Intravenous fluid shortage sparks 10-fold jump in costs

Healthcare providers are paying up to ten times more for imported IV fluid as a shortage causes chaos in hospitals and calls mount for local manufacturing of critical medical supplies.

The shortage is placing enormous stress on hospitals, as doctors are forced to ­severely ration intravenous fluid, reserving it for critically ill patients, postpone ­inductions of labour, and deliver medications by alternative injection methods.

Healthcare providers are paying from five to 10 times as much for imported IV fluid bags as they were prior to the shortage that is now causing chaos in hospitals, as medicos call on the federal government to incentivise a local manufacturing industry for critical medical supplies.

On Friday, the nation’s health ministers promised a recently formed emergency Response Group would bring “unprecedented collaboration” to the ­crisis, as the medicine regulator came under fire for failing to avert the catastrophic shortage of IV fluid bags. Health ministers meeting in Sydney on Friday said the shortages, “while easing, are ­expected to continue through the rest of this year”.

The shortage is placing enormous stress on hospitals, as doctors are forced to ­severely ration intravenous fluid, reserving it for critically ill patients, postpone ­inductions of labour, and deliver medications by alternative injection methods.

Alarm over the shortage of IV fluids comes as a global shortage of crucial blood culture bottles in WA has forced authorities to ­approve use of the bottles up to two months past their expiry date.

“It might not be as profitable for a company to manufacture medical supplies in Australia but Australia does need to have a guaranteed access to a core set of supplies and that might mean ­incentivising manufacturing onshore,” said chair of Royal Australian College of General Practitioners’ expert committee for quality care, Mark Morgan.

“Australia needs the capacity to manufacture essentials onshore, even if this means using taxpayers’ money to build incentives. Australia should take a disaster planning approach to essential supplies.”

Professor Morgan, who is also professor of general practice at Bond University, added: “A planned, responsive, staged alerting system for supplies that might become shortages, and then do become shortages, I think a lot can be learnt from the disaster planning we have in this country and the same should happen for medical supplies.”

AMA president Steve Robson called for some form of national medical inventory, with a continuous monitoring of stocks of medical supplies.

“This is something previous governments should have done, and they’ve left the current government in a really bad spot – we need some form of national inventory of what really are critical medical supplies.

“We should know what our ­requirements are, where we’re getting them from and how secure those supply lines are. At the moment with IV fluids, there’s no national oversight.

“If there’s a good case for stockpiling or building greater sovereign manufacturing here I think that would be really good. It absolutely is time there needs to be an evaluation and this has been let slide by the previous government. The one thing I’d encourage the current government to do is to review that and make sure that we have mechanisms going forward to keep an eye on these critical things and have plans.”

The Therapeutic Goods ­Administration claims its role is around regulation and safety of products and not necessarily ensuring adequate supply, in the face of criticism that the crisis is “the ultimate example of poor procurement policy”.

But Nick Coatsworth, representing the Australian Patients Association, said the role of the TGA was “absolutely to monitor supply of essential medicines”, pointing out that the federal Health Minister oversees the TGA. The states contract individually with companies for saline supplies for the hospitals.

“Australian patients expect both regulator and minister to be constantly vigilant to keep them safe, and in the case of the IV fluid shortage that is coming perilously close to not being the case,” Dr Coatsworth said.

One senior doctor who played a high-level role during the Covid-19 pandemic said: “The issue of our lack of local manufacturing was identified during the pandemic but appears to have been forgotten quickly. Pressure on the government to take more action to promote drug and medical device manufacturing industries (or even minimum stockpiles) in Australia would be helpful.”

A critical shortage of blood culture collection bottles that is expected to last until the end of September is affecting public and private healthcare providers.

In WA authorities have approved the use of blood culture bottles for up to two months after the expiry date in order to manage the reduced supply. The product is used to culture bacteria from a patient’s blood.

“While we are maintaining sufficient supplies to meet demand throughout WA, we are aware that some clinical teams, particularly in remote areas, may have blood culture bottles at or near their expiry date”, a notice from PathWest Laboratory Medicine CEO Narelle Hadlow said. “We are taking all necessary steps to address the issue.”

Australian Clinical Labs advised in July it had taken “steps to review and rationalise blood culture stock levels and mitigate wastage to ensure that we can continue to provide this critical service”.

Founder of chemotherapy at home service ViewHealth, Julie Adams, said that along with the devastating effect on patient care, there were cost issues that would severely impact the private health sector. “The cost of the imported saline is upwards of six times the previous cost,” said Ms Adams, who has worked in oncology and haematology for 25 years. “A bag which cost $2.50 is now $13-$14. We use thousands of these bags. This is going to drive health to the wall. We haven’t recovered from all the additional costs of managing Covid … now this.”

Two senior Queensland Health bureaucrats also confirmed prices for IV alternative products that are being hurriedly imported are between five and 10 times what Australia was paying previously.

Local manufacturer Baxter Health Care had been ramping up production after importers struggled to deliver supplies due to shipping route interruptions but there was no certainty the company would be able to meet demand, Ms Adams said. “It’s a bloody mess,” she said.

State governments each have contracts for the supply of saline fluids, and Baxter Health Care manufactures about 75 per cent of the market’s products onshore, with overseas suppliers B. Braun and Fresenius Kabi supplying the rest. Baxter also exports to New Zealand, with product manufactured in its western Sydney plant. New Zealand’s medicines regulator, Pharmac, says it is not currently experiencing supply issues.

Queensland is faring better than some other states because it sources much of its supply of IV fluids from Baxter and because its Central Pharmacy agency plays a major role in co-ordinating supplies. It also keeps a contingency stockpile, which NSW does not.

Nevertheless, three major Brisbane teaching hospitals that perform the most critical surgery have been in the extraordinary situation of having between 24 and 48 hours’ of the vital IV fluids in their emergency stores in the past fortnight. The Australian understands that those hospitals are the Princess Alexandra, the Royal Brisbane and the Prince Charles.

NSW has also now centralised management of supply. NSW Health Minister Ryan Park said the shortages were not yet impacting surgery, but “we’re not out of the woods”.

The national cross-jurisdictional Response Group, convened by all states and territories and the commonwealth, will include representation from private hospitals and primary care, the health ministers said on Friday. The group will continue to meet on a weekly basis, or more frequently if required, while supply remains constrained in Australia. The Response Group has taken steps to address supply and distribution issues by sharing data; ensuring a co-ordinated national approach to distribution; and working with manufacturers and distributors to address supply issues.

Additional reporting: Joanna Panagopoulos