Drug Shortages: Impact on U.S. Health Systems

Drug shortages are costing U.S. hospitals $359 million a year, and wasting an additional 8.6 million hours of people’s time, according to the results of a recent inaugural survey by Vizient, Inc. 

“We know that, looking just at additional labor costs, the impact to U.S. hospitals annually is at least $360 million,” said Dan Kistner, senior vice president, pharmacy solutions for Vizient, in a prepared statement. “When you also add the cost of more expensive alternative therapies, direct purchases outside the hospital’s traditional channels, medication errors and cancelled or delayed medical procedures, we believe the actual cost of drug shortages to hospitals is significantly higher.”

More than 360 respondents from acute and nonacute care facilities participated in the study, responding to questions about the amount of drug shortages pharmacists face, key drug classes involved in the shortages, how pharmacists mitigate these shortages, and how shortages are affecting budget. 

Of the respondents, 84% worked in an individual facility, while 67% designated themselves as pharmacy leadership, 25% were pharmacy frontline staff, and 4% were health system leadership.

According to the responses, controlled substances, local anesthetics, crash cart drugs, antibiotics, and electrolytes were among to the five drug categories whose shortages had the biggest impact on Vizient member facilities. 

Between July and December 2018, 64% of respondents reported managing more than 21 drug shortages, 33% reported 6 to 20 shortages, and 3% reported less than 5 shortages. 

As a result, respondents said the drug shortages have negatively impacted direct costs, indirect costs, and staffing. 

Most respondents said that drug shortages cause increases in the health system’s drug budget, cause the pharmacy to lose revenue from cancelled infusions and procedures, force reallocation of resources which leads to lost productivity in other areas, induce documented medication errors, and increase the number of full-time pharmacy and technician employees required to manage shortages. 

Managing drug shortages requires an extensive amount of time, according to respondents. Pharmacists, pharmacy technicians, and informatics pharmacists reported an additional average of 9.3 hours, 7.6 hours, and 3.8 hours per week, respectively.

forty-four percent of respondents said that their health system mitigates drug shortages by requiring staff overtime, compared with 46% of respondents whose health system opts to redistribute workflow. Only 10% of respondents said that their health system chooses to hire new staff to mitigate drug shortages.

Respondents also said that drug shortages result in patient delays or cancellations of treatment and increase the threat of medication errors. The top five most reported negative impacts on patients, according to the Vizient report, included delays in medication inpatient setting, delays in outpatient infusion, delays in medical procedures, delays in immunization, and the cancellation of outpatient infusions. 

Results from a six-month period between July and December 2018 indicated that 38% of one or more medication errors are directly related to a drug shortage.

Some of the most popular methods for combatting shortages and subsequent challenges reported by respondents include: 

• Implemented processes to restrict duration of therapy

• Formed task forces or committees dedicated to addressing shortages and allocations 

• Adjusted electrolyte replacement guidelines 

• Purchased alternative presentations

• Increased stock of medications anticipated to be in limited supply

• Used unit dosing 

• Restricted use of short drugs to approved indications or populations deemed most needed

• Adjusted par levels

• Elected to use smaller, appropriate volume IV product to prevent waste 

• Increased “hang time” for continuous IV fluids or transitioned meds form intermittent/continuous infusion to IV push.