Abstract
Objectives: To assess the effects of the National Centralized Drug Purchasing Pilot Program on nucleos(t)ide analogs (NAs) in Shenzhen city.Methods: Drugs procurement records in medical institutions were analyzed covering the period from January 2018 to December 2019. An interrupted time series (ITS) analysis was used to evaluate the impact of the “4+7” pilot policy on NAs in Shenzhen city. The outcome measures were usage volume, expenditures, daily cost, and distribution structure of NAs.Findings: After the introduction of the “4+7” pilot policy, the defined daily doses (DDDs) of NA drugs increased by 76.48%, the expenditures and defined daily dose cost (DDDc) of NAs decreased by 45.43 and 69.08%, respectively. The proportion of winning products in Entecavir and Tenofovir Fumarate DDDs was increased by 64.21 and 19.20%, respectively. The post-intervention period witnessed a significant increase in the regression level for NAs DDDs (level coefficient: β2 = 631.87, p < 0.05). The expenditures (trend coefficient: β3 = 392.24, p < 0.05) and DDDc (level coefficient: β2 = −6.17, p < 0.001; trend coefficient: β3 = −0.21, p < 0.05) of NAs showed decreasing trend in the post-intervention period. The expenditures of original products and generic products both showed a decreasing trend in the post-intervention period (trend coefficient: β3 = −372.78, p < 0.05, trend coefficient: β3 = −130.78, p < 0.05, respectively). The DDDc of original products in the policy-related varieties was a significant decrease in the regression slope and level (level coefficient: β2 = −2.18, p < 0.05; trend coefficient: β3 = −0.32, p < 0.01).Conclusion: After the implementation of the“4+7” policy, the DDDc of NAs decreased, the accessibility of policy-related drugs was improved, and the usage of generic medicine was promoted.
Highlights
The global pharmaceutical spending is set to exceed $1.5 trillion by 2023 growing at a 3–6% compound annual growth rate over the 5 years, as a new report by the Quintiles IMS Holdings, Inc (IQVIA) Institute, a healthcare industry consulting group [1]
The results revealed that annual direct medical costs of hepatitis B virus (HBV)-related diseases among hospitalized patients have reached $4197.9, which accounted for 206.5% of the income of patients [47]
The defined daily doses (DDDs) of Entecavir were increased by 80.45% and the expenditures and defined daily dose cost (DDDc) of Entecavir were decreased by 48.57 and 71.50%, respectively
Summary
The global pharmaceutical spending is set to exceed $1.5 trillion by 2023 growing at a 3–6% compound annual growth rate over the 5 years, as a new report by the Quintiles IMS Holdings, Inc (IQVIA) Institute, a healthcare industry consulting group [1]. Many countriesare facing the challenge of ever-increasing pharmaceutical expenditures all over the world. Using the IQVIA National Sales Perspectives database, total pharmaceutical expenditures in the United States were $535.3 billion in 2020, which grew 4.9% compared to 2019 [2]. A study using the Korean National Health Insurance claims database revealed that total pharmaceutical expenditures increased from $11.3 billion in 2010 to $17.4 billion in 2019 [3]. Pharmaceutical expenditure in lower-middle-income countries can be up to 70% of total healthcare expenditure, much of which is out-of-pocket (OOP) [4]. Medicines account for 20– 60% of health spending in developing and transitional countries. Up to 90% of the population in developing countries face high OOP expenditures when purchasing medicines, making medicines the important family expenditure item. Pharmaceutical spending is unaffordable for large sections of the global population [5]
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