• Callaway KimKatherineKDepartment of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Electronic address: KAC377@pit, Mina Tadrous, Sandra L Kane-Gill, Ian J Barbash, Scott D Rothenberger, and Katie J Suda.
• Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Electronic address: KAC377@pitt.edu.
• Chest. 2021 Dec 1; 160 (6): 2123-2134.

BackgroundDrug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the ICU. Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited.Research QuestionHas COVID-19 impacted global drug purchases of first-, second-, and third-choice agents used in intensive care?Study Design And MethodsWe conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April through August 2020, globally and by development status.ResultsRelative to 2019, ICU drug purchases increased by 23.6% (95% CI, 7.9%-37.9%) in March 2020 (P < .001) and then decreased by 10.3% (95% CI, -16.9% to -3.5%) from April through August (P = .006). Purchases for second-choice medicines changed the most, especially in developing countries (eg, 29.3% increase in March 2020). Despite similar relative changes (P = .88), absolute purchasing rates in developing nations remained low. The observed decrease from April through August 2020 was significant only in developed countries (-13.1%; 95% CI, -17.4% to -4.4%; P < .001). Country-level variation seemed unrelated to expected demand and health care infrastructure.InterpretationPurchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but before peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be purchased more easily in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends seemed unrelated to expected demand, and decreased purchasing from April through August 2020 may suggest overbuying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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