Health Insurance In China Research Articles

PNS117 A STUDY ON THE FACTORS AFFECTING CHINESE CITIZENS' WILLINGNESS TO PURCHASE TAX-DEDUCTIBLE PRIVATE HEALTH INSURANCE

As a special type of private health insurance in China, tax-deductible private health insurance is promoted by the Chinese government in November of 2015 to stimulate the development of private health insurance. A pre-tax discount up to 2,400 yuan is provided to insurers regardless of health status and guarantees renewal, and requires no . Though with various favorable claims standards, tax-deductible private health insurance only accumulated a premium of 940 million yuan, accounting for only 0.172% of the total premium income in private(544.813 billion yuan) in 2018, indicating an unsatisfactory performance. This paper aims to explore the factors influencing Chinese residents’ willingness to purchase tax-deductible private health insurance. A survey was conducted from November 2018 to April 2019 in Hangzhou city in Zhejiang province of China to collect data on citizens’ willingness to purchase tax-deductible private health insurance, and its potential influencing factors. A binary logit model was used to estimate the impact of each influencing factor explained by the odds ratio. A total of 1613 citizens participated in the survey. Middle-income citizens have the strongest willingness. Higher education level, higher family support pressure, participation in urban employee medical basic insurance or urban resident basic medical insurance, preference to high outpatient reimbursement level and low hospital reimbursement level, knowledge of private health insurance and previous experience of purchasing tax-deductible private health insurance are positively correlated with purchasing willingness. Corresponding measures, such as improving the tax incentive, unifying the private and social insurance, strengthening publicity of tax-deductible private health insurance, can be taken to stimulate the development of private health insurance.

The effects of compulsory health insurance on birth outcomes: evidence from China\u2019s UEBMI scheme

BackgroundDespite extensive research concerning the impact of health insurance on the advancement of infant health in developed countries, few studies have adjusted their results for potential confounding due to adverse selection in insurance coverage, wherein those who anticipate a need for health services tend to be the ones that acquire insurance. The presence of compulsory health insurance in China, such as the Urban Employee Basic Medical Insurance (UEBMI) scheme may provide an opportunity to estimate the effect of health insurance on infant health, by reducing the endogeneity problem into insurance due to the adverse selection. The objective is to assess the relationship between UEBMI and infant health outcomes in one sizeable municipal-level obstetrics hospital in Shanghai, East China.MethodsMedical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013 to April 30, 2019 were used to form an analysis dataset of 160,429 live births which was comprised of Shanghai residents with UEBMI coverage (n = 101,153) and women without any insurance coverage (n = 59,276). A propensity score matching approach using conjoint quantile regression and probit regression models was used to eliminate latent endogeneity of UEBMI coverage in order to garner robust results. Further analysis stratified by maternal migrant status was conducted to further assess the sensitivity of the findings to distinct patient subgroups.ResultsThe UEBMI scheme was shown to be associated with improvements in infant birth outcomes. The scheme was associated with: an increase in birth weight of about 30 g (p < 0.001, 95% CI 23.908–35.295). This finding was evident in other five different birth outcomes (premature birth, low birth weight, very low birth weight, low Apgar score, and an abnormal health condition at birth). After stratifying by migrant status, the UEBMI was shown to have a greater effect on migrants compared to local residents of Shanghai.ConclusionsOur findings suggest that health insurance coverage for pregnant women, especially for migrants, has the potential to significantly and directly improve infant health outcomes. Further research is required to determine whether these findings can be replicated for other Chinese jurisdictions.

Clinically Applicable Deep Learning to Automate Pulmonary Scanning: Towards Building Intelligent CT Systems

