Zhu Hong, Zhu Jingmin, Zhou Yingyu, Shan Linghan, Li Cui, Cui Yu, Kang Zheng, Jiao Mingli, Liu Huan, Gao Lijun, Wu Qunhong, Hao Yanhua
Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China.
Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China.
Front Public Health. 2022 Jul 1;10:921093. doi: 10.3389/fpubh.2022.921093. eCollection 2022.
Since 2016, the Chinese government has been regularly implementing the National Reimbursement Drug List Negotiation (NRDLN) to improve the accessibility of drugs. In the second round of NRDLN in July 2017, 18 anticancer drugs were included. This study analyzed the impact of the NRDLN on the accessibility of these 18 anticancer drugs in China.
National hospital procurement data were collected from 2015 to 2019. As measurements of drug accessibility, monthly average of drug availability or defined daily dose cost (DDDc) was calculated. Interrupted time series (ITS) analysis was employed to evaluate the impact of NRDLN on drug accessibility. Multilevel growth curve models were estimated for different drug categories, regions or levels of hospitals.
The overall availability of 18 anticancer drugs increased from about 10.5% in 2015 to slightly over 30% in 2019. The average DDDc dropped from 527.93 CNY in 2015 to 401.87 CNY in 2019, with a reduction of 23.88%. The implementation of NRDLN was associated with higher availability and lower costs for all 18 anticancer drugs. We found an increasing level in monthly drug availability (β = 2.1126), which ascended more sharply after the implementation of NRDLN (β = 0.3656). There was a decreasing level in DDDc before July 2017 (β = -108.7213), together with a significant decline in the slope associated with the implementation of NRDLN (β = -4.8332). Compared to Traditional Chinese Medicines, the availability of Western Medicines was higher and increased at a higher rate (β = 0.4165 vs. 0.1108). Drug availability experienced a larger instant and slope increase in western China compared to other regions, and in secondary hospitals than tertiary hospitals. Nevertheless, regional and hospital-level difference in the effect of NRDLN on DDDc were less evident.
The implementation of NRDLN improves the availability and reduces the cost of some anticancer drugs in China. It contributes to promoting accessibility of anticancer drugs, as well as relieving regional or hospital-level disparities. However, there are still challenges to benefit more patients sufficiently and equally. It requires more policy efforts and collaborative policy combination.
自2016年起，中国政府定期开展国家医保药品目录谈判（NRDLN）以提高药品可及性。在2017年7月的第二轮国家医保药品目录谈判中，18种抗癌药被纳入。本研究分析了国家医保药品目录谈判对这18种抗癌药在中国可及性的影响。
收集2015年至2019年全国医院采购数据。作为药品可及性的衡量指标，计算药品可获得性的月平均值或限定日剂量费用（DDDc）。采用中断时间序列（ITS）分析评估国家医保药品目录谈判对药品可及性的影响。针对不同药品类别、地区或医院级别估计多级增长曲线模型。
18种抗癌药的总体可获得性从2015年的约10.5%增至2019年的略高于30%。平均限定日剂量费用从2015年的527.93元降至2019年的401.87元，降幅为23.88%。国家医保药品目录谈判的实施与所有18种抗癌药的更高可获得性和更低成本相关。我们发现月药品可获得性水平不断提高（β = 2.1126），在国家医保药品目录谈判实施后上升更为明显（β = 0.3656）。2017年7月之前限定日剂量费用水平呈下降趋势（β = -108.7213），与国家医保药品目录谈判实施相关的斜率也显著下降（β = -4.8332）。与中药相比，西药的可获得性更高且增速更快（β = 0.4165对0.1108）。与其他地区相比，中国西部地区以及二级医院的药品可获得性即时和斜率增长幅度更大。然而，国家医保药品目录谈判对限定日剂量费用影响的地区和医院级别差异不太明显。
国家医保药品目录谈判的实施提高了中国部分抗癌药的可获得性并降低了成本。它有助于促进抗癌药的可及性，减轻地区或医院级别差异。然而，要充分且平等地惠及更多患者仍面临挑战。这需要更多政策努力和协同政策组合。
