Here is a very long in depth article about the nation wide shortage of IV IG.
It stands for intravenous immunoglobulin. It has many medical purposes.
I have just been told that our hospital will now ration it. Overtly ration. There's something America hates.
There will be a waiting list to get it. Some may have to go with out.
Here is the explanation I received from my people.
Several years ago there were 6-7 companies making this stuff. At one point it was flooding the market and nobody was making any money from it. So they got out.
The Red Cross got out too.
Now there are three main companies in the US that make the stuff. What used to cost $35/gram now costs $65/gram.
Our hospital is part of a buying group. There are lots of them. They allow you to buy the stuff, to guarantee you a supply of IVIG at a certain price, for an entire year.
The only problem is, the amount that is allotted to the hospital is less than they need for the entire year.
How is a hospital to get more of it?
They have to go onto the secondary market and pay $100/gram. At this rate, it would "bankrupt the hospital"
So the hospital says no. We will have to ration.
Now, hospitalized patients get first crack. You are placed on waiting lists.
So who's at fault?
Supply and demand working in the private market.
Should the government take over the IVIG market and start making it to ensure an adequate supply of IVIG for the rest of eternity.
Should the government take over the IVIG market and manufacture it because it is considered a right as part of medical therapy.
Should the government take over the IVIG market and shut down the private business enterprise for failure to provide adequate medicine that is a right of all Americans?
Or should the government stay out of it, let the market create an incentive to reinvest, make a better product for cheaper.
If your answer is that you believe the government should take over the IVIG market, than you also believe that the government should take over health care via single payer universal coverage. You believe that the government is your savior.
If your answer is to let the market figure it out, then you are a believer in the free market principles that drive this capitalist country of ours.
The demand will create supply. One way or another. If the scarcity of the resource is real, no government intervention will change that. If the scarcity of the resource is market induced, then competition will once again drive down the price.
That I am sure of.
They've been rationing it at a few big-name NYC hospitals since early 2007. We weren't affected, since it might have been fairy dust for all that we ever used it, but we still dutifully read all the Urgent! bulletins sent out asking for rationing. I wonder if they have the same buyer problem?
ReplyDeleteWe have multiple drugs with this problem (latest was remi-fent & radioisotope). I don't think you should/can for companies to produce unless you're prepared to really support them when they're down (and no one will support that). What about a third option where whoever is suppling healthcare (be it gov't/private) takes a harder look at predicting these sorts of problems with key indicators or whatever. I'm sure there's a healthcare statistician out there the gov't could employ that could predict a bit of this with queing theory.
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Ian.
Didn't this happen once before? Back in 1996 or so, I did a rotation at a certain cancer hospital as a pharmacy intern, and I remember that they were having a very hard time getting enough IVIG for a while. (Having bone marrow transplant patients on hand meant that they went through the stuff like water.) I don't think it was officially rationed per se, but if the wholesaler would only give you so many vials per week before running out, that's what it amounted to in practise.
ReplyDelete(During this period we got a call from one floor. "We can't find Mr Burke's IVIG, can you send us up another bag." We checked and found that this particular bag had about $1100 worth of IVIG in it. The other pharmacy intern said, "Let's go up there, I bet I can find it." So we went up to the floor and looked around, and it seems someone had put it in the bin of a Mr Burns, who happened to be on the same floor. Had we sent up a new bag, the first one would have just sat there for 72 hours and then been sent back down to us for destruction, to be greeted by much profanity upon its arrival at the pharmacy. I wonder if any other meds were mixed-up between these two patients while they were there.)
I was in the neurology infusion center this morning getting the 1st of a 5-day Solumedrol drip for an MS exacerbation.
ReplyDeleteThere was a gentleman in for his IVIG drip. Due to the supply issues, he had to use 17 (smaller than usual) bottles to get the appropriate dosage. It was actually a little humorous how quickly the bottles emptied. The nurse was quite busy.
Happy;
ReplyDeleteIVIG may just be the canary in the mine shaft. I don't know the answer to your larger question about government vs. free market. All I know is, if I were the patient, or the parent of a patient, who couldn't get a needed drug/treatment/whatever during the time we were waiting for the free market to catch up, i would be p____ed. Not to mention, dead, in the worst case scenario.
I don't mind the free market punishing people who borrowed too much money to buy a huge house. Punishing a sick and innocent patient is another story. But again, I don't know that there is a good answer for this dilemma.
Isn't this the same boat as vaccinations- but the govt. has stepped in to make sure they are available?
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