Zhao Ziqi, Zhang Shengwei, Zheng Tao, Hu Ming
West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China.
Front Pharmacol. 2025 Jul 25;16:1604008. doi: 10.3389/fphar.2025.1604008. eCollection 2025.
The National Drug Price Negotiation (NDPN) has significantly reduced the prices and improved the nationwide availability of novel anticancer drugs (NADs) in China. However, geographical disparities in their availability remain concerning. This study aims to assess these spatial variations and temporal changes, and the determinants using geographic information system (GIS) and spatial statistical methods.
Two cross-sectional datasets were used corresponding the implementation date of the 2023 NDPN list (1 January 2024) and 9 months after (1 October 2024). Data on drug-providing institutions were extracted from National Healthcare Security Administration (NHSA) platform. Drug availability was measured by the weighted supply number of drug-providing institutions per 1,000 cancer patients, analyzed separately for hospitals and retail pharmacies. Kernel density estimation (KDE) was used to visualize spatial distribution. The Theil index assessed inequality, and Moran's index measured spatial clustering. Multiple linear regression (OLS) and geographically weighted regression (GWR) were employed to examine the influence of economic development and healthcare infrastructure on drug availability.
A total of 71 NADs in the 2023 NDPN list were analyzed. By October, drug-providing institutions had become more concentrated in the eastern coastal provinces compared to January. Availability improved in both hospitals and retail pharmacies, with higher levels observed in eastern and central provinces, with lower in the western provinces, especially in the Southwest. Inequality declined and spatial clustering increased for both hospital-based and overall availability across provinces (Theil index, hospital: 0.074-0.062, overall: 0.045-0.044; Moran's I, hospital: 0.315-0.362, overall: 0.452-0.453). Both OLS and GWR models showed a significant and strengthening association between availability (in hospitals and overall) and GDP [e.g., hospital: OLS coef, 0.787-0.833, p < 0.001; GWR mean coef (SD), 0.795 (0.047)-0.834 (0.044); overall: OLS coef, 0.744-0.794, p < 0.01; GWR mean coef (SD), 0.726 (0.119)-0.763 (0.161)]. Retail pharmacy-based availability was positively associated with the number of local chain pharmacies [OLS coef, 0.098-0.122, p < 0.05; GWR mean coef (SD), 0.084 (0.006)-0.107 (0.010)].
The availability of price-negotiated NADs increasingly concentrated in economically developed and medically advanced eastern provinces, while remaining lower in southwest. Efforts should target economically underdeveloped areas.
国家药品价格谈判（NDPN）显著降低了中国新型抗癌药物（NADs）的价格，并提高了其在全国范围内的可及性。然而，其可及性的地理差异仍然令人担忧。本研究旨在利用地理信息系统（GIS）和空间统计方法评估这些空间差异和时间变化及其决定因素。
使用了两个横断面数据集，分别对应2023年国家药品价格谈判清单的实施日期（2024年1月1日）和之后9个月（2024年10月1日）。药品供应机构的数据从国家医疗保障局（NHSA）平台提取。药品可及性通过每1000名癌症患者的药品供应机构加权供应数量来衡量，分别针对医院和零售药店进行分析。核密度估计（KDE）用于可视化空间分布。泰尔指数评估不平等程度，莫兰指数衡量空间聚类。采用多元线性回归（OLS）和地理加权回归（GWR）来研究经济发展和医疗基础设施对药品可及性的影响。
共分析了2023年国家药品价格谈判清单中的71种新型抗癌药物。到10月，与1月相比，药品供应机构在东部沿海省份更加集中。医院和零售药店的可及性均有所提高，东部和中部省份的水平较高，西部省份较低，尤其是西南部。省级层面基于医院和总体的可及性的不平等程度下降，空间聚类增加（泰尔指数，医院：0.074 - 0.062，总体：0.045 - 0.044；莫兰指数，医院：0.315 - 0.362，总体：0.452 - 0.453）。OLS和GWR模型均显示可及性（医院和总体）与国内生产总值之间存在显著且增强的关联[例如，医院：OLS系数，0.787 - 0.833，p < 0.001；GWR平均系数（标准差），0.795（0.047） - 0.834（0.044）；总体：OLS系数，0.744 - 0.794，p < 0.01；GWR平均系数（标准差），0.726（0.119） - 0.763（0.161）]。基于零售药店的可及性与当地连锁药店数量呈正相关[OLS系数，0.098 - 0.122，p < 0.05；GWR平均系数（标准差），0.084（0.006） - 0.107（0.010）]。
通过谈判的新型抗癌药物的可及性越来越集中在经济发达和医疗先进的东部省份，而西南部地区仍然较低。应针对经济欠发达地区采取措施。
