Abstract

MethodsUsing an interrupted time series design, we conducted segmented regression analyses of utilization changes of targeted anti-cancer medicines covered by the provincial government health insurance program during 2013 to 2016 in 69 hospitals with more than 100 beds in Hangzhou, the capital city of Zhejiang province of China. The WHO/Health Action International Project on Medicine Prices and Availability methodology was used to measure patient affordability of the study medicines.ResultsIn March 2015, the utilization of all study medicines increased by 15.58 (95% CI = 3.86, 27.30, P = 0.01) to 439.14 standard units (95% CI = 311.79, 566.49, P < 0.001). Before covered by government health insurance, the estimated out-of-pocket payment by patient ranged from 3.0 to 13.1 times of the provincial average disposable annual income per capita for urban residents, and 6.2 to 27.3 times for rural residents. Such payments were reduced to 0.6 to 2.1 times for urban residents and 1.8 to 4.4 times for rural population after government health insurance coverage inclusion. During 2015 to 2016, the per capita contribution to Hangzhou catastrophic health insurance program was CNY15 (US$ 2.3), and the reimbursement rate was 70% in Hangzhou city. The cumulative total insurance expenses on six study targeted anticancer medicines accounted for an estimated 53% of the total amount of premiums of the government catastrophic health insurance fund. Sensitivity analyses indicated that this proportion would have changed to 46%, 61% and 69% when changing the per capita contribution to CNY25 (US$ 3.8) and CNY40 (US$ 6.2), and changing the insurance reimbursement rate to 60%, 80 and 90%.ConclusionGovernment health insurance coverage inclusion significantly increased utilization of the expensive targeted anti-cancer medicines, and improved patient affordability. However, the financial burden of patients is still high, especially for the rural low-income population. Rising utilization and expenditures call for careful monitoring of anti-cancer medicines use, and for strategies to decrease prices to facilitate medicines access and keep the insurance system sustainable.

Highlights

  • How government insurance coverage changed the utilization and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study

  • We studied patient affordability of these medicines and the impact of insurance coverage inclusion of these medicines on insurance spending

  • To assess changes in patient’s affordability of the study medicines, we analyzed the number of average per capita disposable annual income needed to cover the OOP expenditure for the study medicines by patients both eligible and not eligible for pharmaceutical companies’ patient assistance program with the following scenarios: (1) Before insurance coverage inclusion, urban and rural patients who were not eligible for the patient assistance program had to pay the study medicines totally OOP; (2) Before insurance coverage inclusion, urban and rural patients who were eligible for the patient assistance program paid for a defined number of initial doses

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Summary

Introduction

How government insurance coverage changed the utilization and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study.

Methods
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Conclusion
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