Trends of Negotiated Targeted Anticancer Medicines Use in China: An Interrupted Time Series Analysis

Abstract

Background: In order to relieve the financial burden of the patients in China, the Ministry of Health (MoH) conducted the first national price negotiation and successfully negotiated three expensive medicines including 2 targeted anticancer medicines (TAMs), icotinib and gefitinib. However, little evidence was available to demonstrate the impact of the national negotiation on TAMs use. The purpose of the study is to evaluate the implementation of the national price negotiation policy in China on TAMs use. Methods: We used interrupted time series (ITS) design to examine the changes in the daily cost, the monthly hospital purchasing volume and spending of icotinib and gefitinib with pharmaceutical procurement data from 594 tertiary hospitals in 29 provinces of mainland China between January 2015 and July 2017. The period between May and July 2016 was applied to assess the impact of policy. Results: The daily cost of icotinib and gefitinib decreased by 50.08% (P < .001) and 53.89% (P < .001) 12 months after the national negotiation, respectively. In terms of volume, the negotiation was associated with increases in the trend of the monthly hospital purchasing volume of icotinib and gefitinib by 4.87 thousand defined daily doses (DDDs) (P < .001) and 6.89 thousand DDDs (P < .001). However, the monthly hospital purchasing spending of icotinib and gefitinib decreased rapidly by US$0.51 million (P < .010) and US$0.82 million (P < .050) following policy implementation, respectively. Conclusion:The first national negotiation had successfully cut off the price of two negotiated TAMs and promoted TAMs use in China. In the future, government should conduct further price negotiations and include more medicines with clinical benefits into reimbursement schemes to alleviate patients' financial burden and promote their access to essential treatment.

Impact of the national drug price negotiation policy on the utilization, cost, and accessibility of anticancer medicines in China: A controlled interrupted time series study

“…To our knowledge, we are the first to analyse the 2018 NDPN policy and most of our findings were similar to those of previous studies. Huang et al [11], after the 2016 NDPN policy was implemented, found that the utilization of two anticancer medicines increased and the average daily cost decreased. Zhu et al [58] found that the availability of 18 negotiated medicines in 2017 was improved and the average daily cost was reduced.…”

“…Previous studies evaluated the impact of the two earlier rounds of NDPN in China [7,10,11]. One study had shown that the second round of negotiation reduced medication prices, increased volumes, and decreased hospital spending on targeted anticancer medications.…”

Cost-effectiveness analysis of nivolumab combination therapy in the first-line treatment for advanced esophageal squamous-cell carcinoma

“…Sensitivity analyses confirmed that the model results were robust. Considering the implementation of the national price negotiation policy in China (36,37), we assumed that nivolumab and ipilimumab were reduced to 40% or 20% of the current price, respectively, to explore the optimal treatment options. The results of PSA indicated that when the price of nivolumab and ipilimumab at 20% price, the cost-effective probability of nivolumab plus ipilimumab improved from 0% to 40.44% and 86.38% in overall and PD-L1-positive advanced ESCC patients, respectively, otherwise chemotherapy was dominant at a WTP threshold of $38,351.20/QALY.…”

Procurement of medicines to treat cancer, 2015–2020, China

“…Researchers who analysed the impact of national negotiations on icotinib and gefitinib found similar results. 42 However, these national negotiations might have had a negative impact on equity of access to targeted anti-cancer medicines, since a study showed that the eastern provinces benefited more from the negotiations than central and western provinces. 43 The reason behind this difference is uncertain.…”