tertiary care hospital and solutions that were used to manage them. Between January 2001 and December 2014, 54 individual shortages were detected, affecting a total number of 21 different drugs. In total, 4127 shortage days were registered with a mean duration of 196.5 SD ± 144.0 days per individual drug shortage. Methotrexate, doxorubicin and carboplatin had the longest supply disruptions. Solutions to address the problems were purchase of a generic alternative, a change of individual treatment plans, cohorting of patients and import from abroad.
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Affiliation(s)
- Tiene Bauters
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Barbara Om Claus
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Koen Norga
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child Center, Antwerp University Hospital, Edegem, Belgium Faculty of Medicine and Health Sciences, Antwerp University, Edegem, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Geneviève Laureys
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
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28
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Li E, Subramanian J, Anderson S, Thomas D, McKinley J, Jacobs IA. Development of biosimilars in an era of oncologic drug shortages. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:3247-55. [PMID: 26150698 PMCID: PMC4484646 DOI: 10.2147/dddt.s75219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute and chronic shortages of various pharmaceuticals and particularly of sterile injectable products are being reported on a global scale, prompting evaluation of more effective strategies to manage current shortages and development of new, high-quality pharmaceutical products to mitigate the risk of potential future shortages. Oncology drugs such as liposomal doxorubicin and 5-fluorouracil represent examples of first-choice drugs critically affected by shortages. Survey results indicate that the majority of hospitals and practicing oncologists have experienced drug shortages, which may have compromised patient safety and clinical outcomes, and increased health care costs, due to delays or changes in treatment regimens. Clinical trials evaluating novel agents in combination with standard-of-care drugs are also being affected by drug shortages. Clinical and ethical considerations on treatment objectives, drug indication, and availability of alternative options may help in prioritizing cancer patients involved in active drug shortages. The United States Food and Drug Administration and the European Medicines Agency have identified manufacturing problems, delays in supply, and lack of available active ingredients as the most frequent causes of recent or ongoing drug shortages, and have released specific guidance to monitor, manage, and reduce the risk of shortages. The upcoming loss of exclusivity for a number of anticancer biologics, together with the introduction of an abbreviated approval pathway for biosimilars, raises the question of whether these products will be vulnerable to shortages. Future supply by reliable manufacturers of well characterized biosimilar monoclonal antibodies, developed in compliance with regulatory and manufacturing guidelines and with substantial investments, may contribute to prevent future biologics shortages and ensure access to effective and safe treatment options for patients with cancer. Preclinical and clinical characterization is ongoing for potential biosimilars of trastuzumab, rituximab, and bevacizumab, with promising results.
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Affiliation(s)
- Edward Li
- University of New England College of Pharmacy, Portland, ME, USA
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29
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de Lemos ML, Waignein S, de Haan M. Evidence-based practice in times of drug shortage. J Oncol Pharm Pract 2015; 22:566-70. [DOI: 10.1177/1078155215589980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Shortage of oncology drugs is a particularly complicated issue because there are usually limited therapeutic options. Moreover, oncology practice may employ medications for supportive indications which differ from their main usage. This means shortage of oncology drugs is not usually addressed by the major drug shortage guidelines. We have previously shown that, during a shortage crisis, it is possible to make a recommendation on the use of an expired drug supply based on a reasonable estimate of its safety and efficacy. Here, we would like to share further examples on how to deduce potential therapeutic alternatives based on pharmacokinetic and pharmacodynamic principles in the absence of direct clinical evidence in the literature.
