The use of trastuzumab affected by health insurance policy in Jiangsu Province of China

Abstract

Background: Breast cancer recurrence and mortality have been shown to decrease after trastuzumab treatment in human epidermal growth factor 2 (HER2)-positive early-stage breast cancer (EBC) patients. In Jiangsu Province, trastuzumab has been subsidized for patients with HER2-positive EBC since 2013. Several studies showed that Jiangsu was one of the provinces with the highest rates of adjuvant trastuzumab therapy.To uncover the underlying reason, we designed the study to investigate trastuzumab use for HER2-positive breast cancer patients, and to examine the changes caused by medical insurance coverage for trastuzumab in Jiangsu province of China.Methods: This was a retrospective, multicenter clinical study with follow-up data. HER2-positive EBC patients diagnosed in 7 representative hospitals in 2010, 2011, and 2013 were enrolled. Demographic and clinical data, and details of diagnosis, treatments, and prognosis, were collected. Data analysis included univariate analysis, multivariate logistic regression, survival analysis, and subgroup analysis.Results: Of the 641 patients (mean age 51.01±10.79 years) included, 412 (64.27%) patients had medical insurance. Trastuzumab therapy was given to 214 (33.39%) patients. The multivariate logistic regression showed that medical insurance coverage, age, and radiotherapy were associated with trastuzumab use (P<0.05).The overall survival was significantly better in the trastuzumab group than in the non-trastuzumab group (HR: 1.607; 95% CI: 1.046-2.469; P=0.040). Subgroup analysis revealed that there was a trend towards more patients with medical insurance (P=0.073), and significantly more patients received trastuzumab therapy (P<0.001) in 2013 than in 2010-2011. Additionally, trastuzumab use in China was lower than in developed countries. Patients with medical insurance were more likely to use trastuzumab, and more patients could afford trastuzumab therapy with the development of China's health-care reform.Conclusions: Our study suggested that the percentage of patients who received trastuzumab in China was lower than developed countries. Patients who had medical insurance were more likely to use trastuzumab than those without medical insurance. The health insurance policy in China has improved access for breast cancer patients who require trastuzumab therapy.

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“…The NHIC policy has signi cantly increased the utilization of IACDs, and the results were consistent with the conclusions of the papers published by our research group in 2022 [16]. Based on a previous study conducted on patients with early-stage breast cancer from 7 representative hospitals in Jiangsu Province, a study concluded that the utilization rate of IACDs had grown markedly after the implementation of the NHIC policy [22]. Before lenvatinib was included in the NDRL, sorafenib was the only IACD included in the NDRL for the treatment of advanced HCC [26,27].…”

“…Diao et al conducted multivariate analyses with a binary logistic regression model to analyze the impact of government health insurance coverage on drug utilization, and the determinants of medication choice among patients receiving data from a tertiary hospital in Fujian Province [21]. Xia et al analyzed the effect of health insurance policy on the use of trastuzumab in Jiangsu Province by enrolling HER2-positive EBC patients diagnosed at 7 representative hospitals [22].…”

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“…Trastuzumab (Herceptin) is the first approved drug targeting HER2, and the only used in Nanjing before 2017. Previous studies have proved that its high price limits the patients' access to trastuzumab in underdeveloped areas without reimbursement policy ( 5 – 7 ). Lammers et al ( 5 ) identified potential barriers to the expansion of trastuzumab use in the United States, Mexico, Turkey, Russia and Brazil via physician-oriented survey.…”

“…In a survey conducted on breast cancer in Africa, trastuzumab could be provided by 10 out of 19 facilities, but afforded by only 5% of the patients ( 6 ). In Jiangsu, a developed province in China, only 33.39% of patients with early-stage breast cancer received trastuzumab in 2010–2013 ( 7 ).…”

How the National Health Insurance Coverage policy changed the use of lenvatinib for adult patients with advanced hepatocellular carcinoma: a retrospective cohort analysis with real world big data

“…Diao et al conducted multivariate analyses with a binary logistic regression model to analyze the impact of government health insurance coverage on drug utilization, and the determinants of medication choice among patients receiving data from a tertiary hospital in Fujian Province [ 23 ]. Xia et al analyzed the effect of health insurance policy on the use of trastuzumab in Jiangsu Province by enrolling HER2-positive EBC patients diagnosed at 7 representative hospitals [ 24 ].…”