A survey of US hospitals' criteria for the allocation of remdesivir to treat COVID-19

• Main Authors: Hale, C.M (Author), Hennrikus, E.F (Author), Mun, F. (Author)
• Format: Article
• Language: English
• Published: Oxford University Press 2021
• Subjects: Adenosine Monophosphate; adenosine phosphate; alanine; Alanine; Antiviral Agents; antivirus agent; Article; clinical pharmacist; clinical trial; comorbidity; coronavirus disease 2019; COVID-19; Cross-Sectional Studies; cross-sectional study; disease course; drug therapy; drug use; epidemiology; EUA; health care personnel; health care rationing/ethics; health care survey; Health Personnel; hospital pharmacy; human; Humans; intensivist; medical staff; multicenter study; multidisciplinary team; pandemic; pandemics; patient care; Patient Care Team; patient identification; pharmacist; Pharmacists; Pharmacy Service, Hospital; physician; priority journal; procedures; questionnaire; remdesivir; resource allocation; Resource Allocation; scoring system; Surveys and Questionnaires; United States
• Online Access: View Fulltext in Publisher

 Purpose: To determine how hospitals across the United States determined allocation criteria for remdesivir, approved in May 2020 for treatment of coronavirus disease 2019 (COVID-19) through an emergency use authorization, while maintaining fair and ethical distribution when patient needs exceeded supply. Methods: A electronic survey inquiring as to how institutions determined remdesivir allocation was developed. On June 17, 2020, an invitation with a link to the survey was posted on the Vizient Pharmacy Network Community pages and via email to the American College of Clinical Pharmacy's Infectious Disease Practice and Research Network listserver. Results: 66 institutions representing 28 states responded to the survey. The results showed that 98% of surveyed institutions used a multidisciplinary team to develop remdesivir allocation criteria. A majority of those teams included clinical pharmacists (indicated by 97% of respondents), adult infectious diseases physicians (94%), and/or adult intensivists (69%). Many teams included adult hospitalists (49.2%) and/or ethicists (35.4%). Of the surveyed institutions, 59% indicated that all patients with COVID-19 were evaluated for treatment, and 50% delegated initial patient identification for potential remdesivir use to treating physicians. Prioritization of remdesivir allocation was often determined on a "first come, first served"basis (47% of respondents), according to a patient's respiratory status (28.8%) and/or clinical course (24.2%), and/or by random lottery (22.7%). Laboratory parameters (10.6%), comorbidities (4.5%), and essential worker status (4.5%) were rarely included in allocation criteria; no respondents reported consideration of socioeconomic disadvantage or use of a validated scoring system. Conclusion: The COVID-19 pandemic has exposed the inconsistencies of US medical centers' methods for allocating a limited pharmacotherapy resource that required rapid, fair, ethical and equitable distribution. The medical community, with citizen participation, needs to develop systems to continuously reevaluate criteria for treatment allocation as additional guidance and data emerge. © 2020 American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: [e-mail].