The association between drug pricing and drug shortage: A retrospective
Aims: Studies suggested that drug pricing might be a risk factor for
drug shortage; however, a few provided a quantitative assessment of this
possible causal association. This study aimed to assess whether drug
prices are associated with drug shortage incidents. Methods: This was a
retrospective database analysis study. Drugs with shortage notifications
(one drug per notification) that were sent to the Saudi Food and Drug
Authority (SFDA) from Jan/2017 to Dec/2020 by different stakeholders
were included in the study. For each drug, the foreign-to-Saudi-price
ratio (FTSPR) was calculated (FTSPR= mean international price/Saudi
price). Accordingly, drugs were split into three groups: Group 1 (FTSPR
>1]), Group 2 (FTSPR =1]), and Group 3 (FTSPR
<1]). The primary outcomes were the ratio of mean counts
(mCR) between the three groups with Group 3 chosen as a control group.
The study outcomes were analyzed using a negative binomial regression
model adjusting for the measured confounders. All study analyses were
conducted using RSudio Version 1.2.5033. Results: A total of 900 drugs
were included (Group 1=348, Group 2=345, Group 3=209). The mean count of
Group 1 higher was higher than Group 3 (mCR: 1.88; 95% confidence
interval [CI] 1.24 to 2.83), while and mean counts of Group 2 vs.
Group 3 were comparable (mCR: 1.39; 95%CI 0.92 to 2.09). Discussion:
The results of our study showed that shortage was associated with drugs
that are more expensive outside Saudi Arabia. Additional international
studies are needed to explore this causal association.