The aim of this report is to investigate aspects affectingavailability and grade high-risk antibiotics in Sweden. 10antibiotics out of 39 antibiotics compiled by the Swedish PublicHealth Authority were studied according to the factors; class(based on chemical structure), industrial production process,number of API manufacturers found, the geographic location of the API manufacturers, number of MAH found in Sweden, number of MAH found in the EEA, number of backorders in Sweden, total length of backorders, currently not provided in Sweden (Number of MAH), assumed profitability per product, uncertainty in annual sales volume (relative standard deviation), uncertainty in annual sales (relative standard deviation), average sales (High/Low) and lastly parallel import to Sweden. The same factors were studied for the remaining 29 antibiotics by group 1 and 2 in order to compile a final grading with the parameters high, medium and low. A grading system was constructed to facilitate the grading system. Itresulted in nine antibiotics graded high, 23 antibiotics graded medium and lastly seven antibiotics were graded low. Also, out of the nine antibiotics formulated as tablets, five were graded ashigh. This drew the conclusion that a correlation between high- risk antibiotics and tablet formulation could be made. Another correlation made was that beta-lactam antibiotics were overrepresented in the antibiotics rated as high. There was also a slight overrepresentation of antibiotics formulated as injection/infusion in the low-risk category. A few limitations occurred during the process of the project such as the research for API manufacturers only included the ones approved in the EEA and the U.S. The grading of the antibiotics assigned to Group 1 and 2 was based only on the tables received from these groups, excluding additional details that may have affected the finalgrading. Nevertheless, the project conceived variation in theresult previously compiled by the Swedish Public Health Authority.

The discovery of antibiotics in the early 1900s saved millions of lives; nevertheless, in recent years there has been an antibiotics shortage in the European market. In the effort to solve this problem, and as part of the PLATINEA project, this research focuses on understanding the global antibiotics market structure and the main strategies used by companies within the market.  Through archival studies, including online reports, company websites, and companies' annual reports, an exploratory study has been conducted.  The antibiotics supply chain progresses through several stages including delivering raw materials, manufacturing APIs, manufacturing the product and ultimately distributing the drug through market authorization holders.  This research identifies the main company strategies, including cost leadership, differentiation, internationalization, product range breadth, and acquisition. Four main strategic groups are identified, in which companies tend to apply the same strategies in the antibiotics supply market.

Rising Antimicrobial Resistance is a threat faced all over the world. Bacterial infections that were treatable with antibiotics only a few years ago can now lead to life-threatening conditions. This thesis is part of the work of a large platform, PLATINEA, trying to reduce the rate of new resistances occurring in Sweden by preventing non optimal treatment. Due to shortages of the right antibiotics, suboptimal antibiotics are prescribed, which has shown to be accelerating the resistances among the bacterial populations. This study proposes an information exchange database and a central storage model for critical antibiotics to circumvent stock outs and inconveniences resulting from shortages of medically valuable antibiotics. Through interviewing prominent actors in the Swedish pharmaceutical supply chain an inside into the procurement of antibiotic in Sweden and what concerns are faced by the organs involved was created. Literature studies on occurred shortages of antibiotics in Sweden and the world were examined and possible reasons for these were identified. Examination of governmental efforts and assignments created the context in which gaps were identified that this thesis work could fill. A focus on Benzylpenicillin and Rifampicin were kept throughout the study. The collected data led to the implementation recommendation of two models by this study. An information platform suggested to allow better, faster and more accurate information exchange between all involved actors of the supply chain as well as a centralized storage model for the storage of antibiotics with medically high value in Sweden.  Through the implementation of the model systems shortages of critical antibiotics can be circumvented and better availability of information leads to quicker reactions ability to stock outs of other antibiotics.

