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Critical medicines supply modelling supports return to elective surgery
Statement from the Medicines Shortages Working Party
New modelling demonstrates that current and anticipated supply of critical medicines for ventilating patients is sufficient to support both a return to elective surgery and a rise in COVID-19 cases.
The modelling was undertaken as part of a coordinated effort to manage medicines supply during the COVID-19 pandemic by the Therapeutic Goods Administration (TGA) within the Department of Health, the pharmaceutical industry and medicines wholesaler groups, health professional bodies and state and territory health departments.
The modelling, combined with information from sponsors about current stock and future deliveries, indicates that anticipated supply of sedatives, neuromuscular blocking agents and analgesic medicines from June to October is sufficient for usual surgical activity in addition to 200 intensive care unit (ICU) beds per month to be occupied with ventilated COVID-19 patients - or ICU management of approximately 1750 COVID-19 patients over this time.
A total of 50 patients with COVID-19 in Australia have been admitted to ICU and received ventilation.
Since the emergence of COVID-19 in Australia, the TGA has been working with the members of the Medicine Shortages Working Party to monitor supply of critical medicines used in the intensive care setting, and to identify and respond to medicine supply issues as they arise.
Some hospitals and health professional groups have raised concerns that supply of intensive care medicines in Australia may not be sufficient to support a rise in COVID-19 cases requiring intensive care as elective surgery recommences. These concerns arose in March and April when many hospitals' orders for critical medicines were only being partially filled. As purchasing increased to prepare to operate additional ventilated ICU beds, medicine sponsors reported supplying significantly increased quantities of critical ICU medicines, but actively limited orders and held some reserve stocks to allow for equitable allocation and emergency supply.
The current modelling does not take into account stock already held by hospitals, which would support a further increase in ICU capacity given that medicines stock levels will be increased due to the cessation of elective surgery, lower than expected COVID-19 case numbers, and increase in supply in March and April.
The estimates derived from the modelling will be used by the Department of Health to work with industry and health professional groups to monitor and manage medicines supply during the pandemic for ICU management of COVID-19 patients and for elective surgery.
The model was developed with advice from a working group including representatives of state and territory health departments, anaesthetists, intensivists and the TGA, chaired by Professor Michael Dooley, Director of Pharmacy at the Alfred Hospital in Melbourne.
The Medicines Shortages Working Party is chaired by the Australian Government Department of Health and includes:
- Australian Commission on Safety and Quality in Health Care
- Australian Medical Association
- Chemist Warehouse
- Consumer Healthcare Products Australia
- Generic and Biosimilar Medicines Association
- Medicines Australia
- National Pharmaceutical Services Association
- Pharmaceutical Society of Australia
- Pharmacy Guild of Australia
- Society of Hospital Pharmacists Australia
- TGA Licensed Compounders
Additional information about the modelling, including graphs portraying projected national demand for key ICU medicines, is available in the documents below.
- Background paper: National demand model for ICU medication for COVID-19 treatment (pdf,123kb)
- Background paper: National demand model for ICU medication for COVID-19 treatment (docx,33kb)
- Supporting graphs: National demand model: ICU medicines required for ventilation of COVID-19 patients (pdf,421kb)
A: The Medicine Shortages Working Party (MSWP), chaired by the Department of Health, consists of the following healthcare, health professional, pharmaceutical industry and wholesaler groups:
- Australian Commission on Quality and Safety in Healthcare (ACQSHC)
- Australian Medical Association (AMA)
- Chemist Warehouse
- Consumer Health Products Australia (CHPA)
- Generic and Biosimilar Medicines Association (GBMA)
- Medicines Australia (MA)
- National Pharmaceutical Services Association (NPSA)
- Pharmaceutical Society of Australia (PSA)
- Pharmacy Guild of Australia
- Society of Hospital Pharmacists of Australia (SHPA)
- TGA Licenced Compounders
A: The purpose of the Medicine Shortages Working Party, originally formed in 2017, is to facilitate a coordinated approach to the identification and management of medicines shortages issues as they arise.
The Working Party aims to improve medicine shortage reporting, communications, and mitigation across all aspects of the supply chain.
During the pandemic we have been meeting weekly to discuss and resolve shortage issues.
A: In Australia, the states and territories are largely responsible for purchasing medicines for use in hospitals.
Some hospitals and health professional groups have raised concerns that supply of intensive care medicines in Australia may not be sufficient to support a significant rise in COVID-19 cases as elective surgery recommences.
The number of COVID-19 cases requiring intensive care in Australia remains very low. As of 3 June 2020 only two patients in Australia are requiring ventilation and as of 17 May 2020 a total of 50 patients have required ventilation in Australia during the pandemic. National demand forecast modelling helps to clarify the amount of medicine supplies that may be needed should the number of cases increase in the future.
Of course, medicine supplies are only one aspect that would be considered in any public health response should the number of cases increase.
A: A working group convened by the Department of Health undertook the modelling. The working group includes representatives of state and territory health departments, anaesthetists, intensivists and the Department of Health, chaired by Professor Michael Dooley, Director of Pharmacy at the Alfred Hospital in Melbourne.
A: The estimates from the modelling will be used to help inform medicine sponsors (also known as manufacturers or pharmaceutical companies) of the potential quantities required for future orders made by states and territories.
The modelling will also be used by the TGA to continue to monitor the adequacy of medicine supply during the pandemic.
The collaborative work between the TGA, states and territories, health professional and industry groups will continue to identify and respond to supply issues.
A: This is the number of ventilated ICU beds that could be occupied continuously with COVID-19 patients. Australian admissions data shows that the average duration of ventilation for COVID-19 patients is 17 days and total length of stay in ICU is slightly longer. This means that the 200 beds/month figure could equate to approximately 350 individual patients with COVID-19 every month.
It is important to emphasise that the current number of COVID-19 patients in ICU in Australia is very low and this has been the case for some months.
Having 200 ICU beds per month occupied with ventilated COVID-19 patients at any one time across Australia would represent a significant increase in the number of Australian cases, noting that for many people COVID-19 is a mild illness. Public health authorities are closely monitoring the number of cases during the pandemic and will continue to act as required to minimise the burden on the health systems.