COVID-19疫情期間醫院藥品庫存風險評估與管理

Risk Assessment and Management of Drug Inventory in Hospitals during COVID-19 Pandemic in Taiwan

COVID-19疫情造成全球藥品最大供應鏈源頭，中國之原料藥生產停工導致製藥廠無原料可繼續生產，衍生醫院藥品庫存不足進而影響臨床治療之潛在風險。若單純將全醫院藥品庫存量拉高固然可降低短期缺藥風險，但相對也會增加醫院藥品之庫存成本（Inventory costs）。故本研究希望以原料藥來自中國之藥品為例，藉由建立庫存管理之風險評估機制，找出各項藥品短缺時影響醫療之優先排序，進而擬定不同因應做法以達到庫存管理的最佳效益。本研究制訂藥物庫存風險的「缺藥發生機率表」及「缺藥衝擊程度表」，分別各列4個等級進行評估，並參考R0值及疫情預測的模式資料，依照缺藥發生機率與衝擊程度設計「缺藥風險評估矩陣」將原料藥來自中國的每個藥品進行評估後進行危害指數排序，以對應增加不同週數之備量庫存與尋找替代品之行動策略。本研究成功地透過風險評估機制偵測本醫院原料來自中國的藥品庫存風險等級，依照等級高低增加不同備量庫存週數，整體僅需增加採購金額485萬元，與全部訂購三個月備量庫存1,461萬元相較，約可降低三分之二庫存成本。由此研究結果得知科學結構化庫存管理與傳統思維庫存管理之顯著差異。希望藉由本研究於COVID-19防疫期間藥品庫存風險評估之手法與新思維，提供其他醫療機構或衛生主管機關於面臨其他新興傳染疾病或其他重大突發事件時，對於藥品庫存量的調整有一完整且可供依循的之參考。

The COVID-19 pandemic has caused the suspension of active pharmaceutical ingredients (APIs) production in China, the source of the global largest medication supply chain, resulting in the potential risks of hospital insufficient drug stocks affecting clinical treatment. If all drug inventory of the hospital increased, the short-term drug shortage risk can be reduced, but the inventory costs will be increased. Therefore, the purpose of this study is to establish a risk assessment mechanism for inventory management of APIs from China, to identify the medical priorities affected by drug shortages, and to plan different countermeasures to achieve the best effect of inventory management. In this study, the tables of ''Incidence of Drug Shortage'' and ''Impact Level of Drug Shortage'' related to the risk of drug inventory were developed, which were evaluated in four levels respectively, and ''Drug Shortage Risk Assessment Matrix'' was designed according to the probability of drug shortage and impact according to the model data of Reproductive Number (R0) value and pandemic prediction. Each drug requiring APIs from China was evaluated and ranked according to the hazard index, so as to increase the different inventory and to find alternatives. We have evaluated the inventory risk level of drugs requiring APIs from China through the risk assessment mechanism, and increased the different backup stock according to the levels. The total increasing purchase amount was NTD 4.85 million, which could reduce the stock cost by about 2/3 compared with NTD 14.61 million of the total inventories for three months. The study shows that there are significant differences between scientific inventory management and general method during COVID-19 pandemic. It can provide a reliable reference for other hospitals to adjust drug stocks in the face of other emerging infectious diseases or major emergencies by using the innovative mechanism.