Sweden faces shortages in antibiotics. Shortages are caused due to a variety of reasons. Due to low profit margins and opportunity costs, antibiotic supply chains may experience a lack of competition. Lack of competition across the various stages of supply chains leads to fragility in the supply chain which ultimately results in shortages. Lack of communication is another such factor leading to shortages. Incorporating an AI/IT system across the supply chain would help prevent the occurrence of shortages by addressing such factors.  PLATINEA, an innovation platform, aims to address the threat of anti-microbial resistance by ensuring a steady supply of antibiotics. Their work package 4 is dedicated to eliminating risk factors or causes of shortages that arise from supply chains of antibiotics. PLATINEA has drafted a mind map to identify the risk factors or causes of shortages in Sweden. This thesis revolves around conducting a cost benefit analysis for implementing an AI/IT tool that addresses the risk factors and causes of shortages identified from the mind map that stem from the Swedish supply chains of antibiotics. A model consisting of a breakdown in costs and benefits was created. The model not only helped us frame the various costs and benefits, but also evolved during the research to help us structure our results better. An AI/IT tool has been devised keeping the risk factors and causes of shortage in mind. This tool has four versions that have varying levels of integration and automation. Semi-structured Interviews were conducted with experts in the field of artificial Intelligence and machine learning. calculation based on historical data were made to determine costs of shortages and to some extent, visualize the extent of costs involved in antibiotic resistance. Based on the information gathered from the interviews and literatures, the costs and benefits identified in the model are addressed, including the significant benefit of reducing cost of shortages.

The fast-increasing issue of antibiotic unavailability or relatively their shortages in the healthcare system has been the point of concern for many countries. With these shortages come unnecessary costs and the need to utilize less optimal treatment thus increasing the risk of antimicrobial resistance and jeopardizing a patient’s health. This thesis is a collaboration with PLATINEA (Platform for Innovation of Existing Antibiotics), aiming to optimize the usage of antibiotics and to increase the availability of important antibiotics in Sweden. To understand the causes that affect antibiotic unavailability, a good view into the antibiotic and pharmaceutical supply chain is important, especially the purchasing systems of it. The complexities in the purchasing system can lead to interruptions in the antibiotics supply chain thus increasing the risk of antibiotic shortages. These shortages in turn increases the risk of antimicrobial resistance, therefore, the purchasing system requires the need to be analysed extensively. This study aims to explore different purchasing systems and conduct cost-benefit analysis of centralized purchasing system in efforts to help reduce shortages of antibiotics in Sweden. This study is based on the existing literature on centralized and decentralized purchasing and also the pharmaceutical supply chain. Qualitative interviews (semi-structured), multiple reports and articles steered the authors in exploring the purchasing systems and mapping the costs and benefits of centralized purchasing. Throughout the research, emphasis was kept on reducing antibiotic shortages. The findings of this study outline the various costs and benefits of a centralized purchasing system and resulted in the implementation recommendation of it over an existing decentralized purchasing system in Sweden.

The gap between demand and supply for antibiotics in the healthcare sector has seen a steady growth over the past decades, further increasing the risk of antibiotic resistance and unavailability in the Swedish healthcare sector and market. The thesis is part of the work of the multisectoral platform, PLATINEA, which is working towards better availability of antibiotics. This study focuses on analysing the supply structure of antibiotics and pharmaceutical supply chains using a risk assessment model. A literature review of previous research has been done to identify risk factors, understand their importance and develop the risk assessment model. The risk assessment model uses these risk factors to assess the supply risk of an antibiotic. The study is designed in a quantitative manner, where the antibiotics are classified as very high, high, medium, and low risk of shortage using risk scores. Expert opinions were collected using a self-completion questionnaire, in which experts allocate weights that measure the importance of said risk factors. Weights were used to measure value of risk for antibiotics using MCDA process. The outcomes of the study are (1). the weights of risk factors given by industry experts, (2). the developed multi-criteria risk assessment model, (3). ranking of selected 39 antibiotics from high to low supply risk, based on re-assessed risk scores.