Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the intensive care unit (ICU). Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited.
Has COVID-19 impacted global drug purchases of first, second- and third-choice agents used in intensive care?
We 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 (ARIMA) models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April to August 2020, globally and by development status.
Relative to 2019, ICU drug purchases increased by 23.6% (95% CI: 7.9-37.9%) in March 2020 (P-value<0.001), and then decreased by 10.3% (95% CI:-16.9 to -3.5%) from April to August (P-value=0.006). Purchases for second-choice medicines changed the most, especially in developing countries (e.g.: 45.8% increase in March 2020). Despite similar relative changes (P-value=0.88), absolute purchasing rates in developing nations remained low. The observed decrease from April to August 2020 was only significant in developed countries (-13.1%; 95% CI: -17.4 to -4.4%; P-value< 0.001). Country-level variation appeared unrelated to expected demand and healthcare infrastructure.
Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but prior to peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be more easily purchased in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends appeared unrelated to expected demand, and decreased purchasing from April to August 2020 may suggest over-buying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.

Copyright © 2021. Published by Elsevier Inc.