Impact of public health insurance coverage of novel anticancer medication on medical expenditure and patient affordability in a provincial medical centre of China: a propensity score-matching analysis with the quasi-experimental design

Abstract

IntroductionLittle is known about the impact of the government’s efforts in having novel anticancer medicines covered by the public health insurance system in China. This study targeted the above policy implemented in Fujian province in 2017, analysed the policy impact on the medical expenditure of cancer treatment and patient affordability based on the clinical data of Fujian provincial medical centre.MethodsThe study included 253 human epidermal growth factor receptor 2-positive patients with breast cancer who completed at least one course of trastuzumab treatment extracted from the hospital health information system of the provincial medical centre of Fujian. We adopted the propensity score-matching method to mimic a quasi-experimental design to estimate the impact of the public health insurance coverage policy on all the indicated patients with a before–after comparison of the total breast cancer-associated direct medical expenditures for a standard course of treatment or maintenance treatment and the proportionate patient out-of-pocket (OOP) expenditure based on the real clinical data.ResultsWe found evidence of an association between the public health insurance coverage of novel breast cancer medication and the reductions of the medical expenditure by US$18661.02 (95% CI 13 836.57 to 28 201.45), and the proportionate patient OOP expenditure by 24% (95% CI0.20 to 0.27). The medical expenditure and the proportionate patient OOP expenditure might be generally reduced.ConclusionsThe coverage of innovative antibreast cancer medicines by the public health insurance was found to be associated with a reduction of the medical expenditure and share of patient OOP expenditure for cancer treatment of the indicated patients. Patients with lower ability-to-pay did not benefit well from the coverage policy. To maximise the welfare of the public health insurance coverage of novel anticancer medication, the study called for strengthened health insurance benefit packages of the rural patient and the patient enrolled in the urban and rural resident health insurance programme, who might have lower ability-to-pay and need more support from the public security system.

Comparative cost-effectiveness of first-line pembrolizumab plus chemotherapy vs. chemotherapy alone in persistent, recurrent, or metastatic cervical cancer

“…The government anticipates pharmaceutical enterprises to substantially reduce the market prices of their premium drugs in exchange for inclusion in the national medical insurance scheme. In response, many domestic pharmaceutical entities have recalibrated their pricing strategies, optimizing for broader market access, thereby ensuring that a larger patient demographic benefits from these medications ( 48 , 49 ). This recalibration, coupled with insurance negotiations, aims to achieve long-term value maximization ( 50 , 51 ).…”

Factors associated with the uptake of biosimilars for breast cancer treatment from the perspectives of physicians and patients-Evidence from China

“…Thus, physicians are more inclined to recommend cheaper biosimilars to patients covered by a health insurance program with weaker benefits packages and lower ability-to-pay ( Sullivan et al, 2017 ; Cook et al, 2019 ). Promoting the uptake of biosimilars will help to improve the accessibility of biologic agents for patients, especially for those with weaker health insurance benefits packages and lower ability-to-pay ( Diao et al, 2019 ; Li et al, 2021a ; Li et al, 2021b ; Diao et al, 2021 ; Diao et al, 2022 ).…”

“…The European Union (EU) approved the world’s first biosimilar in 2006 and successively implemented a series of policies to promote the uptake of biosimilars, aiming to address the affordability issue of those highly-priced biological agents for both the health systems and individuals ( Dylst et al, 2014 ; Chen et al, 2019 ; Diao et al, 2019 ; Jiang et al, 2019 ; Li et al, 2021a ; Li et al, 2021b ; Diao et al, 2021 ; Lobo and Río-Álvarez, 2021 ; Moorkens et al, 2021 ; Diao et al, 2022 ; Godman et al, 2022 ). These policies include biosimilar substitution ( Dong et al, 2019 ), the requirement of a proportional volume or value of biosimilars prescribed by healthcare providers ( Moorkens et al, 2017 ), financial incentives for clinical use of biosimilars for both patients and healthcare providers associated with health insurance reimbursement and settlement ( Costa-Font and Rico, 2006 ; Berdud et al, 2016 ; Leonard et al, 2019 ; Gasteiger and Petrie, 2022 ).…”

Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis

“…Patients facing financial difficulties are more likely to refuse targeted therapy due to the substantial financial burden it imposes. The inclusion of the first breast cancer targeted therapy in China's public health insurance in September 2017 marked a significant milestone in mitigating the financial burden experienced by patients (25)(26)(27). It is important to know if this policy led any changes of the refusal rate.…”