The impact of the national centralized drug procurement on the use of original and generic targeted anti- tumor drugs in Hohhot, China: an interrupted time-series analysis

Abstract

Objectives: In December 2022, the implementation of the seventh round of national centralized drug procurement(NCDP) in China, encompassing a range of targeted anti-tumor drugs. This study aims to assess the explored the different effect of the NCDP on three original and generic targeted anti-tumor drugs use in clinical practice. Method: Clinical drug volume data was collected covering 18 months before, during, and after the the seventh round of the National Centralized Drug Procurement in Inner Mongolia. Three targeted anti-tumor drugs associated with the seventh round of NCDP were chosen for investigation and categorized into original and generic products based on bidding outcomes. Interrupted time-series method was employed to estimate the net effect of policy impact. Results: After the implementation of national centralized drug procurement (NCDP), there has been a significant increase in the utilization of generic targeted antineoplastic drugs. The volume of generic afatinib(30mg) increased by 25.78DDDs, the expenditures decreased by 3641.14 yuan (95 % CI: -5581.16 to -1701.12, p=0.001), and the DDDc decreased by 124.35 yuan (95 % CI: -128.23 to -120.46, p<0.001). The volume of generic afatinib(40mg) increased by 65.19DDDs (95 % CI: 35.38 to 96.43, p<0.001), the expenditures increased by 1304.93 yuan (95 % CI: 700.55 to 1909.31, p<0.001), and the DDDc decreased by 120.2 yuan (95 % CI: -120.2 to -120.2, p<0.001). The volume of generic sunitinib increased by 75.79DDDs (95 % CI: 37.99 to 112.46, p<0.001), the expenditures decreased by 15869.78 yuan (95 % CI: -23275.57 to -8463.98, p<0.001) , and the DDDc decreased by 243.28 yuan. There was no significant change trend in volume, expenditures and DDDc of the three original targeted drugs after NCDP intervention. Conclusions: After the policy intervention, generic afatinib (40mg) successfully aligned with the objectives of NCDP by reducing drug costs and enhancing patient affordability; however, the desired outcomes were not achieved for generic afatinib (30mg) and generic sunitinib. This discrepancy may be attributed to the inherent clinical efficacy and safety profiles of these drugs. Therefore, in implementing NCDP, it is necessary to enhance the clinical efficacy and safety of generic targeted anti-tumor drugs while considering economic efficiency.