Changes in Purchases for Intensive Care Medicines During the COVID-19 Pandemic: A Global Time Series Study.
Changes in Purchases for Intensive Care Medicines During the COVID-19 Pandemic: A Global Time Series Study.
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DOI：
10.1016/j.chest.2021.08.007
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发表时间：
2021-12
期刊：
影响因子：
9.6
通讯作者：
Suda KJ
中科院分区：
文献类型：
--
作者：
Callaway Kim K;Tadrous M;Kane-Gill SL;Barbash IJ;Rothenberger SD;Suda KJ
2019冠状病毒病大流行期间，药品供应中断情况有所增加，特别是重症监护室使用的药品。尽管富裕国家报告短缺，但对COVID-19期间ICU药物购买的全球分析有限。COVID-19是否影响了重症监护中使用的第一、第二和第三选择药物的全球药品采购？我们在全球药房销售数据集中进行了一项横断面时间序列研究，该数据集包括约60%的世界人口。我们分析了69名ICU代理人每1,000人购买的单位的流行病相关变化。干预性自回归综合移动平均模型测试了宣布大流行时（2020年3月）以及2020年4月至8月的第一阶段全球和发展状况的重大变化。与2019年相比，2020年3月ICU药物购买量增加了23.6%（95%CI，7.9%-37.9%）（P < .001），然后从4月到8月下降了10.3%（95%CI，-16.9%至3.5%）（P = .006）。第二选择药物的购买变化最大，特别是在发展中国家（例如，2020年3月增加了29.3%）。尽管有类似的相对变化（P = 0.88），发展中国家的绝对购买率仍然很低。从2020年4月到8月观察到的下降仅在发达国家中显著（-13.1%; 95% CI，-17.4%至-4.4%; P < .001）。国家一级的变化似乎无关的预期需求和医疗保健基础设施。在宣布COVID-19大流行的当月，但在感染率达到峰值之前，全球重症监护药物的购买量有所增加。这些变化在第二选择药物中最为明显，这表明在预期与流行病相关的ICU激增时，可能更容易购买廉价的仿制药。然而，在获得服务方面仍然存在差距。趋势似乎与预期需求无关，2020年4月至8月的购买量减少可能表明过度购买。需要制定国家和国际政策，以确保在今后的大流行病期间公平地购买药物。
Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the ICU. Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. Has COVID-19 impacted global drug purchases of first-, second-, and third-choice agents used in intensive care? We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world’s population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April through August 2020, globally and by development status. Relative to 2019, ICU drug purchases increased by 23.6% (95% CI, 7.9%-37.9%) in March 2020 (P < .001) and then decreased by 10.3% (95% CI, –16.9% to –3.5%) from April through August (P = .006). Purchases for second-choice medicines changed the most, especially in developing countries (eg, 29.3% increase in March 2020). Despite similar relative changes (P = .88), absolute purchasing rates in developing nations remained low. The observed decrease from April through August 2020 was significant only in developed countries (–13.1%; 95% CI, –17.4% to –4.4%; P < .001). Country-level variation seemed unrelated to expected demand and health care infrastructure. Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but before peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be purchased more easily in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends seemed unrelated to expected demand, and decreased purchasing from April through August 2020 may suggest overbuying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.
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