Investigating variation in the inpatient allocation of scarce COVID-19 therapeutics: Equity and Clinical Outcomes

The COVID-19 pandemic resulted in an urgent need for effective therapeutics to treat hospitalized patients with severe infections. In less than two years, new drugs were developed and existing medications were repurposed to provide a range of effective treatment approaches. However, many of these medications were in extremely short supply as there was intense global demand and only limited production capacity. This resulted in an unprecedented situation where multiple lifesaving drugs for the same condition were in short supply. The impact of drug shortages on the equity and quality of inpatient care for COVID-19 is unknown. It is clear that marginalized populations have faced a disproportionate impact from COVID-19, and inequitable allocation of scarce COVID-19 therapies has already been established in the USA. In a Canadian context, there is a pressing need to understand how patient, hospital, and regional factors intersected with inequity in medication use. Our first aim is to investigate the equitable allocation of scarce COVID-19 therapies in 33 Ontario hospitals representing ~65% of all adult medical/intensive care beds in the province. Our second aim is to develop a novel ethical framework for when multiple medications for the same condition are in short supply. A panel of international experts and local patient partners will guide the development of this framework and will be informed by an international scoping review of drug allocation frameworks used during the COVID-19 pandemic, and a survey of clinicians who have first-hand experience with these drug shortages. Our third aim is to use advanced methods in simulation modeling to estimate how this novel drug allocation framework might affect equity of drug allocation and clinical outcomes. The overarching goal of this research is to better understand how to deliver effective and equitable hospital care in situations when key therapeutics are scarce and in high demand.