ObjectivesPharmaceutical supply chain is a significant component of the health system in supplying medicines, particularly in countries where main drugs are provided by local pharmaceutical companies. No previous studies exist assessing risks and disruptions in pharmaceutical companies while assessing the pharmaceutical supply chain. Any risks affecting the pharmaceutical companies could disrupt supply medicines and health system efficiency. The goal of this study was the risk assessment in pharmaceutical industry in Iran considering process's priority, hazard and probability of risks.MethodsThe study was carried out in 4 phases; risk identification through literature review, risk identification in Iranian pharmaceutical companies through interview with experts, risk analysis through a questionnaire and consultation with experts using group analytic hierarchy process (AHP) method and rating scale (RS) and risk evaluation of simple additive weighting (SAW) method.ResultsIn total, 86 main risks were identified in the pharmaceutical supply chain with perspective of pharmaceutical companies classified in 11 classes. The majority of risks described in this study were related to the financial and economic category. Also financial management was found to be the most important factor for consideration.ConclusionAlthough pharmaceutical industry and supply chain were affected by current political conditions in Iran during the study time, but half of total risks in the pharmaceutical supply chain were found to be internal risks which could be fixed by companies, internally. Likewise, political status and related risks forced companies to focus more on financial and supply management resulting in less attention to quality management.

IntroductionSupply of medicine as a strategic product in any health system is a top priority. Pharmaceutical companies, a major player of the drug supply chain, are subject to many risks. These risks disrupt the supply of medicine in many ways such as their quantity and quality and their delivery to the right place and customers and at the right time. Therefore risk identification in the supply process of pharmaceutical companies and mitigate them is highly recommended.ObjectiveIn this study it is attempted to investigate pharmaceutical supply chain risks with perspective of manufacturing companies.MethodsScopus, PubMed, Web of Science bibliographic databases and Google scholar scientific search engines were searched for pharmaceutical supply chain risk management studies with 6 different groups of keywords. All results found by keywords were reviewed and none-relevant articles were excluded by outcome of interests and researcher boundaries of study within 4 steps and through a systematic method.ResultsNine articles were included in the systematic review and totally 50 main risks based on study outcome of interest extracted which classified in 7 categories. Most of reported risks were related to supply and supplier issues. Organization and strategy issues, financial, logistic, political, market and regulatory issues were in next level of importance.ConclusionIt was shown that the majority of risks in pharmaceutical supply chain were internal risks due to processes, people and functions mismanagement which could be managed by suitable mitigation strategies.

BackgroundData modeling techniques can create a virtual world to analyze decision systems. National drug authorities can use such techniques to take care of their deficiencies in decision making processes. This study was designed to build a system dynamics model to simulate the effects of market mix variables (5 P’s) on the national drug policy (NDP) indicators including availability, affordability, quality, and rationality. This was aimed to investigate how to increase the rationality of decision making, evaluate different alternatives, reduce the costs and identify the system obstacles.System dynamics is a computer-based approach for analyzing and designing complex systems over time. In this study the cognitive casualty map was developed to make a concept about the system then the stock-flow model was set up based on the market demand and supply concept.ResultsThe model demonstrates the interdependencies between the NDP variables through four cognitive maps. Some issues in availability, willingness to pay, rational use and quality of medicines are pointed in the model. The stock-flow diagram shows how the demand for a medicine is formed and how it is responded through NDP objectives. The effects of changing variables on the other NDP variables can be studied after running the stock-flow model.ConclusionThe model can initiate a fundamental structure for analyzing NDP. The conceptual model made a cognitive map to show many causes’ and effects’ trees and reveals some relations between NDP variables that are usually forgotten in the medicines affairs. The model also provides an opportunity to be expanded with more details on a specific disease for better policy making about medication.

fasalazine, Multi-Matrix System mesalamine [MMX], balsalazide disodium, mesalamine delayed release [MDR]) during 2007-2011. Patients were continuously enrolled in the 6-month pre-and 12-month post-initiation period. 5-ASA treatment persistence and adherence according to the initial prescription filled (index medication) were compared. Persistence was defined as the duration between initiation and discontinuation of therapy with a permissible gap Ͻ60 days, and analyzed using Kaplan-Meier survival analysis. Persistence rates at month 12 were calculated. Adherence was measured by medication possession ratio (MPR) for index drug, and proportion of days covered (PDC) for any 5-ASA. Analysis of covariance was used to compare MPR and PDC across index medication. Covariates included age, gender, insurance, residential region, comorbidities at index date, and use of immunosuppressive/biologic agents, rectal form of 5-ASA and access to specialist care post 12-month index date. RESULTS: A total of 5245 patients met selection criteria, 59% were on MDR, 17% MMX, 13% sulfasalazine, and 11% balsalazide. The median persistence days ranged from 151 [sulfasalazine] to 221 [MMX] days, Pϭ0.001). Persistence rates at month 12 was highest for MMX (28%) compared to other 5-ASAs (24% MDR, 23% balsalazide, and 20% sulfasalazine, respectively, logrank PϽ0.001). Mean adjusted MPR/PDC Ϯ standard error was significantly higher in the patients on MMX (0.48Ϯ0.02/0.53Ϯ0.02) than that of patients on other 5-ASAs (0.43Ϯ0.

To estimate the potential unmet need for Magnetic Resonance Imaging (MRI) among Medicare patients with pacemaker implants, via the prevalence of diagnoses and conditions for which MRI is the preferred investigation method. METHODS: The data analyzed comprised of fee-for-service portion of the 2008 Medicare patient population. Using this sample, two issues were examined: the prevalence of the diseases for which MRI is the preferred imaging modality, and the uptake rates of all imaging modalities for MRI-indicated beneficiaries with pacemaker implants compared with those having no implants. For each of those diseases for which MRI is the preferred modality we also identified any trade-offs between lower MRI rates and higher rates for other imaging modalities in pacemaker-implanted compared with non-implanted patients. RESULTS: There was almost no use of MRI in the pacemaker-implanted population, whereas 13% of patients without any kind of implant received an MRI in 2008. Clinical practice appears in line with the contraindication for MRI in pacemaker-implanted patients. Cancer of the CNS and suspected Stroke are conditions which require timely, accurate imaging for good therapeutic decision making. A total of 73% and 41% of non-paced subjects received whole body MRI for these conditions respectively, compared with 1% of paced subjects for each disease. Similar diagnostic discrepancies were observed for Motion disorders, Dementia, Chronic orthopaedic pain and spinal disorders. Pacemaker implanted patients also had high rates of co-morbidities. CONCLUSIONS: There seems to be a large unmet clinical need for pacemakers and other implanted cardiac devices which allow MRI to be used as a diagnostic method. The very high rate of MRI use in non-implanted patients with acute, progressive and often fatal conditions of stroke and cancer, and its absence of use in the same patient groups with implants is a concern. The use of MRI conditional cardiac devices would facilitate greater diagnostic method choice.