Using decision modeling to guide drug allocation during a shortage

作者：Russell Heidi V^*; Bernhardt M Brooke; Berg Stacey

来源：Pediatric Blood and Cancer, 2017, 64(7): UNSP e26331.

DOI：10.1002/pbc.26331

• chemotherapy
• decision model
• drug shortage
• ethics

BackgroundDrug shortages require clinical teams to decide how to allocate drugs in limited supply among their patients. Ethical frameworks are invaluable for promoting rational approaches to drug distribution, but gaps remain between ethical theory and clinical application. The goal of this work was to explore how decision modeling could supplement ethical frameworks to inform drug distribution from the perspective of a clinical team.
ProcedureWe created a hypothetical pediatric oncology clinic with a limited supply of 50,000mg of methotrexate (MTX) and 21 patients due for treatment on one of six regimens. We constructed a simple decision analytic model to compare the effectiveness of MTX in milligrams per life year saved for each regimen. The robustness of the model was tested under various conditions including alternative drug effectiveness and time horizons. Effects on outcomes and distribution by substituting alternative dosing were explored for each regimen.
ResultsPrescribed therapy for this group of patients required 108,791mg MTX. Two regimens for three patients required 20,000mg/m(2). If distributed in order of arrival, only seven patients could receive full treatment. If distributed in order of efficiency, 19 patients could receive treatment. If less effective regimens were substituted, 20 patients could receive treatment. The primary driver of efficiency was dose per square meter.
ConclusionsIn this hypothetical drug shortage, no allocation scenario exists that does not result in a worse outcome for some patients. Evidence of drug efficacy affected the decisions to substitute alternative treatments. First-come-first-served allocation resulted in fewer patients receiving treatment than allocation based on efficiency.

• 出版日期2017-7