Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
Front Public Health. 2022 Jul 22;10:942638. doi: 10.3389/fpubh.2022.942638. eCollection 2022.
In order to establish a long-term strategy for bearing the costs of anti-cancer drugs, the state had organized five rounds of national-level pricing negotiations and introduced the National Health Insurance Coverage (NHIC) policy since 2016. In addition, the National Healthcare Security Administration (NHSA) introduced the volume-based purchasing (VBP) pilot program to Nanjing in September 2019. Taking non-small cell lung cancer as an example, the aim of the study was to verify whether national pricing negotiations, the NHIC policy and the VBP pilot program had a positive impact on the accessibility of three targeted anti-cancer drugs.
Based on the hospital procurement data, interrupted time series (ITS) design was used to analyze the effect of the health policy on the accessibility and affordability of gefitinib, bevacizumab and recombinant human endostatin from January 2013 to December 2020 in Nanjing, China.
The DDDs of the three drugs increased significantly after the policy implementation ( < 0.001, < 0.001, = 0.008). The trend of DDDc showed a significant decrease ( < 0.001, < 0.001, < 0.001). The mean availability of these drugs before the national pricing negotiation was <30% in the surveyed hospitals, and increased significantly to 60.33% after 2020 ( < 0.001, = 0.001, < 0.001). The affordability of these drugs has also increased every year after the implementation of the insurance coverage policy. The financial burden is higher for the rural patients compared with the urban patients, although the gap is narrowing.
The accessibility of targeted anti-cancer drugs has increased significantly after the implementation of centralized prices, the NHIC policy and the VBP pilot program, and has shown sustained long-term growth. Multi-pronged supplementary measures and policy approaches by multiple stakeholders will facilitate equitable access to effective and affordable anti-cancer drugs.
为了制定抗癌药物成本的长期策略，国家自 2016 年起组织了五轮国家层面的药品价格谈判，并推出了国家医保目录政策。此外，国家医疗保障局于 2019 年 9 月在南京启动了以量定价的药品集中带量采购试点。本研究以非小细胞肺癌为例，旨在验证国家药品价格谈判、国家医保目录政策和以量定价的药品集中带量采购试点对三种靶向抗癌药物可及性的影响。
本研究基于医院采购数据，采用中断时间序列（ITS）设计分析了 2013 年 1 月至 2020 年 12 月期间，在中国南京，国家医保目录政策和以量定价的药品集中带量采购试点对吉非替尼、贝伐珠单抗和重组人血管内皮抑制素可及性和可负担性的影响。
政策实施后，三种药物的用药频度（DDD）均显著增加（<0.001，<0.001，=0.008）。用药频度日费用（DDDc）的趋势呈显著下降（<0.001，<0.001，<0.001）。在调查医院中，三种药物在国家药品价格谈判前的可及性均<30%，但在 2020 年后显著增加至 60.33%（<0.001，=0.001，<0.001）。国家医保目录政策实施后，三种药物的可负担性逐年增加。农村患者的经济负担高于城市患者，尽管差距正在缩小。
实施集中采购、国家医保目录政策和以量定价的药品集中带量采购试点后，靶向抗癌药物的可及性显著提高，并呈现持续的长期增长。多方利益相关者采取多管齐下的补充措施和政策方法，将有助于公平获得有效和负担得起的抗癌药物。