Background: Artificial intelligence (AI) has not been experimented with the enhancement of the upstream clinical care, especially imaging acquisition; thus, we hypothesize AI may empower CT with intelligence. We herein combine two state-of-the-art deep learning architectures for object detection and semantic segmentation to build an intelligent system to automate pulmonary scanning and reduce radiation dose. Methods: Facial boundary detection was realized by ingeniously recognizing the adjacent jaw position through training and testing a region proposal network (RPN) on 76,882 human faces after a preinstalled 2-dimensional camera; we then segmented the lung-fields by deploying V-Net on another training set with 314 subjects and calculated the moving distance of scanning couch based on a pre-generated calibration table. A multi-cohort comprising 1,186 patients was used for independent validation and radiation dose quantification under three clinical scenarios. Findings: A U-HAPPY (United imaging Human Automatic Planbox for PulmonarY) scanning CT was designed. The error distance of RPN was 4·46±0·02mm with a success rate of 98·7% in the training set and 2·23±0·10mm with 100% success rate in the testing set. The average Dice's coefficient was 0·99 in the training set and 0·96 in the testing set. A calibration table with 1,344,000 matches was generated to support the linkage between the camera and scanner. This real-time automation makes an accurate planbox to cover exact location and area that needs to scan, which thus reduces amounts of radiation exposures significantly in scenario fully navigated by U-HAPPY as compared to others (all, P<0·001). Interpretation: Our U-HAPPY CT designed for pulmonary imaging acquisition standardization and upstream workflow optimization may complete the last puzzle piece that combines AI and medical imaging. Funding Statement: This work was supported by the National Natural Science Foundation of China (81720108022, 91649116, 81571040, 81973145), the Social Development Project of Science and Technology in Jiangsu Province (BE2016605, BE201707), the National Key R&D Program of China (2017YFC0112801), the Key Medical Talents of Jiangsu Province, the ‘13th Five-Year’ Health Promotion Project of Jiangsu Province (B.Z.2016-2020), the Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKA2016020), the Project of the Sixth Peak of Talented People (WSN-138, BZ), the China Postdoctoral Science Foundation (2019M651805), the Fundamental Research Funds for the Central Universities grants of China (Grant No. 2632018FY04), the “Double First-Class” University project (CPU2018GY09). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the institutional review board of the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School. Institutional review board (IRB)/ethics committee approvals were obtained. The work was conducted in a manner compliant with the People's Republic of China Health Insurance Portability and Accountability Act (HIPAA) and was adherent to the tenets of the Declaration of Helsinki. Patient consent was waived for access to the training, validation, and independent testing datasets.

Epidemiological characteristics, medical costs and healthcare resource utilization of diabetes-related complications among Chinese patients with type 2 diabetes mellitus

ABSTRACT Objectives: To estimate the direct medical costs (DMCs) and healthcare resource utilization (HRU) of type 2 diabetes mellitus (T2DM)-related complications in China. Methods: Data from a total of 74,507 patients were extracted from the 2015 China Health Insurance Research Association Claims Database. The complications determined by primary diagnoses were categorized into three groups: 1) for mild acute and local chronic complications, both outpatients and inpatients were considered; 2) for severe acute complications, only inpatiens were considered; 3) for systemic chronic complications, a 1:1 propensity-score matching was performed to calculate the incremental DMCs and HRU of preexisting and new-onset patients. Results: Among the mild acute and local chronic complications, the DMCs and HRU per event were the highest for gangrene and laser treatment. Of the severe acute complications, the DMCs and HRU per event were highest for hyperosmotic nonketonic diabetic coma (HNDC), followed by severe hypoglycemia and ketosis. For systemic chronic complications, the DMCs and HRU associated with dialysis and myocardial infarction were the highest both in patients with new-onset complications and preexisting complications. Conclusions: The estimated economic data are required for policy decisions to optimize resource allocation and to evaluate different approaches for disease management.

China Kidney Disease Network (CK-NET) 2015 Annual Data Report

China Kidney Disease Network (CK-NET) 2015 Annual Data Report

Effects of China's urban basic health insurance on preventive care service utilization and health behaviors: Evidence from the China Health and Nutrition Survey.

BackgroundLifestyle choices are important determinants of individual health. Few studies have investigated changes in health behaviors and preventive activities brought about by the 2007 implementation of Urban Resident Basic Health Insurance (URBMI) in China. This study, therefore, aimed to explore whether URBMI has reduced individuals’ incentives to adopt healthy behaviors and utilize preventive care services.MethodsData were drawn from two waves of the China Health and Nutrition Survey. Respondents were categorized according to their insurance situation before and after the URBMI reform in 2006 and 2011. Propensity score matching and difference-in-differences methods were used to measure levels of preventive care and behavior changes over time. Estimations were also made based on gender, self-reported health, and income.ResultsWe found that URBMI implementation did not change residents’ utilization of preventive care services or their smoking habits, drinking habits, or other risky behaviors overall. However, the likelihood of sedentariness did increase by five percentage points. Females tended to be more sedentary while males were less likely to drink soft drinks. Residents with poor self-reported health exercised less while those who reported good health were more likely to be sedentary. Low- and middle-income residents were likely to be sedentary while middle-income people tended to smoke after becoming insured.ConclusionSince URBMI implementation, some unhealthy behaviors like sedentariness have increased among those who were newly insured, and different subgroups have reacted differently. This suggests that the insurance design needs to be optimized and effective measures need to be adopted to help improve people’s lifestyle choices.

