Abstract
BackgroundIn 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. “4 + 7” policy. Competitive bidding was conducted by the government based on the annual agreed procurement volume submitted by each public medical institution in pilot cities. Pilot cities were required to implement bid winning results in March 2019 and the use volume of bid winning products was examined to ensure the completion of agreed procurement volume. In the policy, an oral antibiotic (cefuroxime) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the impact of “4 + 7” policy on the use of policy-related antibiotics.MethodsThis study used drug purchase data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Oral antibiotic drugs related to “4 + 7” policy were selected as study samples, including cefuroxime and 12 antibiotic drugs that have an alternative relationship with cefuroxime in clinical use. Purchase volume and expenditures were selected as outcome variables, and were measured using Defined Daily Doses (DDDs) and Chinese yuan, respectively. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of “4 + 7” policy.ResultsAfter the implementation of “4 + 7” policy, the overall volume of cefuroxime and its alternative drugs increased from 9.47 million DDDs to 13.42 million DDDs, with an increase of 41.8 %. The results of segmented linear regression showed that the volume of cefuroxime significantly increased 161.16 thousand DDDs after “4 + 7” policy (95 % CI: 59.43 to 262.90, p-value = 0.004). The volume of alternative drugs significantly increased 273.65 thousand DDDs (95 % CI: 90.17 to 457.12, p-value = 0.006). The overall “4 + 7” policy-related antibiotics significantly increased 436.31 thousand DDDs (95 % CI: 190.81 to 681.81, p-value = 0.001) after “4 + 7” policy.ConclusionsThis study provides evidence that the implementation of “4 + 7” volume-based procurement policy was associated with significant increases in the volume of policy-related antibiotic drugs. The increase in antibiotic use after the policy needs special attention and vigilance.
Highlights
In 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. “4 + 7” policy
A national survey showed that 52.9 % of the patients visiting primary care institutions in China were prescribed antibiotics, but only 39.4 % of those who received antibiotics needed them based on their clinical condition [9]
Significant statistical increasing was observed in the Interrupted time-series (ITS) analysis of volume for overall policy-related antibiotic drugs. These findings suggested that “4 + 7” policy might promoted the overuse of policy-related antibiotic drugs, The main reason is the increase in the use of alternative drugs, mainly manifested in the increasing use of alternative antibiotic drugs
Summary
In 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. “4 + 7” policy. Competitive bidding was conducted by the government based on the annual agreed procurement volume submitted by each public medical institution in pilot cities. 76 % of the overall increase in antibiotic consumption between 2000 and 2010 was attributable to BRICS countries (Brazil, Russia, India, China, and South Africa) [7]. In BRICS countries, up to 57 % of the increase of antibiotic use in the hospital sector was attributable to China [7]. A national survey showed that 52.9 % of the patients visiting primary care institutions in China were prescribed antibiotics, but only 39.4 % of those who received antibiotics needed them based on their clinical condition [9]. As a result of antibiotic misuse, China has the highest level of antibiotic resistance and the most rapid growth of antibiotic resistance globally [11, 12]. The overuse of antibiotics is an important issue China needs to be vigilant about
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