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Affiliation(s)
- Mário L. de Lemos
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
| | - Sally Waignein
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
| | - Marie de Haan
- Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC V5Z 1H5, Canada
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30
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Goodman E, Bernhardt MB, Li Y, Aplenc R, Adamson PC. The impact of chemotherapy shortages on COG and local clinical trials: a report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:940-4. [PMID: 25704486 PMCID: PMC4670038 DOI: 10.1002/pbc.25445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/02/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oncology drug shortage is associated with increased patient adverse events and decreased enrollment on clinical trials for adult patients; however, the impact of oncology drug shortages has not been well studied in children with cancer. PROCEDURE The Children's Oncology Group (COG) distributed a 5-item survey to 226 COG site-specific principal investigators (PI's) and 14-item survey to 161 COG pharmacists to gather data the impact of chemotherapeutic shortages on clinical trials and patient care. RESULTS The response rate was 66.4% (150/226) for PI's and 29.8% (48/161) for pharmacists. COG PI's reported daunorubicin (73%), methotrexate (56%), asparaginase/PEG-asparaginase (42%), doxorubicin (26%), thiotepa (21%), and cytarabine (20%) were most commonly in shortage, while COG pharmacists reported daunorubicin (80%), methotrexate (66%), vincristine (21%), thiotepa (41%), asparaginase/PEG-asparaginase (34%), and cytarabine (34%) were most commonly in shortage over the past two years. Pharmacists were twice as likely to report a shortage compared with PI's (OR 2.1, 95% CI: 1.6-2.7, P < 0.0001). Fifty percent (74/147) of COG PI's reported at least one patient enrolled on a clinical trial was impacted by drug shortage, and 66% (98/148) of COG PI's reported at least one patient had clinical care impacted by drug shortage. CONCLUSIONS Chemotherapy shortages remain widespread across institutions, hinder clinical trials, and may contribute to adverse events in children with cancer. The increased frequency of chemotherapy shortages reported by pharmacists suggests that pharmacist efforts may mitigate negative impact chemotherapy shortages. Over half of pediatric institutions are implementing recommendations to address shortages, such as cross-institutional collaboration and center-level guidelines.
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Affiliation(s)
- Elizabeth Goodman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Correspondence to: Elizabeth K. Goodman, AB, Perelman School of Medicine, University of Pennsylvania, 3501 Civic Center Blvd, CTRB 4200, Philadelphia, PA 19146, Tel: 267-426-7252,
| | | | - Yimei Li
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, University of Pennsylvania
| | - Richard Aplenc
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter C. Adamson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Kehl KL, Gray SW, Kim B, Kahn KL, Haggstrom D, Roudier M, Keating NL. Oncologists' experiences with drug shortages. J Oncol Pract 2015; 11:e154-62. [PMID: 25549653 PMCID: PMC4371121 DOI: 10.1200/jop.2014.000380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE There have been numerous reports of shortages of injectable drugs for cancer in the last decade. We assessed physician experiences with drug shortages in a population-based cohort of medical oncologists caring for patients with lung or colorectal cancer. METHODS We surveyed medical oncologists caring for patients with lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium from 2012 to 2013 (participation rate, 53%). Oncologists reported experiences with shortages of leucovorin, fluorouracil, dexamethasone, cyanocobalamin, paclitaxel, cisplatin, and etoposide in the prior year and whether they had used a less-effective alternative because of a shortage. We used multivariable logistic regression to assess for associations between physician or practice characteristics and encountering shortages. RESULTS Among 330 respondents, 74% reported experiences with a shortage of at least one drug in our survey, and 28% reported using a less-effective alternative because of a shortage. Although physician demographic characteristics did not predict reports of drug shortages, practice characteristics did. Veterans Affairs (VA) oncologists were less likely to report experiencing any shortage than oncologists in single-specialty group practice (odds ratio [OR], 0.4; 95% CI, 0.2 to 0.9). The reported use of a less effective alternative to any drug was also less common among VA oncologists (OR, 0.3; 95% CI, 0.1 to 0.9) and oncologists affiliated with health maintenance organizations (OR, 0.4; 95% CI, 0.2 to 0.9) compared with physicians in single-specialty groups. CONCLUSION Most oncologists encountered drug shortages in the year before our survey, but experiences with shortages varied with practice structure. Further research is needed to quantitatively assess the impact of drug shortages on patients and evaluate various strategies for managing them.
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Affiliation(s)
- Kenneth L Kehl
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - Stacy W Gray
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin Kim
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - Katherine L Kahn
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - David Haggstrom
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - Maryse Roudier
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
| | - Nancy L Keating
- The University of Texas MD Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute; Frontier Science & Technology Research Foundation; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of California San Francisco, San Francisco; University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Veterans Affairs (VA) Health Services Research & Development, Roudebush VA; and Indiana University School of Medicine, Indianapolis, IN
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32
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Meyer GE. 2014 Report of the President and Chair of the Board. ASHP: aiming higher. Am J Health Syst Pharm 2014; 71:1409-13. [PMID: 25074965 DOI: 10.2146/ajhp140384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gerald E Meyer
- Gerald E. Meyer, Pharm.D., M.B.A., FASHP, is Immediate Past-President, ASHP, Bethesda, MD
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