The impacts of Chinese drug volume-based procurement policy on the volume and expenditure of antibiotic drugs

Abstract

Background: In 2019, Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China, in which an oral antibiotic agent (cefuroxime axetil) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the potential effect of the "4+7" policy on antibiotic use. Methods: This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Oral antibiotic drugs related to "4+7" policy were selected as study samples, including cefuroxime axetil and its alternative drugs. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of "4+7" policy on the volume and expenditure of antibiotic drugs. Results: Compared with April to December 2018, the total volume and expenditures of cefuroxime axetil and its alternative antibiotic drugs from April to December 2019 increased 41.8% and 18.1%, respectively. The results of segmented linear regression showed that the volume of cefuroxime axetil products significantly increased 161.16 thousand DDDs after "4+7" policy (95% CI: 59.43 to 262.90, p-value = 0.004). For the alternative drugs of cefuroxime axetil, the volume and expenditures significantly increased 273.65 thousand DDDs (95% CI: 90.17 to 457.12, p-value = 0.006) and 3471.66 thousand RMB (95% CI: 1529.70 to 5413.62, p-value = 0.001), respectively. Conclusion: This study provides evidence that the implementation of "4+7" volume-based procurement policy was associated with significant increases in the volume and expenditure of cefuroxime axetil and its alternative drugs. The increase in antibiotic use after the policy needs special attention and vigilance.

The impact of “4+7” volume based drugs procurement on the volume, expenditures, and daily costs of antihypertensive drugs in Shenzhen, China: a interrupted time series analysis

“…We supposed there is certain possibility that the price of drugs without policy intervention have increased after policy implementation. The increasing of DDDc for the non-winning and the alternative drugs might be related to the unreasonable prescription behavior, such as increased daily doses of some antihypertensive drugs [36,37].…”

Impact of Volume-Based Drug Procurement Policy on Drug Use Structure of Chinese Public Medical Institutions: A Difference-in-Difference Analysis of Nine Pilot Cities and Twelve Non-pilot Provinces

“…The implementation of NCDP policy has achieved remarkable results in improving the accessibility of policy-related drugs [14][15][16], promoting the substitution use of generic drugs [17], and increasing overall drug use quality level of the public [18]. However, several previous studies reported an upward trend in the consumption of policy-related drugs after the implementation of NCDP policy [11,19], which should be concerned, especially for the incrased consumption of drugs have not been covered by NCDP policy. For drugs did not covered by volume-based procurement, the increase in usage might be explained that the gray interest chain between physicians and pharmaceutical enterprises still exists, and physicians still have the motivation to prescribe more medicines or choose higher-priced medicines [20].…”