Causes and management of drug shortages: A scoping review

BACKGROUND: Drug shortages form a significant global challenge and may lead to treatment delays, increased healthcare costs, and negative health outcomes. Gaining more insight into the causes is crucial to develop interventions to prevent shortages and manage their consequences. This scoping review aims to provide an overview of the causes and management of drug shortages in high-income countries.

METHODS: This scoping review was conducted in accordance with the JBI methodology. A comprehensive search was performed in PubMed, EMBASE, Web of Science, and CENTRAL on December 21, 2023. Studies published in English or Dutch on the causes and management of drug shortages in high-income countries were included. Two reviewers independently screened titles/abstracts and full texts. Relevant data on study characteristics, causes, and interventions were extracted using a standardized form. Findings were analysed descriptively.

RESULTS: Thirty-six studies were included out of 4531 citations. Causes of drug shortages included manufacturing issues, fluctuating demand and market forces, poor supply chain management, political and strategic decisions, and external influences. Several studies emphasized that causes were frequently unknown. Interventions to manage shortages focused on alternatives and substitutions, inventory management, communication and coordination, regulatory and policy measures, and forecasting. While causes are primarily linked to early stages of the product life cycle, most interventions occur at later stages and tend to be reactive.

CONCLUSIONS: Most current interventions focus on temporary solutions at the end of the supply chain, while shortages often originate earlier. A focus on early-stage causes is needed for more effective, preventive solutions.