Impact of the national drug price negotiation policy on the utilization, cost, and accessibility of anticancer medicines in China: A controlled interrupted time series study

Abstract

Background China implemented the national drug price negotiation (NDPN) policy to include 17 innovative anticancer medicines in the national reimbursement drug list in 2018. We aimed to assess the impact of this policy on the utilization, cost, and accessibility of anticancer medicines. MethodsWe obtained monthly medicine procurement data from 1039 hospitals from October 2017 to December 2019. We examined changes in availability, utilization, defined daily dose cost (DDDc), and affordability of the medicines using descriptive statistics and controlled interrupted time series analysis, measuring utilization by defined daily doses (DDDs). Cetuximab and raltitrexed were compared separately for the same indication. ResultsThe mean availability of 17 negotiated anticancer medicines was 28.78% after the NDPN, amounting to an increase of 25.22%. The availability increased by 7.88% (95% confidence interval (CI) = 4.31%, 11.45%, P < 0.001) immediately and by 1.23% (95% CI = 0.81%, 1.64%, P < 0.001) per month after policy implementation. Compared with the control group, the utilization of the medicines increased by 11.44 DDDs (95% CI = 2.42, 20.46, P = 0.014) immediately and by 3.54 DDDs (95% CI = 2.47, 4.60, P < 0.001) per month after policy implementation, while the DDDc decreased by US$109.09 (95% CI = 68.14, 150.05, P < 0.001) immediately and remained stable thereafter. The results on cetuximab and raltitrexed were similar. Availability and utilization differed among regions in east, middle, and west China. Out-of-pocket costs decreased by 17.35 times the catastrophic health expenditures to 1.99 times, but the affordability ratio for 14 negotiated medicines was still greater than 1. ConclusionsThe NDPN policy improved the availability, utilization, and affordability of anticancer medicines. China's experience in NDPN provides a reference for other countries. However, the availability and affordability of anticancer medicines still need further improvement.Cancer has become a leading cause of death globally, accounting for nearly 10 million deaths, or nearly one in six deaths in 2020 [1]. Among them, lung cancer was the most common cause of cancer death, accounting for 1.80 million. In China, there were 4.57 million new cancer cases, accounting for 23.7% of the cases globally, and three million cancer deaths, accounting for 30% of cancer deaths globally in 2020 [2]. China ranked first in the world in both the number of new cancer cases and cancer deaths, far surpassing other countries in the world. Cancer has become a major problem affecting human health. Simultaneously, cancer treatment expenditures appear to be catastrophic for patients in China [3]. About half of cancer patients borrowed money or went into debt and approximately 10% of cancer patients reported forgoing some medical care because of cost [4]. Many cancer patients cannot afford targeted anticancer medicines -the main cancer treatment [5].

Access to Essential and Innovative Anti-cancer Medicines: A Longitudinal Study in Nanjing, China

“…Fourth, we found that the drug utilization of EAMs is higher than that of IAMs, in other words, essential medicines dominated in clinical diagnosis and treatment. During the study period, the total drug utilization of essential medicines showed a downward trend, but slowly increased after 2019, while the drug utilization of IAMs continued to increase, which is consistent with the results of a study on the utilization of anti-cancer medicines nationwide [11,54] . The dominance of EAMs in cancer diagnosis and treatment can be attributed to the reimbursement policies of medical insurance and the prices of drugs.…”

“…In recent years, the development of IAMs has been continuous, especially since 2015, the speed of approval and listing of IAMs such as targeted anti-cancer drugs and monoclonal antibodies in China has been accelerating [52] . In addition, its precise clinical effect and the national drug price negotiation (NDPN) policy implemented by China after 2016 have reduced the price of IAMs to enter the medical insurance catalog, which has improved the availability of IAMs in healthcare institutions [20,53,54] . The continuous research and development of IAMs may affect the availability of EAMs in healthcare institutions.…”

“…Most EAMs (OBs) and IAMs are expensive, and the prices of these two types of drugs are generally high and unaffordable in many similar studies [11,20,53,54] . The reason for the overall downward trend of the prices of the two types of drugs may be related to the implementation of the NDPN policy in China since 2016 [53] .…”

Cost-effectiveness analysis of toripalimab plus chemotherapy versus chemotherapy alone for advanced non-small cell lung cancer in China

“…Although it is a promising field of cancer treatment, it was of considerable significance to the influence of its high cost, especially for low- and middle-income countries. Since 2016, the Chinese government has been implementing an NDPN policy, aiming to reduce the price of innovative medicines with high clinical value ( 32 , 33 ). High-value innovative medicines, represented by anticancer drugs, have gradually established a value-oriented negotiation access model since 2017 ( 34 ), and pharmacoeconomic evaluation has started to play an important role in drug market evaluation.…”

The usage and costs of national drug price-negotiated anticancer medicines in a first-tier city in Northeast China: a study based on health insurance data

“…For example, Jiang [16] conducted a study on the accessibility of anticancer medicines and found that the NDPN policy increased the affordability and accessibility of these medicines for patients. Other scholars, such as Huang [17], Liu [18], Zhang [19], Liu [20], Zhu [21], Sun [22], Cai [23], Fang [24], Diao [25], and Ding [26], have investigated the use of NDPN anticancer medicines by utilising hospital procurement data and employing interrupted time series methods. Their results indicated that the implementation of the NDPN policy resulted in a noticeable increase in the use of anticancer medicines, accompanied by a further decrease in drug costs.…”