Effects of volume-based procurement policy on the usage and expenditure of first-generation targeted drugs for non-small cell lung cancer with EGFR mutation in China: an interrupted time series study

Abstract

ObjectivesIn December 2018, China launched national volume-based procurement (NVBP) to negotiate drug prices with manufacturers. Gefitinib was one of the 25 pilot drugs, which is used for treatment of non-small cell lung cancer. Lung cancer is the most common type of cancer in China and targeted drugs like gefitinib have been proven to provide clinical benefits to patients. This study aims to explore the impact of NVBP policy on the usage and expenditure of anticancer drugs.MethodsGefitinib and alternative drugs (icotinib and erlotinib) were used as objects of study. Quarterly data from the China Hospital Pharmaceutical Audit database in 9454 hospitals in China were used for analysis. Descriptive analysis was conducted using purchase volume and expenditure as variables. Interrupted time-series (ITS) analysis was applied to further analyse the effect of NVBP policy on the medicines under study.ResultsDuring the 12-month period before (2018Q2–2019Q1) and after (2019Q2–2020Q1) the NVBP policy, the total purchase volume of medicines rose from 4.48 million defined daily dose (DDD) to 7.02 million DDD, with an increase of 56.66%. Purchase volume of gefitinib and alternative drugs increased 100.61% and 14.88%, respectively. After the implementation of NVBP policy, procurement volume of alternative drugs decreased by 72 051 DDD (p value=0.044) and trend change decreased by 56 738 DDD (p value<0.01). The overall expenditure reduction was 14.7%, with the expenditure of gefitinib reducing by 38.47% and alternative drugs increasing by 10.70%. ITS analysis indicated statistically significant differences in level and trend changes for expenditure of total drugs and gefitinib.ConclusionsThe evidence provided in this study indicated that the implementation of NVBP policy was related to the expenditure reduction of the first generation of anti-EGFR lung cancer drugs. The policy effectively controlled the increase in expenditures for corresponding drugs while ensuring the use of drugs.

The impact of the national centralized drug procurement on the use of original and generic targeted anti- tumor drugs in Hohhot, China: an interrupted time-series analysis

“…In this study,our ndings indicate a signi cant increase in the use of generic targeted anti-tumor drugs following policy implementation(305.26%, 167.31%, and 347.94%), consistent with previous studies by Lu et al [20,21]. At the same time, the expenditure of the generic targeted anti-tumor drugs decreased(-81.64%, -43.45%, and − 93.10%), and the DDDc decreased(-85.54%, -85.86%, and − 84.93%), which met the requirements of the NCDP to reduce medicines cost and alleviate the drug burden of patients, which was similar to the results of previous studies [22,23]. Furthermore, a signi cant decrease in both the quantity and dosage of original targeted drugs employed was observed subsequent to the policy intervention, aligning with the ndings reported by Yang et al [7,[10][11][12].…”

Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients

“…Therefore, compared with inpatient department, physicians operating in outpatient setting were more likely to change their prescription behavior by increasing the number of prescriptions to generate higher salaries. Compared to outpatients, inpatients might have a high degree of compliance with drug brands due to more severity of disease, and it is difficult for inpatients to change their medication habits to switch to bid-winning generic drugs ( Wang et al, 2023 ). These considerations could also be some of the reasons for the differences in drug utilization between the outpatient and inpatient departments.…”

Trends and prescribing patterns of oral anti-neoplastic drugs: a retrospective longitudinal study

“…This has resulted in a growing interest and demand for these treatment options among healthcare providers and patients. Thirdly, the accessibility and affordability of targeted anti-cancer drugs have significantly increased following the implementation of government healthcare policies (20,21). The prescriptions of oral cytotoxic and hormonal anti-neoplastic drugs remained stable, resulting in decreasing proportions.…”

“…National volume-based procurement was launched in 2018 to negotiate drug price with manufacturers in "4 + 7" pilot cities, which covered 4 provincial municipalities and 7 sub-provincial cities (10). The procurement volume was set based on 60-70% of the actual annual drug consumption of all public hospitals in pilot cities in the previous year (21). The centrally purchased pilot drugs were high-quality generic drugs with the same therapeutic effect through the quality consistency evaluation procedure.…”