PCN76 - BUDGET IMPACT ANALYSIS OF AFATINIB FOR THE FIRST-LINE TREATMENT OF ADVANCED OR METASTATIC NON–SMALL-CELL LUNG CANCER IN CHINA

Afatinib is approved in China for the first-line treatment of patients with advanced or metastatic non–small-cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) mutations. The objective of this study is to evaluate the budget impact of adding afatinib to the National Reimbursement Drug List (NRDL) covered by basic health insurance (BHI) in China. A simple model was developed to evaluate the budget impact over a 5-year time horizon. The number of patients eligible for treatment was estimated using published incidence data. Therapies included in the model were afatinib, erlotinib, gefitinib (including a generic drug), and icotinib. Drug-acquisition costs were retail price or reimbursement payment standard. Market share of tyrosine kinase inhibitors (TKIs) was estimated by market-research data. The mean time for patients using TKIs was assumed to be 11 months, based on progression-free survival data from clinical trials. Using the base-case parameter assumptions, the total budget would increase by ¥79 million, ¥147 million, ¥172 million, ¥169 million, and ¥152 million in the first 5 years of afatinib on NRDL. This translates into small increases in the per-patient-per-year (PPPY) cost of ¥757, ¥1,255, ¥1,430, ¥1,363, and ¥1,188; and increases in the per-member-per-year (PMPY) costs of ¥0.06, ¥0.11, ¥0.13, ¥0.13, and ¥0.11 in years 1 through 5, respectively. Afatinib is likely to have a marginal impact on the BHI budget in China. Considering that afatinib is the only drug that has demonstrated improvement in overall survival versus chemotherapy in the del19 population and has shown superiority in progression-free survival versus gefitinib in this setting, afatinib is a budget-neutral way of improving cancer care for patients with EGFR+ NSCLC in China. Further analysis needs to consider progression-free and overall survival times of patients, costs of managing adverse reactions, and additional disease management costs.

PUK11 - ECONOMIC BURDEN OF CHRONIC KIDNEY DISEASE RELATED COMPLICATIONS AND THERAPIES IN CHINA: QUANTIFYING THE COSTS OF CARDIOVASCULAR EVENTS, BLOOD TRANSFUSION FOR ANEMIA AND DIALYSIS

Our objective was to estimate the costs of common chronic kidney disease (CKD)-related complications and therapies (cardiovascular (CV) events, blood transfusion for anemia, and dialysis) in China, for use in health economic analysis. This retrospective observational study used inpatient and outpatient insurance claims data from the China Health Insurance Research Association (CHIRA) in 2015. Adult patients with a CKD diagnosis were included. For patients with a hospitalization for CV events between 01/01/2015 and 30/09/2015, total inpatient costs per hospitalization were calculated, stratified by CV event type and dialysis status. Outpatient costs were determined for the three months post hospital discharge. Mean monthly costs before hospitalization were calculated for a patient subset with hospital admission after 01/04/2015. Furthermore, the cost of red blood cell transfusion (RBCT) during anemia-related hospitalizations was determined. Finally, monthly health care costs, including dialysis costs, were calculated for patients with ≥3 consecutive months with dialysis records. Among 31,886 CKD patients included in 2015, 2,871 patients had a CV hospitalization. The overall mean (median) cost per hospitalization was ¥14,488 (¥7871). Myocardial infarction was the costliest CV event (mean/median inpatient cost ¥29,203/¥13,046). Mean monthly outpatient costs per patient were higher post discharge (1st month: ¥264; 2nd month: ¥251; 3rd month: ¥228) than before the hospitalization (¥188.10; based on patient subset). Among the 1,227 patients with anemia-related hospitalizations with RBCT, the mean/median cost of blood products was ¥1,895/¥960 per patient per hospitalization. The 3,447 dialysis patients in our dataset incurred a mean/median monthly health care cost of ¥10,235/¥8,002 per patient, of which ¥5,874/¥5,240 were dialysis costs. Hemodialysis was more costly than peritoneal dialysis (mean/median monthly costs ¥6,096/¥5,348 vs. ¥3,861/¥3,939, respectively). Using high-quality insurance data from China, we quantified the costs of common CKD-related complications and therapies, which are major contributors to the economic burden of CKD.

