Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
J Glob Health. 2023 Aug 11;13:04083. doi: 10.7189/jogh.13.04083.
High prices of targeted anticancer medicines (TAMs) result in financial toxicity for patients and the health insurance system. How national price negotiation and reimbursement policy affect the accessibility of TAMs for cancer patients remains unknown.
In this population-based cohort study, we used national health insurance claims data in 2017 and identified adult patients with cancer diagnoses for which price-negotiated TAMs were indicated. We estimated the half-month prevalence of price-negotiated TAMs use before and after the policy implementation in September 2017. We calculated direct medical costs, out-of-pocket (OOP) costs, and the proportion of OOP cost for each cancer patient to measure their financial burden attributable to TAMs use. We performed segmented linear and multivariable logistic regression to analyse the policy impact.
We included 39 391 of a total 118 655 cancer beneficiaries. After September 2017, the prevalence of price-negotiated TAMs use increased from 1.4%-2.1% to 2.9%-3.1% (P = 0.005); TAMs users' daily medical costs increased from US$261.3 to US$292.5 (P < 0.001), while median daily OOP costs (US$68.2 vs US$65.7; P = 0.134) and OOP costs as a proportion of daily medical costs persisted (28.5% vs 28.5%; P = 0.995). Compared with resident beneficiaries, the relative probability of urban employee beneficiaries on TAMs uses decreased after the policy (adjusted odds ratio (aOR) = 2.4 vs aOR = 2.2).
The government price negotiation and reimbursement policy improved patient access to TAMs and narrowed disparities among insurance schemes. China's approach to promoting the affordability of expensive medicines provides valuable experience for health policy decision-makers.
靶向抗癌药物（TAMs）的高价给患者和医疗保险制度带来了财务毒性。国家价格谈判和报销政策如何影响癌症患者获得 TAMs 的机会尚不清楚。
在这项基于人群的队列研究中，我们使用了 2017 年的国家健康保险索赔数据，确定了患有 TAMs 适用的癌症诊断的成年患者。我们估计了政策于 2017 年 9 月实施前后，TAMs 使用率的半月患病率。我们计算了每位癌症患者的直接医疗费用、自付费用（OOP）和 OOP 费用占比，以衡量他们因 TAMs 使用而产生的财务负担。我们进行了分段线性和多变量逻辑回归分析来评估政策的影响。
我们纳入了总共 118655 名癌症受益人的 39391 名。2017 年 9 月后，TAMs 使用率从 1.4%-2.1%增加到 2.9%-3.1%（P=0.005）；TAMs 用户的日医疗费用从 261.3 美元增加到 292.5 美元（P<0.001），而每日 OOP 费用中位数（68.2 美元对 65.7 美元；P=0.134）和 OOP 费用占日医疗费用的比例（28.5%对 28.5%；P=0.995）保持不变。与居民受益人相比，政策实施后，城市职工受益人的 TAMs 使用相对概率下降（调整后优势比（aOR）=2.4 对 aOR=2.2）。
政府的价格谈判和报销政策改善了患者获得 TAMs 的机会，并缩小了不同保险计划之间的差距。中国促进昂贵药物可负担性的方法为卫生政策决策者提供了宝贵的经验。
