The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China

Abstract

IntroductionNew targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending.MethodsUsing a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017.ResultsAfter the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146).ConclusionsThe 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.

Prices and Clinical Benefit of National Price-Negotiated Anticancer Medicines in China

“…Since 2017, new anticancer medicines were listed in NRDL simultaneously with each round of annual centralized price negotiation. Compared with treatment costs before policy implementation, drug prices dropped sharply, leading to increased affordability of expensive cancer therapies [ 22 ]. Though health technology assessments were a key aspect during NRDL negotiations, our results showed no association between daily costs of cancer treatment and their QALY, an essential factor in technical assessments supporting decisions in setting reimbursement and pricing [ 52 ].…”

“…patented originator medicines) [ 6 ]. To temper growing costs and improve the affordability of anticancer medicines, the Chinese government has implemented centralized price negotiation since 2017 [ 22 , 23 ]. Taking a value-based pricing approach that required evidence of comparative outcomes and budget impact analyses, medicine price negotiation was a criterion for inclusion in the National Reimbursement Drug List (NRDL) [ 24 ].…”

“…Taking a value-based pricing approach that required evidence of comparative outcomes and budget impact analyses, medicine price negotiation was a criterion for inclusion in the National Reimbursement Drug List (NRDL) [ 24 ]. The policy was reported to have reduced drug prices by half [ 22 ], yet little is known about the relation between anticancer medicines’ clinical benefit and their negotiated prices in China. Therefore, in this paper, we assess the correlation between the daily cost and clinical benefit of anticancer therapies listed in the NRDL through national price negotiations between 2017 and 2020.…”

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

“…are determined by NRDLN as well (13). Following the NRDLN, public hospitals must purchase listed drugs via provincial procurement websites based on the negotiated prices, and then the reimbursement is paid by national medical insurance fund (14). In July 2017, 36 drugs were added to the list, 18 of which were anticancer drugs for major cancers, such as lung cancer, rectum cancer and leukemia (15).…”

Impact of National Volume-Based Procurement on the Procurement Volumes and Spending for Antiviral Medications of Hepatitis B Virus

“…Cost per DDD was calculated for each of the antivirals by dividing procurement spending and the volume of a given drug. As the actual daily dose may vary between patients over time, DDD, defined as the assumed average maintenance daily dose for a drug used for adults, was used as a proxy for daily dose ( Organization, 2021 ; Zhang et al, 2021 ). DDDs were obtained from the ATC Index published by the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology ( WHO, 2021 ).…”