{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:52:22Z","timestamp":1791175942137,"version":"4.1.0"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["HEPL"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Drug shortages disrupt healthcare delivery and pose a critical challenge to the resilience of pharmaceutical supply chains. This study investigates the drivers of drug shortages in Italy \u2013 Europe\u2019s leading pharmaceutical producer \u2013 to identify the factors associated with supply disruptions and inform evidence-based health policy. Using national data from 2018 to 2023, we analysed 17,619 drugs across 3,013 groups of substitutes, covering\n                    <jats:italic>community<\/jats:italic>\n                    ,\n                    <jats:italic>dual-dispensed<\/jats:italic>\n                    , and\n                    <jats:italic>hospital<\/jats:italic>\n                    distribution channels. Generalised linear mixed models were employed to assess how drug characteristics, market dynamics, and regulatory features influence shortage risk. Shortages were most prevalent among community drugs, where high market fragmentation and low-profit margins contributed to supply instability. Patent protection was associated with lower shortage risk for non-sterile drugs, while sterile drugs remained vulnerable regardless of patent status, likely due to manufacturing complexity. Notably, price effects were age-dependent: higher prices mitigated shortage risk, particularly for older drugs. This study offers a comprehensive evaluation of shortage patterns in a key pharmaceutical market, identifying structural risk factors and market vulnerabilities. The findings provide actionable insights for policymakers aiming to design targeted interventions, strengthen supply chain resilience, and ensure continuous access to essential medicines.\n                  <\/jats:p>","DOI":"10.1017\/s1744133126100681","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:26:16Z","timestamp":1791174376000},"page":"1-26","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Drug shortages in Italy: strategic insights and empirical evidence from the Italian pharmaceutical market"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8404-8573","authenticated-orcid":false,"given":"Benedetta","family":"Dal Canto","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/025602r80","id-type":"ROR","asserted-by":"publisher"}],"name":"Scuola Superiore Sant\u2019Anna"},{"id":[{"id":"https:\/\/ror.org\/03ad39j10","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Pisa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Panhuysen","sequence":"additional","affiliation":[{"name":"Hertie School gGmbH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5838-448X","authenticated-orcid":false,"given":"Giaele","family":"Moretti","sequence":"additional","affiliation":[{"name":"Sant\u2019Anna School of Advanced Studies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Vinci","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/025602r80","id-type":"ROR","asserted-by":"publisher"}],"name":"Scuola Superiore Sant\u2019Anna"},{"name":"Italy Ministry of Health Directorate General of Health Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Vainieri","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant\u2019Anna"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"S1744133126100681_ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-008-0114-5"},{"key":"S1744133126100681_ref18","doi-asserted-by":"publisher","DOI":"10.1108\/IJOPM-09-2022-0581"},{"key":"S1744133126100681_ref7","unstructured":"DECRETO (14 April 2005) Criteri di classificazione dei farmaci attraverso la classificazione anatomico-chimico terapeutica (ATC) complementare. 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Available at: https:\/\/www.ema.europa.eu\/en\/about-us\/who-we-are\/executive-steering-group-shortages-medicinal-products\/executive-steering-group-shortages-safety-medicinal-products-mssg-meetings (accessed 2 April 2025)."},{"key":"S1744133126100681_ref30","unstructured":"Agenzia ICE (2025) L\u2019Italia nell\u2019economia internazionale. Rapporto ICE 2024\u20132025. Rome: Agenzia ICE. 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Silver Spring, MD: U.S. Food and Drug Administration. October 2019."},{"key":"S1744133126100681_ref32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249274"},{"key":"S1744133126100681_ref14","unstructured":"Farmindustria (2025) Indicatori Farmaceutici. Centro Studi Farmindustria, July 2025. Rome: Farmindustria."},{"key":"S1744133126100681_ref2","unstructured":"AIFA (2025) Drug shortages Italian list. Available at: https:\/\/www.aifa.gov.it\/en\/web\/guest\/farmaci-carent (accessed 9 December 2025)."},{"key":"S1744133126100681_ref21","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18052532"},{"key":"S1744133126100681_ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-016-0808-z"}],"container-title":["Health Economics, Policy and Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1744133126100681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:26:20Z","timestamp":1791174380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1744133126100681\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":39,"alternative-id":["S1744133126100681"],"URL":"https:\/\/doi.org\/10.1017\/s1744133126100681","relation":{},"ISSN":["1744-1331","1744-134X"],"issn-type":[{"value":"1744-1331","type":"print"},{"value":"1744-134X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}