Trends in anti-HER2 drugs consumption and influencing factors

Abstract

BackgroundHuman epidermal growth factor receptor 2 (HER2) inhibitors have been approved to treat various cancers with HER2 amplification. The Chinese government has made great efforts to improve the availability and affordability of these drugs. This study aimed to analyze the trends in anti-HER2 drug consumptions in Nanjing from 2012 to 2021, and explore influencing factors.MethodsData about use of anti-HER2 drugs in 2012–2021 were extracted from Jiangsu Medicine Information Institute. Six types of anti-HER2 drugs were included. Drug consumption was expressed as defined daily doses (DDDs) and expenditure. Time series analysis was adopted to find trends in consumption, while interrupted time series was used in analyzing the impact of policy on consumption. The correlation between DDDs and defined daily cost (DDC) was analyzed by Pearson's correlation test.ResultsThe DDC, DDDs, and expenditure of anti-HER2 drugs changed little from 2012 to 2016. The DDC decreased intermittently, while the DDDs and expenditure of these drugs grew continuously from 2017 to 2021. The anti-HER2 monoclonal antibodies contributed to the majority of total consumption in 2012–2019. The DDDs of anti-HER2 tyrosine kinase inhibitors surpassed the DDDs of monoclonal antibodies in 2020–2021. Trastuzumab was the predominantly prescribed drug in 2012–2019, but the DDDs of pyrotinib surpassed the DDDs of trastuzumab in 2020–2021. The ln value of DDC or self-paid DDC of trastuzumab was negatively correlated with the ln value of its DDDs. The national health insurance coverage (NHIC) and national drug price negotiation policy about anti-HER2 drugs were initiated in 2017. Low-price generics and biosimilar of trastuzumab came into the market in 2020 and 2021, separately. Interrupted time series analysis showed that the DDDs increased significantly after the implementation of NHIC, price negotiation or generic drug replacement.ConclusionThe consumption of anti-HER2 drugs has significantly increased and their DDC has decreased after the implementation of NHIC, price negotiation, or low-price generic drug replacement since 2017. Further efforts are needed to translate the high consumption into clinical benefits.

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

“…Consistently, previous studies have indicated that drug price was an important determinant of drug consumption, and there was a negative relationship between DDC and the number of DDDs (11,13,24). In order to improve the availability and affordability of drugs, China established its fundamental health insurance system in 2009, which was enhanced by the implementation of price negotiation and mandatory reimbursement policies in 2017 (13). The policies of price negotiation have been implemented in many countries, which resulted in a significant reduction in drug prices and an increase in drug consumption (24, 25).…”

“…DDC is an efficient indicator that guides the market prices of pharmaceutical products (15). Consistently, previous studies have indicated that drug price was an important determinant of drug consumption, and there was a negative relationship between DDC and the number of DDDs (11,13,24). In order to improve the availability and affordability of drugs, China established its fundamental health insurance system in 2009, which was enhanced by the implementation of price negotiation and mandatory reimbursement policies in 2017 (13).…”

“…The defined daily dose (DDD) is a statistical unit used for calculating and comparing medicine consumption. As there is no standard DDD for anti-neoplastic drugs, the DDD was obtained based on the daily dose and indications from the instructions and authoritative specification databases as well as literatures (13,14). The defined daily doses (DDDs) were calculated as the ratio of the total dose of a specific drug used in grams to the corresponding DDD value.…”

“…Given the shift of cancer treatment paradigm and the increasing clinical importance, the patterns and trends of oral anti-neoplastic drugs have been studied in some countries over the past decade, mainly in France and Manitoba (9,12). However, limited studies regarding this issue have been conducted in China, specifically focusing on certain classes of anti-tumor drugs, such as EGFR-TKIs and human epidermal growth factor receptor 2 inhibitors (11,13). Therefore, the present study aims to investigate the prescribing patterns and trends of oral anti-neoplastic drugs at our institution in China from 2017 to 2022, and analyze the DDDs and DDC values of oral targeted anti-neoplastic agents during this time period.…”

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.…”