School of Public Health, Dalian Medical University, Dalian, China.
Department of Respiratory Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China.
BMC Public Health. 2024 May 14;24(1):1309. doi: 10.1186/s12889-024-18820-3.
The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China.
We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region.
During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend.
This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.
国家药品价格谈判（NDPN）政策已进入常态化阶段，旨在在一定程度上减轻癌症患者的疾病相关和经济负担。本研究分析了中国东北一线城市癌症患者使用抗癌药物的情况及后续负担。
利用实际药物配置情况、医疗保险报销频次和实际用药费用等数据评估 64 种谈判抗癌药物的使用情况。采用灾难性卫生支出（CHE）发生率和发生强度来衡量这些药物的可负担性。最后，使用限定日剂量（DDD）和限定日剂量费用（DDDc）作为指标来评估该地区这些药物的实际使用情况。
在研究期间，64 种药物中有 63 种均可获得。从药物使用情况看，2018 年至 2021 年，谈判抗癌药物的医疗保险报销频次和用药费用呈上升趋势。癌症患者通常在三级医院就诊，在社区药房购药。城镇职工基本医疗保险（UEBMI）覆盖患者的药物总量和费用是城乡居民基本医疗保险（URRMI）覆盖患者的五倍。肺癌和乳腺癌患者的医疗保险报销频次和用药费用最高。此外，2018 年至 2021 年，在城镇患者支付能力水平下，CHE 发生率呈下降趋势（2.85%-1.60%），而在农村患者支付能力水平下呈上升趋势（11.94%-18.42%）。城镇（0.55-1.26 倍）和农村（1.27-1.74 倍）患者的平均发生强度呈上升趋势。从药物利用情况看，谈判抗癌药物的总 DDD 呈上升趋势，而 DDDc 呈下降趋势。
本研究表明，城市癌症患者的药物可及性有所改善。然而，患者的医疗行为受到医院级别和医疗保险类型等因素的影响。未来，中国医保管理部门应进一步做好促进医疗资源分配公平性的工作，加强对国家医保基金的监管。
