Multidose Drug Dispensing and Drug Shortages A Quantitative Analysis

Abstract

III. Summary/ Abstract Objective: The primary objective of this thesis is to explore the impacts of drug shortages on Multidose Drug Dispensing (MDD) system, and assess how MDD practices, particularly those relating to wholesaler prioritization and the system for safety stock, affect drug shortages. Methods: The study is primarily based on a descriptive quantitative analysis but supported by qualitative data that aimed at detailing the multidose production process. Results: Among the drugs packed in the MDD system during 2022 and 2023, our study identified Panodil 1gm, Acetylsalisylsyre 75mg, and Calcigran Forte 500mg/400IE as the most frequently packaged drugs. Regarding the impact of drug shortages on MDD, we found that among all drugs packaged within Apotek 1 multidose for 2022 and 2023, over 78% did not experience any shortages. The national drug shortage report reached its peak in 2019 and was at its lowest in 2018, whereas Apotek 1’s multidose system reported highest shortages in 2018 and the fewest in 2019. Compared to 2018, Apotek 1's multidose system has demonstrated a significant reduction in shortage reports, with a p-value of less than 0.01 for each consecutive year from 2019 through 2022. This clearly indicates an effective and sustained decrease in shortages over this period. On the other hand, our research on the impact of MDD on drug shortages is inconclusive, showing potential for both positive and negative effects.

Additionally, while foreign-packaged drugs account for only 8% of the total drugs in the MDD system, they represent 25% of the total number of tablets/capsules packed annually due to their larger sizes, enhancing MDD efficiency and reducing the probability of drug wastage. However, their impact on mitigating shortage problems was found to be minimal. This is because in 2022 and 2023, foreign packs could potentially resolve only 6% of drug shortage problems within the MDD.

Our packaging analysis indicates that 44% of drugs in the MDD system are supplied in formats that require deblistering of tablets and capsules. This process potentially increases the likelihood of drug wastage during the repackaging process.

Keywords: Multidose drug dispensing (MDD), drug shortages, foreign packages, safety stock, Apotek 1.