Yang Ying, Zhang Jieming, Duan Yuanhui, Zhou Lei, Gan Sisheng, Mao Zongfu, Wu Shaotang, Wang Furong
School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, China.
Department of Hospital Information Network, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 3, Shang Qin Road, Xi'an, 710004, China.
Health Res Policy Syst. 2024 Dec 2;22(1):157. doi: 10.1186/s12961-024-01250-3.
The phenomenon of growth in drug consumption within the framework of national volume-based procurement (VBP) policy raises speculations about demand release and policy inducing. This study aims to explore the reasons and mechanisms of drug consumption increases following VBP policy from two perspectives.
We collected data from the China Drug Supply Information Platform, National Bureau of Statistics and the Joint Procurement Office. Twenty cardiovascular international non-proprietary names (INNs) in the first three VBP batches and 28 observation regions were included, constructing 418 valid INN-region combinations as the unit for analysis. The average monthly consumption volume of VBP cardiovascular drug was assigned as the explained variable. The generalized difference-in-difference method was conducted using the price reduction level and the size of policy assessment task as the policy intensity indicator. Moderating effect model was employed to examine the role of resident's income level.
Increased cardiovascular drug consumption was observed in 285 (68.18%) INN-region combinations after policy implementation. Under VBP policy, the price reduction level was significantly correlated with drug consumption in total (β = 0.144, p < 0.001), as well as in tertiary hospitals, secondary hospitals and primary healthcare centers (PHCs) (all p-values < 0.05). Resident's income level negatively moderated the impact of price reduction level on drug consumption in total (β = -0.089, p < 0.001) and in secondary hospitals (β = 0.154, p < 0.001) and PHCs (β = -0.2.9, p < 0.001), rather than in tertiary hospitals (β = -0.079, p > 0.05). The size of policy assessment task was positively associated with drug consumption in total (β = 0.052, p < 0.001), as well as in tertiary hospitals, secondary hospitals and PHCs (all p-values < 0.05).
Two mechanisms codrive drug consumption increases under VBP policy: first is the improvement of cardiovascular medication access and consumption toward lower-income groups following price reduction, pointing to the fulfillment of unmet needs, and second is policy pressure from supporting assessment measures on hospital drug use, indicating potential overprescribing.
在国家药品集中带量采购（VBP）政策框架下药品消费增长的现象引发了对需求释放和政策诱导的猜测。本研究旨在从两个角度探讨VBP政策实施后药品消费增加的原因和机制。
我们从中国药品供应信息平台、国家统计局和联合采购办公室收集数据。纳入前三批VBP中的20种心血管国际非专利药（INN）和28个观察地区，构建418个有效的INN-地区组合作为分析单位。将VBP心血管药物的月平均消费量作为被解释变量。使用降价水平和政策评估任务规模作为政策强度指标进行广义差分法分析。采用调节效应模型检验居民收入水平的作用。
政策实施后，285个（68.18%）INN-地区组合的心血管药物消费量有所增加。在VBP政策下，降价水平与总体药物消费显著相关（β = 0.144，p < 0.001），在三级医院、二级医院和基层医疗中心（PHC）中也显著相关（所有p值 < 0.05）。居民收入水平对降价水平对总体药物消费的影响具有负向调节作用（β = -0.089，p < 0.001），在二级医院（β = 0.154，p < 0.001）和基层医疗中心（β = -0.29，p < 0.001）中也是如此，而在三级医院中则不然（β = -0.079，p > 0.05）。政策评估任务规模与总体药物消费呈正相关（β = 0.052，p < 0.001），在三级医院、二级医院和基层医疗中心中也呈正相关（所有p值 < 0.05）。
VBP政策下有两种机制共同推动药品消费增加：一是降价后低收入群体心血管药物可及性和消费量的提高，这表明未满足需求得到了满足；二是医院用药支持性评估措施带来的政策压力，这表明可能存在过度开药的情况。
