Drug shortages in a state-owned academic hospital during the COVID-19 pandemic in Ecuador

Abstract

Background During a pandemic, medical supplies are at increased risk of being depleted rapidly. The COVID-19 sanitary emergency has generated global shortages in critical supplies, like personal protective equipment and medicines. This study aimed to describe the pharmaceutical procurement challenges to overcome medicine shortages in a state-owned academic hospital during the COVID-19 pandemic in Ecuador. Methods We conducted a cross-sectional study using secondary administrative data of documented public tenders for medicines and drug prescriptions for the critical care unit at Hospital Pablo Arturo Suárez in Quito, Ecuador. The occurrence of shortages, their frequency, and the procurement mechanisms used to overcome them were documented by the pharmacy service between January 1st and July 31th, 2020. The units purchased and unitary price of pharmaceuticals procured by the hospital was also documented and compared to data from 2019. Results From 38 medicines analyzed from 12 ATC groups, there were 84 shortages during the sanitary emergency period covered by the study, and 25 medicines had one or more shortages. Norepinephrine and midazolam shortages were most frequent. Retail or emergency direct purchase and loan-stock from other public hospitals were the main procurement methods to overcome the shortages. The purchase mechanism directly influenced the price. Drugs purchased in small tenders via retail or emergency direct purchase had the most significant price increase (up to 819%), while medicines acquired via the electronic catalog managed by the public procurement service experienced no price changes. Conclusion Monitoring and responding to drug shortages during a pandemic can be challenging, and governments must adapt quickly, providing specific guidance on how to deal with shortages.