(101) Changes in Anticoagulant and Antiplatelet Drug Supply at US Hospitals During The COVID-19 Pandemic

Publication Number: 775

Background: This study describes supply trends of anticoagulants and antiplatelets at United States (US) hospitals during the COVID-19 pandemic, highlighting the need for institutional strategies to manage drug supply in the setting of ongoing shortages.

Objectives: The objective of this research was to describe the trends in supply of anticoagulants and antiplatelets at US hospitals during the COVID-19 pandemic.

Methods: We used IQVIA National Sales Perspective (NSP) monthly projections of the total volume of medications purchased by US hospitals, focusing on anticoagulants and antiplatelets. Medication volume is standardized using extended units (EUs), calculated by multiplying the number of product units or packages by the package size. We calculated the total monthly EUs for predefined drug categories (aspirin, oral anticoagulants, oral antiplatelets, parenteral anticoagulants, parenteral antiplatelets) and specific medications between January 2018 and February 2021. We then determined mean volumes over 3 month periods to account for monthly variations. We also determined the year-over-year (YoY) change in supply by comparing the volume in a period in a given year with the volume in the same period of the previous year. Volumes were compared between the COVID-19 pandemic period (April 2020 onward) and the pre-pandemic period (March 2020 and earlier). These dates aligned with the US declaration of a national emergency in March 2020.

Results: At the start of the COVID-19 pandemic, there was a 43.7% decline in the total volume of anticoagulants and antiplatelets at US hospitals between March 2020 and April 2020, falling from approximately 450 million EUs to 255 million EUs. The 3 month average total volume in the period prior the the pandemic (January 2020 - March 2020) was 403 million EUs (95% CI: 299 million - 507 million), which fell to 318 million EUs (95% CI: 234 million - 403 million) in the 3 months after, representing a 21.1% decline. The 3 month average total volume subsequently increased 27.6% and 6.7%, respectively, in the subsequent periods. The YoY change in supply was negative for aspirin (-27.5%), oral anticoagulants (-4.6%), oral antiplatelets (-20.3%), parenteral anticoagulants (-23.1%), and parenteral antiplatelets (-37.0%) from April 2020 through June 2020. While YoY change became positive for oral (8.8%) and parenteral anticoagulants (11.9%) by the year end, it remained negative for aspirin (-14.0%), oral antiplatelets (-0.7%), and parenteral antiplatelets (-11.5%).

Conclusions: Though the onset of COVID-19 pandemic corresponded to a decrease in antithrombotic supply at US hospitals, volume returned to prepandemic levels. As the pandemic exacerbates drug shortages, institutions must develop strategies to best allocate limited resources.