PCV60 - Analysis of Anticoagulation Therapy In Patients With Pulmonary Embolism Among The Population With Urban Basic Health Insurance In China

To analyze the anticoagulation therapy of patients with pulmonary embolism (PE) among the population with urban basic health insurance in China in 2014. This retrospective analysis identified patients diagnosed with PE in 2014 in the China Health Insurance Research Association (CHIRA) claims database, which is the largest nationwide claims database in mainland China. All of the patients were included if they were aged 18 years and older and their diagnosis included PE based on the ICD-10 codes or the physician’s notes. Patients’ demographic characteristics, prescription drug information and healthcare expenses were also collected from the database. Descriptive statistics of anticoagulation prescription were conducted. A total of 475 PE patients with 1090 hospital visits were identified in 2014 (mean age of 65.87 ± 14.62 years, 47.2% male). Of all patients’ hospital visits, 74.1% were outpatient treatment and 25.9% were inpatient treatment.Of all inpatient visits, 52.1% didn’t receive any anticoagulant therapy, 14.5% received low-molecular-weight (LMWH) and warfarin, 7.8% received unfractionated heparin (UFH) only, 5.3% received LMWH only, 5.3% received warfarin only, 4.3% received LMWH and UFH, 3.5% received UFH and warfarin and 7.1% received other anticoagulant drugs.Of all outpatient visits, 66.3% didn’t receive any anticoagulant therapy, 28.8% received warfarin only, 1.9% received LMWH only, 0.4% received UFH only, 0.1% received LMWH and warfarin, as well as 2.5% received other anticoagulant drugs. More than half of PE patients’ hospital visits didn’t receive any anticoagulant treatment. For PE patients with inpatient treatment, LMWH and warfarin was the most used anticoagulant treatment; while, for PE patients with outpatient treatment, warfarin was the most used anticoagulant treatment.

PDB38 - Epidemiological Characteristics, Medical Cost and Healthcare Resource Utilization of Diabetes-Related Complications Among Chinese Patients with Type 2 Diabetes Mellitus

To characterize epidemiological features and estimate the economic burden of diabetes-related complications among Chinese patients with type 2 diabetes mellitus (T2DM). Patients with T2DM were extracted from the 2015 China Health Insurance Research Association Claims Database that includes 4,641,636 public basic medical insurance enrollees in 61 cities across 30 provinces. For 16 chronic complications, patients with diagnosis of a certain complication were categorized into those with the new-onset and those with the pre-existing complication. A propensity-score matching was performed to control patients’ baseline characteristics between patients with and without a certain chronic complication. The incremental medical cost and resource utilization of patients with the new-onset and pre-existing complication vs. without the complication were calculated respectively and extended to a one-year period. For 5 acute complications, the medical cost and resource utilization per event were calculated. Overall 74,507 T2DM patients with an average age of 61 years were included, among which 37,994 had ≥1 complication. The chronic complications with the top 3 highest prevalence were stroke (15.6%), diabetic peripheral neuropathy (10.9%), and angina (7.1%). Their annual medical costs were RMB 24,237; 6,937 and 30,290 for the new-onset complications, and RMB 11,588; 824 and 7,521 for the pre-existing complications, respectively. The length of days in hospital was greatest for stroke, followed by angina and diabetic peripheral neuropathy both for patients with the new-onset (20.38, 14.01 and 12.58 days, respectively) and those with pre-existing complications (7.84, 4.44 and 3.77 days, respectively). Hypoglycemia was a common acute complication, with incidences of 2.67% and 0.12% for non-severe and severe hypoglycemia, respectively. Average costs per inpatient for non-severe and severe hypoglycemia were RMB 7,272 and 11,412, respectively, with average lengths of stay of 7.55 and 9.48 days, respectively. Diabetes-related complications were associated with substantial medical costs and healthcare resource utilization in China.

Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China.

