Impact of the National Reimbursement Drug List Negotiation Policy on Accessibility of Anticancer Drugs in China: An Interrupted Time Series Study

Abstract

ObjectiveSince 2016, the Chinese government has been regularly implementing the National Reimbursement Drug List Negotiation (NRDLN) to improve the accessibility of drugs. In the second round of NRDLN in July 2017, 18 anticancer drugs were included. This study analyzed the impact of the NRDLN on the accessibility of these 18 anticancer drugs in China.MethodsNational hospital procurement data were collected from 2015 to 2019. As measurements of drug accessibility, monthly average of drug availability or defined daily dose cost (DDDc) was calculated. Interrupted time series (ITS) analysis was employed to evaluate the impact of NRDLN on drug accessibility. Multilevel growth curve models were estimated for different drug categories, regions or levels of hospitals.ResultsThe overall availability of 18 anticancer drugs increased from about 10.5% in 2015 to slightly over 30% in 2019. The average DDDc dropped from 527.93 CNY in 2015 to 401.87 CNY in 2019, with a reduction of 23.88%. The implementation of NRDLN was associated with higher availability and lower costs for all 18 anticancer drugs. We found an increasing level in monthly drug availability (β2 = 2.1126), which ascended more sharply after the implementation of NRDLN (β3 = 0.3656). There was a decreasing level in DDDc before July 2017 (β2 = −108.7213), together with a significant decline in the slope associated with the implementation of NRDLN (β3 = −4.8332). Compared to Traditional Chinese Medicines, the availability of Western Medicines was higher and increased at a higher rate (β3 = 0.4165 vs. 0.1108). Drug availability experienced a larger instant and slope increase in western China compared to other regions, and in secondary hospitals than tertiary hospitals. Nevertheless, regional and hospital-level difference in the effect of NRDLN on DDDc were less evident.ConclusionThe implementation of NRDLN improves the availability and reduces the cost of some anticancer drugs in China. It contributes to promoting accessibility of anticancer drugs, as well as relieving regional or hospital-level disparities. However, there are still challenges to benefit more patients sufficiently and equally. It requires more policy efforts and collaborative policy combination.

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].…”

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

“…Huang et al [11], after the 2016 NDPN policy was implemented, found that the utilization of two anticancer medicines increased and the average daily cost decreased. Zhu et al [58] found that the availability of 18 negotiated medicines in 2017 was improved and the average daily cost was reduced. However, these two studies above had fewer outcome measures and no control group.…”

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.…”