Anti-cancer medicine shortages in an oncology tertiary hospital of Pakistan: A five-year retrospective study

Abstract

Objective Anti-cancer medicine shortages are advancing challenges for patients and hospitals. This study aims to evaluate anti-cancer and supportive medicine shortages in a tertiary hospital in Pakistan and propose solutions. Method A retrospective observational research was performed in a tertiary care hospital in Pakistan from 2016 to 2020. Data was retrieved from the hospital database using a questionnaire regarding short medicines’ generic name, brand, dosage, source, total source, frequency, causes, impact, management, and analyzed by Microsoft Excel 2013. Results Between January 2016 and December 2020, 43 individual medicine shortages were observed, with an average of 8.6 shortages per year. There were shortages of 22 medicines, including 8 anti-cancer (36.4%) and 14 supportive agents (63.6%). Total shortage days were 27,100, with an average of 1232 days (SD 757) per medicine. Supportive medicines’ shortages were frequent, but oncology agents’ shortages were constant. The most affected dosage form was injection. Cardiovascular drugs and alkylating agents were the most affected class in supportive and anti-cancer medicines, respectively. The use of “alternative medicine” and “patient needs based importation” were the most common mitigation strategies. Conclusion Shortages of oncology medicines are challenging in Pakistan. The most prominent causes are the lack of updated governmental regulations, registration, and import issues. The tertiary care hospital has very few sources of supply, so it imports these drugs on a need basis to manage the shortages. But it is still concerning because of the huge financial burden on patients and institutions due to expensive import, and therapy become delayed as the import process takes time. Moreover, the most affected drug class was alkylating agents, and dosage was both injectable and oral medicines.

Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study

“…According to a study in Ghana, the compromised role of the drug regulatory authority is the main reason for the lack of access and shortages of necessary medicines in LMICs [ 29 ]. A recent study from Pakistan also highlighted regulatory issues as the prominent cause of shortage [ 17 ]. Some causes related to other stakeholders are the presence of a single supplier/drug, lack of resources, lack of communication among stakeholders, and small market size.…”

“…The impacts of anti-cancer drugs shortage in Pakistan, a low-income country with the absence of a national cancer registry/drug shortage platform [ 17 ], increasing cancer cases and fewer registered drugs [ 17 ], are underestimated. Most participants highlighted suboptimal treatment and delayed treatment along with increased out-of-pocket costs.…”

“…Managing within the country would be challenging since few suppliers supply the drugs throughout countries so most probably the short drug in one institution will be short in others too [ 17 ]. Moreover, pharmacists or patients themselves have to purchase drugs from the gray market, where the short drugs are expensive and have compromised efficacy.…”

“…In this case, the out-of-pocket cost for the patient will increase more due to purchasing expensive drugs [ 33 ]. Furthermore, arranging through import is an expensive and lengthy process that lags the treatment duration of the patients who are already vulnerable to a chronic condition at a specific disease stage [ 17 ].…”

“…The country is a big pharmaceutical hub but imports most of its cancer drugs from other countries. With the increasing cancer burden [ 13 , 14 ], absence of a national cancer registry/drug shortage reporting system [ 15 , 16 ], the compromised role of drug regulatory authorities, outdated drug policies [ 17 ], inadequate treatment facilities [ 18 ], few research studies [ 4 , 17 ], and low availability, the shortages of these drugs further make this issue challenging [ 17 , 19 ]. A study conducted in a tertiary care hospital also found a severe shortage of anti-cancer drugs [ 17 ].…”