BackgroundThe burden of pneumococcal disease in China is high, and a 13-valent pneumococcal conjugate vaccine (PCV13) recently received regulatory approval and is available to Chinese infants. PCV13 protects against the most prevalent serotypes causing invasive pneumococcal disease (IPD) in China, but will not provide full societal benefits until made broadly available through a national immunization program (NIP).ObjectiveTo estimate clinical and economic benefits of introducing PCV13 into a NIP in China using local cost estimates and accounting for variability in vaccine uptake and indirect (herd protection) effects.MethodsWe developed a population model to estimate the effect of PCV13 introduction in China. Modeled health states included meningitis, bacteremia, pneumonia (PNE), acute otitis media, death and sequelae, and no disease. Direct healthcare costs and disease incidence data for IPD and PNE were derived from the China Health Insurance and Research Association database; all other parameters were derived from published literature. We estimated total disease cases and associated costs, quality-adjusted life years (QALYs), and deaths for three scenarios from a Chinese Payer Perspective: (1) direct effects only, (2) direct+indirect effects for IPD only, and (3) direct+indirect effects for IPD and inpatient PNE.ResultsScenario (1) resulted in 370.3 thousand QALYs gained and 12.8 thousand deaths avoided versus no vaccination. In scenarios (2) and (3), the PCV13 NIP gained 383.2 thousand and 3,580 thousand QALYs, and avoided 13.1 thousand and 147.5 thousand deaths versus no vaccination, respectively. In all three scenarios, the vaccination cost was offset by cost reductions from prevented disease yielding net costs of ¥29,362.32 million, ¥29,334.29 million, and ¥13,524.72 million, respectively. All resulting incremental cost-effectiveness ratios fell below a 2x China GDP cost-effectiveness threshold across a range of potential vaccine prices.DiscussionInitiation of a PCV13 NIP in China incurs large upfront costs but is good value for money, and is likely to prevent substantial cases of disease among children and non-vaccinated individuals.

Reducing the medical economic burden of health insurance in China: Achievements and challenges.

The aims of this study were to describe health insurance reforms initiated by the Chinese government over the past two decades, to review their achievements in reducing the medical economic burden, and to summarize the challenges that still exist regarding a further reduction in out-of-pocket expenditures in this country. China has successfully attained the goal of providing health insurance coverage to almost the entire population by developing a mixed health insurance system, which consists of Urban Employees Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NCMS), and supplementary Catastrophic Health Insurance. Despite this achievement, China is still facing the challenges of a disparity in the medical economic burden by region and by health insurance scheme, relatively little protection from financial risk compared to developed countries, as well as low efficiency and quality of care under current payment systems. To further reduce the disparity in the medical economic burden and to increase the overall protection from financial risk in China, the Government should increase central government transfers to NCMS and URBMI enrollees in poor regions and increase the total amount of government subsidies to NCMS. In addition, China should improve the efficiency and quality of health insurance by further reforming the payment system.

Development of Commercial Health Insurance in China: A Systematic Literature Review.

Facing difficulties like increasing health burden and health inequity, China government started to promote commercial health insurance (CHI) in recent decades. Several policies and announcement have been issued to build up a favorable environment for development of commercial health insurance. Meanwhile, scholar tried to investigate the related issues in purpose to further improve the situation in China. Therefore, we performed this systematic review in order depict a comprehensive picture on the current evidence-based researches of CHI in China. We searched PubMed, ScienceDirect, and CNKI, supplemented with hand search in reference lists, for eligible studies published from 1990 January to 2018 April. Also, hand search was conducted to select suitable articles from international organization and reference list of eligible articles. Two independent reviewers extracted the data from eligible articles and input into a standardized form. Based on the inclusion criteria, 35 articles were included in this systematic review. Most of the studies were quantitative researches with topics such as the development level of commercial health insurance in China, the demand and supply issues related, and the relationship and influence of social health insurance, as well as the moral issues evolved from commercial health insurance system. In summary, CHI in China is still at the early development stage. Among those few evidence-based articles, the findings suggested several policy implication and different market strategy. With the initiation of new health reforms and implementation of taxes policy, more empirical researches should be conducted on issues relating to the practical operation of CHI.

Social health insurance vs private health insurance in China: Revisit crowd-out effect based on a multiple mediation analysis.

