Impact of the economic crisis and drug shortage on Lebanese cancer patients’care

BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.

Enlightenment and Suggestions on the Construction of Information Platform and Processing Mechanism of Drug Shortages in Developed Countries to China

Objective To study how to improve and perfect the information platform and processing mechanism of drug shortages in China.Methods By searching the relevant policies from official websites of FDA,European Medicines Agency(EMA),Health Canada(HC)and National Health Commission,the good experience of the United States,the European Union and Canada in the construction of information platform and processing mechanism of drug shortages was summarized for reference in China.Results and Conclusion China has initially established the processing mechanism of drug shortages,but the platform construction should be improved,and the information disclosure of drug shortages varies from province to province.We should improve the information platform of drug shortages,strengthen the disclosure and communication of information,enrich the processing tools and measures after the drug shortages occurs,and strengthen the cooperation with relevant associations and other non-governmental departments.

Effect of the Policies to Prevent Drug Shortage and Stabilize Drug Prices in Medical Institutions

Objective To evaluate the effect of some policies to prevent drug shortage and stabilize drug prices,and to provide reference for improving relevant policies.Methods With a combination of random stratified sampling and quota sampling,532 medical institutions in 20 provinces were selected to carry out questionnaire surveys.Then,a comparative analysis was made to study the changes of drugs on the shortage list and drugs on non-shortage list before and after the release of the policy of ensuring supply and stabilizing prices.Results and Conclusion The policy played an important role in curbing the growth of drug shortage in the medical institutions,but it did not curb the growth of drugs on non-shortage list.Besides,the drugs on non-shortage list showed an overall fluctuation and upward trend.Meanwhile,from the perspective of drug prices,the price stability problem of drugs on the shortage list and on the non-shortage list became more serious,and the average price increase was 256% and 239%,respectively.The implementation of policies related to the supply and price stability of drugs prevents the growth trend of drug shortages in the list of medical institutions,which has been recognized by most medical institutions.However,there is an increasing trend in the number of drugs on non-shortage list.In addition,the price increase of drugs on both the shortage list and non-shortage list is severe.Some medical institutions report that they have difficulties in using the information reporting system of drug shortage and the classification,grading and the alternative use of drug shortages.It is recommended to strengthen the management of price stabilization of drugs on the shortage list.Further attention should be paid to the supply and price stabilization of drugs on non-shortage list.At the same time,trainings in the classification and substitution of drug shortage and information reporting system should be actively organized,thus comprehensively improving the capabilities of medical institutions at all levels to deal with the problem of drug shortage.

Analysis on Causes of Drug Shortages and Countermeasures

Objective To analyze the causes of drug shortages in China and put forward some countermeasures and suggestions accordingly.Methods Based on the relevant data of 14 provinces that issued the lists of drug shortages from 2018 to 2020,377 kinds of drugs were sorted out first,and then the features of shortage were analyzed descriptively.Finally,the degree and causes of shortage were studied based on field investigation and literature summary.Results and Conclusion Among the drugs in short supply across the country,69.2%of them were listed in the National Medical Insurance Catalogue,37.1%were essential drugs and 26.5%were low-price drugs.They were used for different diseases,and most were for treating nervous system and blood system.There were many reasons for drug shortages.For instance,any problems in supply chain(production,circulation,use)could lead to drug shortages,of which the production accounted for the largest proportion.This paper puts forward targeted measures to solve drug shortages from the aspects of unwillingness and inability of manufacturing enterprises in their production.

Reference of New Zealand’s Drug Shortage Management Measures

Objective To provide a scientific reference for China’s drug shortage and supply mechanism by conducting a specific study on New Zealand’s management measures for dealing with the shortage of drugs.Methods Through reviewing the official website of the New Zealand Pharmaceutical Management Agency(PHARMAC)and relevant literature,the specific measures to deal with drug supply and shortage in New Zealand were sorted out,and then some countermeasures were put forward for our domestic drug supply.Results and Conclusion PHARMAC worked closely with the pharmaceutical suppliers and signed contracts to maintain their relationship.A sound drug supply mechanism has been established to respond to various supply issues.At present,there are some problems in drug supply in China,such as the lack of timely publicity of shortage information,the lack of management team for supply,and the lack of alternative drug supply mechanism.China should learn from the PHARMAC to establish a supply contract management team to promote the transparency of drug shortage information and seek alternative drug supply actively.

Cause Analysis and Preventive Measures of Drug Shortage

Objective To study the current situation and the root cause of drug shortage in China, and put forward countermeasures and suggestions accordingly for relevant national policy decisions. Methods Based on literature research, questionnaire survey and expert consultation, the causes of drug shortage in China were comprehensively investigated, and fishbone diagram was used to further analyze the logical relationship among the causes. Results and Conclusion The main reasons for the shortage of drugs are the low profit of production enterprises and insufficient active pharmaceutical ingredients (APIs). The other reasons include uncertain demand, standard problem and few exclusive manufacturers. Besides, the monopoly of circulation enterprises also leads to the shortage of drugs to a certain extent. It is suggested that we should increase the punishment of monopoly, optimize the market environment, and establish a reasonable drug price mechanism. In addition, enterprises should participate in the information communication platform of medical institutions to solve the asymmetry between supply and demand. The research on clinical drugs to substitute drugs in need should be strengthened, and the reporting system of drug discontinuation should be improved.