How National Health Insurance Coverage Policy Affected the Use of Trastuzumab and Rituximab in China: A Bicentric Retrospective Study

Abstract

Background: Cancer is a significant health concern and is China's leading cause of mortality. Targeted therapies, such as trastuzumab and rituximab, have enhanced clinical treatment efficacy. However, their high costs burden patients and healthcare systems considerably. Patient demographic factors further influence the utilization of these expensive drugs. On September 1, 2017, China implemented the National Health Insurance Coverage (NHIC) policy, necessitating additional real-world evidence to assess its impact on patients. Methods: Data on human epidermal growth factor receptor 2-positive breast cancer and CD20-positive non-Hodgkin B-cell lymphoma patients were gathered in Jiangsu Cancer Hospital and Fujian Cancer Hospital from September 2015 to August 2019, including demographic and clinical information. All eligible patients were divided into two groups. Univariate analysis and multivariable logistic regression were used to investigate the differences between subgroups. An interrupted time-series regression was used to examine the change in trastuzumab and rituximab utilization percentages. Results: Before and after the NHIC policy, utilization of trastuzumab increased from 61.13% to 75.10%, and the increase was statistically significant. Rituximab therapy increased statistically significantly from 64.79% to 74.88%. The key factor influencing trastuzumab and rituximab use was the NHIC policy. With policy implementation, medical insurance status, occupations, and cancer disease stage affected trastuzumab and rituximab use. Conclusion:The NHIC policy is essential to the utilization of trastuzumab and rituximab, and the patient's income level and repayment abilities continue to impact the use of innovative anti-cancer drugs. Appropriate steps, such as reducing the urban-rural gap and broadening medical insurance coverage, would enable more people to access novel anti-cancer drugs.

Trastuzumab Accessibility and Utilization for Breast Cancer Treatment in an eastern prefecture-level city in China: Does health insurance coverage matter?

“…A signi cant increase in Trastuzumab utilization was observed following the introduction of basic medical insurance coverage and the price reduction, which is consistent with ndings from studies conducted in other Chinese provinces [16,26,35]. Our study found that the level of medical insurance coverage is the only factor in uencing Trastuzumab utilization in JX city.…”

“…This is similar to the ndings by Shang, indicating that HER2-positive patients covered by both UEBMI and URRBMI didn't show signi cant differences in Trastuzumab usage. Instead, the crucial determinant was the availability of basic medical insurance coverage in 2017 [35]. Furthermore, our study revealed a signi cant rise in utilization rates, reaching approximately 90% from 2020 to 2022 after a price reduction in 2020.…”

Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis

“…Secondly, Chinese hospitals implement the strict medical technology charging standards, and most of the charging standards have not been adjusted for a long time, while the prices of drugs and medical consumables are widely influenced by the regulation of the market, and have been on a rising trend in recent years. 31 , 32 As a result, the surgery expenses in Chinese hospitals are underestimated, while the drug expenses usually account for a relatively high proportion.…”