Plenty of scholars have studied social health insurance and private health insurance in different economies, and many concentrate on crowd-out effect. Different results have been presented due to various data choices and empirical methodologies, but few of them have revealed the transaction mechanism. We study this issue based on updated Chinese provincial panel data from 2002 to 2014 and improved methods. We focus on how the crowd-out effect happens through 3 channels-saving, demographic factor, and medical expenditure using multiple mediator models. Besides, we apply Panel VAR model to study magnitude of the impact these 3 channels contribute, corporately and respectively. Results clearly show that social health insurance has crowd-out effect in penetration but crowd-in effect in density caused by different mediation variables. In addition, the 3 channels have shown lasting and dynamic influences on the crowd-out (in) effect. Finally, our paper provides the anti-crowd-out solutions from both perspectives according to our empirical analyses. For social health insurance system, it is necessary to improve the efficiency and fairness of the funds. For the private health insurance companies, insurance products innovation and privilege policy should be made to decrease the negative impact of saving and medical service overuse.

Descriptions of self-treatment for the middle-aged and elderly in Shanxi, China.

ObjectivesSelf-treatment is a widespread practice among patients with common symptoms and ailments; it is necessary to explore multiple aspects of it. Notably, there is little research into self-treatment among middle-aged and elderly people, who are more likely to fall ill. Our goals are to provide a comprehensive description of self-treatment and explore associated factors with insurance utilization and expenditures among the middle-aged and elderly populations in China.MethodsA survey was conducted in July 2016 in Shanxi, China. A stratified sampling scheme was applied to achieve representativeness. A total of 972 subjects were surveyed. Descriptive statistics, t- and Chi-squared tests, multivariate logistic regression, and multivariate linear regression were utilized.ResultsIn our study, 772 (79.4%) of the surveyed subjects self-treated during the previous twelve months. Among them, 253 (32.8%) used health insurance. Subjects’ characteristics were associated with insurance utilization and expenditures for self-treatment. Total cost was positively associated with insurance utilization. The subjects with a junior high education (p-value < 0.001, aOR = 0.049) and senior high education (p-value = 0.020, aOR = 0.146) had a lower probability of using insurance. For both total costs and out-of-pocket costs, subjects who were 51 to 60 years old had lower costs. The subjects who were seriously sick and had a primary school education, as well as enterprise occupations, had higher costs. Self-treatment times were also positively associated with costs. Finally, it was found that subjects who didn’t use insurance had lower total costs.ConclusionsThe prevalence of self-treatment was high (79.4%). Some characteristics were associated with insurance utilization and expenditures in self-treatment. Our results may be helpful for policy interventions, which are needed to further improve the effectiveness of health insurance in China.

PHS103 - Medical Expenditures for Patients with Pulmonary Embolism Among the Population with Urban Basic Health Insurance in China

PHS103 - Medical Expenditures for Patients with Pulmonary Embolism Among the Population with Urban Basic Health Insurance in China

PCN216 - Treatment Pattern And Direct Medical Costs Among Patients With Lung Cancer In China

To explore the treatment pattern and to estimate direct medical costs in lung cancer patients. A retrospective observational study was carried out on the basis of China Health Insurance Research Association (CHIRA) database in 2016. Patients with ≥1 diagnosis of lung cancer during the first season were identified. If the patient met one of the following criteria: 1) with other cancer diagnosis; 2) complicated with schizophrenia; 3) receiving hemodialysis or peritoneal dialysis treatment, he (she) would be excluded. Eligible patients were classified into one of the subgroups by the treatment methods: 1) chemotherapy group; 2) radiotherapy group; 3) radiotherapy combined with chemotherapy group; 4) surgical treatment group; 5) targeted agent group; 6) palliative treatment group. The age, sex, proportion and annual direct medical costs of those subgroups were described and calculated. 3,365 lung cancer patients met the inclusion criteria. The mean age was 65.2±11.0 years. 65.1% of the total participants were male. The proportion of the chemotherapy group, radiotherapy group, radiotherapy combined with chemotherapy group, surgical treatment group, targeted agent group and palliative treatment group was 20.5% (n=691), 6.2% (n=210), 10.4% (n=350), 4.7% (n=157), 2.9% (n=96) and 55.3% (n=1,861), respectively. The annual mean all-cause direct medical cost per capita was CNY 53,143.8±60,771.3. The ratio of the cost covered by medical insurance reimbursement was 71.8%. Medication cost made up 55.6% of the total cost. The annual mean all-cause direct medical cost per capita of the subgroups above was CNY 61,253.0±58,682.3, CNY 63,266.5±51,248. 7, CNY 113,001.5±66,705.1, CNY 100,338.3±4,8949.3, CNY 161,089.4±90,240.3 and CNY 28,183.2±39,141.9, respectively. The percentage of the medication cost was the highest in the targeted agent group (CNY 104,534.5±67,592.3, 64.9%). In this database analysis, more than half of the lung cancer patients received palliative treatment. The total annual direct medical cost was the highest in patients who received targeted agent treatment.

