Yuan Jing, Lu Z Kevin, Xiong Xiaomo, Lee Tai-Ying, Huang Huang, Jiang Bin
Department of Clinical Pharmacy & Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China.
University of South Carolina College of Pharmacy, Columbia, SC, United States.
Front Pharmacol. 2022 Jun 6;13:842944. doi: 10.3389/fphar.2022.842944. eCollection 2022.
Although persistent inhibition of HBV replication by antiviral therapy has shown to slow disease progression, cost-related access barriers to these essential medicines are becoming salient. The national volume-based procurement (NVBP) was piloted in China and led to substantial reduction in the list price of prescription drugs. To examine the impact of NVBP on selected antiviral medication costs per defined daily dose (DDD), procurement volumes, and spending. We employed an interrupted time series design to examine changes in cost per defined daily dose (DDD), procurement volumes, and spending for NVBP bid-winning antiviral medications (tenofovir disoproxil fumarate and entecavir) in 11 pilot cities from 2017 to 2020. Procurement transaction data were obtained from 9,454 hospitals in the Chinese Hospital Pharmaceutical Audit (CHPA) database. In the secondary analysis, the control group comprised two non-NVBP drugs (adefovir and lamivudine) procured in 11 cities not exposed to the NVBP. Cost per DDD of the two hepatitis B virus (HBV) antiviral medications reduced by CNY1.598 ( = 0.002) immediately following the implementation of NVBP, dropping from an average cost of CNY16.483 per DDD at baseline to CNY6.420 at the end of the observation period. NVBP implementation resulted in a substantial reduction in daily costs of antivirals and an increase in monthly procurement volumes by 6.674 million DDDs ( = 0.017), while monthly spending was reduced by CNY138.26 million ( = 0.002). In the secondary ITS analysis with a control group, the average cost per DDD of the NVBP bid-winning antivirals declined by CNY4.537 ( < 0.001), monthly procurement volumes increased by 7.209 million DDDs ( = 0.002), and monthly spending dropped by CNY138.83 million ( < 0.001). Volume-based procurement piloted in China may be effective for reducing price and total expenditures and improving drug utilization, which is especially important for HBV patients who need constant access to antiviral therapies.
尽管抗病毒治疗持续抑制乙肝病毒复制已显示出能减缓疾病进展，但这些基本药物与成本相关的获取障碍正变得日益突出。中国开展了国家药品集中带量采购试点工作，并大幅降低了处方药的标价。为了研究国家药品集中带量采购对选定抗病毒药物每限定日剂量（DDD）成本、采购量和支出的影响，我们采用了中断时间序列设计，以研究2017年至2020年期间11个试点城市中，国家药品集中带量采购中标的抗病毒药物（富马酸替诺福韦二吡呋酯和恩替卡韦）每限定日剂量（DDD）成本、采购量和支出的变化。采购交易数据来自中国医院药品采购数据（CHPA）数据库中的9454家医院。在二次分析中，对照组包括在11个未开展国家药品集中带量采购的城市采购的两种非国家药品集中带量采购药物（阿德福韦和拉米夫定）。在实施国家药品集中带量采购后，两种乙肝病毒（HBV）抗病毒药物的每限定日剂量（DDD）成本立即降低了1.598元（ = 0.002），从基线时每限定日剂量平均成本16.483元降至观察期结束时的6.420元。国家药品集中带量采购的实施使抗病毒药物的每日成本大幅降低，每月采购量增加了667.4万限定日剂量（ = 0.017），而每月支出减少了1.3826亿元（ = 0.002）。在有对照组的二次中断时间序列分析中，国家药品集中带量采购中标的抗病毒药物每限定日剂量平均成本下降了4.537元（ < 0.001），每月采购量增加了720.9万限定日剂量（ = 0.002），每月支出下降了1.3883亿元（ < 0.001）。中国开展的带量采购试点工作可能有助于降低价格和总支出，并提高药物利用率，这对于需要持续接受抗病毒治疗的乙肝患者尤为重要。
