Causes and consequences of drug shortages

充足的药品供应是实现全民保健覆盖的关键方面的根本。然而，新冠肺炎大流行中断了基本药物的供应，危及了人们获得护理的机会。在德国，在2020年3月至6月期间，据报道，116种药物展示供不应求。其中包括用于治疗患有严重新冠肺炎症状的患者的药物，如用于使危重患者和需要呼吸机的患者镇静的异丙酚。药物短缺反映出缺乏足够的(基本)药物，至少在国家一级供应不能满足需求的有限时间内是如此。在新冠肺炎大流行之前，药物短缺存在于许多治疗领域，从复杂的可注射癌症药物，廉价的产品，如生理盐水，到大容量药物，如治疗常见高血压的valsartan。该项目分析了药物短缺的原因和后果。我们的目标是开发一个框架，帮助确定跨越经济学、管理学和医学学科的药物短缺的原因。与描述美国情况的绝大多数现有证据不同，我们将重点关注欧洲医疗体系提供的医疗服务，特别是德国、奥地利和瑞士报告的短缺情况。此外，我们将提供新的数据来源，以描述欧洲报告的药物短缺的范围，对药物短缺的原因进行分类，并在国家一级对药物短缺的驱动因素进行因果分析。具体地说，我们的目标是描述药品供应链，并确定由于新冠肺炎疫情造成的中断，供应链框架内的瓶颈。我们将规划各国政府和卫生保健系统为克服这种干扰而采取的所有全球和区域政策和行业措施。然后，我们将经验性地确定供应链、监管和治理相关方面导致特定卫生系统药物短缺的因果影响。其目标是结合国家药品短缺报告系统、贸易流量、价格、监管和治理系统中关于药品短缺的产品级数据，并进行计量经济学分析。然后，我们将使用一个医疗保险系统中的医疗保险索赔数据，分析药品短缺对一个特定医疗保健系统(瑞士)的医疗保健成本的影响。我们的工作重点将是新冠肺炎疫情带来的形势以及由此带来的药品供需变化。

Adequate supply of medicines is fundamental to the achievement of key aspects of universal health coverage. The COVID-19 pandemic however, has jeopardized access to care by interrupting the supply of essential medicines. In Germany, between March and June 2020, 116 drug presentations were newly reported to be on short supply. Among them were medicines to treat patients suffering from severe symptoms of COVID-19 such as probofol used to sedate patients in critical care needs and in patients requiring ventilation.Drug shortages reflect the lack of sufficient access to (essential) medicines, at least for a limited amount of time where supply cannot meet demand at a national level. Before the COVID-19 pandemic, drug shortages were present in many fields of therapy from complex injectable cancer drugs, inexpensive products such as saline, to high volume drugs such as valsartan to treat common high blood pressure.This project analyzes the causes and consequences of drug shortages. We aim to develop a framework that aids in identifying causes of drug shortages across economics, management, and medical disciplines. Unlike the vast majority of the existing evidence that describes the situtation in the United States, we will focus on health care provided by European health care systems and particularly shortages reported in Germany, Austria and Switzerland. Moreover, we will make accessible new data sources to characterize the scope of drug shortages reported in Europe, classify the causes of drug shortages and perform causal analysis of the drivers of drug shortages at national level. Specifically, we aim to describe the pharmaceutical supply chain and identify bottlenecks within the supply chain framework, due to the interruptions caused by the COVID-19 pandemic. We will map all global and regional policy and industry measures taken by governments and health care systems to overcome such interruptions. We will then empirically identify causal effects of supply-chain, regulatory and governance related aspects that lead to drug shortages in a particular health system. The objective is to combine product level data on drug shortages from national reporting systems of drug shortages, trade-flows, prices, regulatory and governance systems, and perform econometrics analysis. We will then turn to analyzing the consequences of drug shortages on health and health care cost in one particular health care system (Switzerland), using health insurance claims data in one health insurance system. The focus of our work will center on the situation arising from the COVID-19 pandemic and the resulting changes in supply and demand of medicines.