PCV56 - Cost-Effectiveness Of Rivaroxaban Compared With Combined Low Molecular Weight Heparin/Vitamin K Antagonist For The Treatment Of Pulmonary Embolism In China

Pulmonary embolism (PE) is a serious condition associated with high mortality and an annual incidence around 0.1% among hospitalized patients in China. Compared with standard of care (SOC), combined low molecular weight heparin (LMWH) and vitamin K antagonist (VKA), the direct oral anticoagulant rivaroxaban is easier to use without monitoring and lower bleeding risk. Since there is limited economic evaluation of rivaroxaban among Chinese people, the aim was to estimate the cost-effectiveness of rivaroxaban compared with combined LMWH/VKA form a perspective of the third payer in China. A Markov model was constructed using data derived from EINSTEIN PE studies of rivaroxaban, China health insurance database and other published literature. Main outcomes were total costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The QALYs and direct medical costs were reported over a 5-year horizon. An annual discount rate with 5% was adopted for costs and outcomes. One-way and probabilistic sensitivity analyses were performed to test uncertainty concerning the model parameters. Rivaroxaban therapy had more QALYs (4.015 vs 4.010) and lower total costs (CNY 40,444 vs. CNY 41,916) compared with LWMH/VKA, which demonstrated it as a cost-saving treatment strategy. The result was most sensitive to the cost per day of hospitalization avoided and length of hospitalization in PE patients on LMWH/VKA. In addition, geometric mean ratio of length of hospitalization of rivaroxaban vs. LMWH and cost of rivaroxaban (per day) were other important variables. At a willingness-to-pay threshold of ¥161,940/QALY(2016), the likelihood of rivaroxaban being cost-effective was 91.3%. In conclusion, rivaroxaban therapy resulted in cost-saving compared with LMWH/VKA for anticoagulation treatment of PE patients in China.

Improvement of the reduction in catastrophic health expenditure in China's public health insurance.

This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.

Toward a normalized clinical drug knowledge base in China-applying the RxNorm model to Chinese clinical drugs.

In recent years, electronic health record systems have been widely implemented in China, making clinical data available electronically. However, little effort has been devoted to making drug information exchangeable among these systems. This study aimed to build a Normalized Chinese Clinical Drug (NCCD) knowledge base, by applying and extending the information model of RxNorm to Chinese clinical drugs. Chinese drugs were collected from 4 major resources-China Food and Drug Administration, China Health Insurance Systems, Hospital Pharmacy Systems, and China Pharmacopoeia-for integration and normalization in NCCD. Chemical drugs were normalized using the information model in RxNorm without much change. Chinese patent drugs (i.e., Chinese herbal extracts), however, were represented using an expanded RxNorm model to incorporate the unique characteristics of these drugs. A hybrid approach combining automated natural language processing technologies and manual review by domain experts was then applied to drug attribute extraction, normalization, and further generation of drug names at different specification levels. Lastly, we reported the statistics of NCCD, as well as the evaluation results using several sets of randomly selected Chinese drugs. The current version of NCCD contains 16 976 chemical drugs and 2663 Chinese patent medicines, resulting in 19 639 clinical drugs, 250 267 unique concepts, and 2 602 760 relations. By manual review of 1700 chemical drugs and 250 Chinese patent drugs randomly selected from NCCD (about 10%), we showed that the hybrid approach could achieve an accuracy of 98.60% for drug name extraction and normalization. Using a collection of 500 chemical drugs and 500 Chinese patent drugs from other resources, we showed that NCCD achieved coverages of 97.0% and 90.0% for chemical drugs and Chinese patent drugs, respectively. Evaluation results demonstrated the potential to improve interoperability across various electronic drug systems in China.