The COVID-19 pandemic affected the stable supply and demand for drugs in the Hospital. For example, to cope with the pandemic situation, an increased cost of NTD 14.61 million would be required an increasing stock of three months for 90 drugs that require APIs from China. In this study, it is important to notice that no drug needs an increasing stock of 12 weeks. Therefore, according to the risk assessment level of each drug, it only needs to increase the purchase amount by NTD 4.85 million, which can reduce the inventory cost by 2/3 (66.8%). The results show that there are significant differences between scientific structured inventory management and general method.
In addition, R0 is used to assess the severity and continuity of most infectious diseases, and the R0 value varies at different times and locations. Therefore, the R0 value in the middle (pharmaceutical production) and upper (raw material production) reaches of drug supply is closely related to the stability of the medication supply chain. In this study, the drug inventory was considered to be positively correlated with the R0 value, so the R0 value was taken into account in the risk assessment. Therefore, if the R0 value varies, the backup stock of drugs will be adjusted simultaneously. However, there is no mathematical equation for the relationship between R0 and backup stock of drugs. In the future, the mathematical model on the number of days of backup stock based on R0 can be established for the situation of COVID-19 or other pandemic emerging infectious diseases.
Most of the potential drug shortage risks are difficult to detect when they do not occur. To predict the potential impact of drug shortage depends on the sensitivity and attention of the drug supervisor to the risk of drug shortage, as well as their accumulation of experience in the event of drug shortage. Therefore, the daily management of drug shortage risks can help to cope with more unpredictable drug supply problems. The following three daily management mechanisms can be used as a reference for other hospitals.
(1) Monitoring of the information on the medication shortages in real time
Due to the development of network information, the information about the shortage of APIs in the global drug market, contamination in the drug manufacturing process or defective products spread on the Internet more quickly than ten years ago. Hospitals can establish a real-time monitoring mechanism of the medication supply chain to collect data. For example, it is to regularly update news about the international supply shortage, such as the substantial increase in the cost of blood preparation caused by the infection of bovine blood or the impact of African swine fever on the production process of Heparin in China. Only with real-time and sufficient information, hospitals can seek early response plans to resolve drug shortages .
(2) Principle of decentralized drug procurement
Based on the principle of risk spreading, even if a certain drug supplier has a complete range of drugs and the price is cheap, the hospital should not be centralized procurement from the manufacturer, it is advisable for the hospital to purchase different kinds of drugs from several drug suppliers instead of a single supplier to reduce the risk of drug shortage. In addition, when drugs with unstable supply are detected, other alternative suppliers should be found immediately. Take Hydroxychloroquine (formerly used to treat malaria and immunomodulators) which can be used for emergency treatment COVID-19 announced by FDA as an example , after the announcement, a large number of orders have been made from various countries and hospitals, resulting in the unstable supply of the drug. To avoid the impact caused by drug shortage, the Hospital purchased Hydroxychloroquine from another drug supplier for standby. Although purchasing drugs with the same ingredient from different suppliers increases the management cost, it can reduce the clinical treatment impact caused by the inability to supply of a single supplier.
(3) Contract management of low-alternative drugs
Low-alternative drugs can be listed through a comprehensive review of the standing drugs of the hospital. The definition of low-alternative drugs is that (1) drugs that must be used for clinical treatment such as Heparin and Digoxin; (2) exclusive drugs in the drug market, such as the Glypressin® (Terlipressin) for esophageal variceal bleeding, and the anticancer drug, Alkeran® (Melphalan). With regard to low-alternative drugs, we should not only take the price as the basis for judging whether to purchase or not, but also fully evaluate the supply status and raw material source of the drug supplier in the procurement negotiation, and we should sign a continuous supply contract, which can avoid or decrease the impact of the shortage. In addition, we can also increase the safety days of inventory for low-alternative drugs to avoid the impact of the short-term drug shortage.