Health Economics / Outcomes Research

3C-12 - The Association between Drug Shortages and Prices Across 74 Countries: Uncovering Global Access Inequities

Monday, August 25, 2025

9:30 AM - 9:35 AM ET

Presenting Author(s)

SC

Shanzeh Chaudhry

University of Toronto, Canada

Co-Author(s)

SH

Shuchen Hu

Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, China., China (People's Republic)
AS

Araniy Santhireswaran

University of Toronto, Canada
CC

Cherry Chu, MSc

Women's College Hospital, Canada
CY

Caijun Yang

Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, China., China (People's Republic)
YF

Yu Fang

Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, China., China (People's Republic)
KS

Katie Suda, PharmD, MS, FCCP

Associate Director, Center for Pharmaceutical Policy and Prescribing
University of Pittsburg, United States
EG

Etienne Gaudette

University of Toronto, Canada
QG

Quinn Grundy

Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada., Canada
MT

Mina Tadrous, PhD

University of Toronto, Canada

Background: Drug shortages are a global concern and sometimes prompt clinical or health system crises. Lower prices and market pressures are often cited as drivers of drug shortages; thus, a commonly proposed policy lever is to increase drug prices. However, global evidence to evaluate the association between shortages and prices is lacking.

Objectives: This research aims to fill the gap by examining global cases of drug shortages and assessing the impact of price on the occurrence and intensity of shortages.

Methods: We included 25 global shortage cases by reviewing publications on drug shortages from 2013 to 2023. We used quarterly pharmaceutical sales data across 74 countries from the IQVIA MIDAS® quarterly sales volume data database from Q3 2011 to Q3 2022. Our outcome of interest was shortage intensity, defined as the drug shortage duration between its onset and end of meaningful shortages. We used zero-inflated negative binomial regression, with price as the independent factor, and included GDP per capita and the number of manufacturers as covariates. P-values less than a Bonferroni-corrected significance level (0.00625) were considered statistically significant.

Results: Out of 1,096 case-country pairs, 65% (712 pairs) experienced meaningful shortages with a median shortage intensity of 10 quarters. We found price was not a significant predictor of either shortage odds (P = 0.044) or intensity (P=0.066). Factors significantly associated with the odds of a non-shortage occurrence were unit increases in GDP per capita by 70.7% (aOR: 1.707, 95% CI: 1.428–2.040) and the number of manufacturers by 303.8% (aOR: 4.038, 95% CI: 3.045–5.354). A unit increase in GDP per capita was significantly associated with a 10.4% decrease (aRR: 0.896, 95% CI: 0.834–0.962) in the duration of shortage intensity.

Conclusions: Overall, price was not a strong significant predictor in this analyses, disproving the assumption that most drug shortages can be explained by the price of those medications. Our study reveals global inequities in the impact of drug shortages, with countries with lower GDP per capita disproportionately affected. Persistent shortages of essential medications have likely disrupted clinical practices globally. Collectively, our findings suggest the need to consider creative and alternative policy strategies beyond pricing to address both critical drug shortages and global inequities in shortage experiences.