scholarly journals Influence of Chinese National Centralized Drug Procurement on the price of policy-related drugs: an interrupted time series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ni Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Zongfu Mao ◽  
Dan Cui
Keyword(s):  
Time Series ◽  
Price Change ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Its Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Alternative Drugs

Abstract Background The Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China in 2019. This study aims to examine the impact of “4 + 7” policy on the price of policy-related drugs. 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. “4 + 7” policy-related drugs were selected as study samples, including 25 drugs in the “4 + 7” procurement list and 57 alternative drugs that have an alternative relationship with “4 + 7” List drugs in clinical use. “4 + 7” List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Single-group Interruption Time Series (ITS) analysis was adopted to examine the change of Drug Price Index (DPI) for policy-related drugs. Results The ITS analysis showed that the DPI of winning (− 0.183 per month, p < 0.0001) and non-winning (− 0.034 per month, p = 0.046) products significantly decreased after the implementation of “4 + 7” policy. No significant difference was found for the immediate change of DPI for alternative drugs (p = 0.537), while a significant decrease in change trend was detected in the post-“4 + 7” policy period (− 0.003 per month, p = 0.014). The DPI of the overall policy-related drugs significantly decreased (− 0.261 per month, p < 0.0001) after “4 + 7” policy. Conclusions These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

scholarly journals Influence of Chinese National Centralized Drug Procurement on the price of policy-related drugs: an interrupted time series analysis

2021 ◽  
Author(s):  
Ni Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Zongfu Mao ◽  
Dan Cui
Keyword(s):  
Time Series ◽  
Price Change ◽  
Chinese Government ◽  
Price Behavior ◽  
Drug Procurement ◽  
Its Analysis ◽  
Significant Difference ◽  
The Impact ◽  
Alternative Drugs ◽  
Pharmaceutical Enterprises

Abstract Background: The Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China in 2019. Under cross-price elasticity theory, the price behavior of pharmaceutical enterprises for policy-related drugs might change. This study aims to examine the impact of "4+7" policy on the price of policy-related drugs.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. Eighty-two drugs (by generic name) were selected as study samples, including "4+7" policy-related drugs (consisted of winning and non-winning products) and alternative drugs. Single-group Interruption Time Series (ITS) analysis was adopted to examine the change of Drug Price Index (DPI) for policy-related drugs.Results: The ITS analysis showed that the DPI of winning (-0.183 per month, p<0.0001) and non-winning (-0.034 per month, p=0.046) products significantly decreased after the implementation of "4+7" policy. No significant difference was found for the immediate change of DPI for alternative drugs (p=0.537), while a significant decrease in change trend was detected in the post-"4+7" policy period (-0.003 per month, p=0.014). The DPI of the overall policy-related drugs significantly decreased (-0.261 per month, p<0.0001) after "4+7" policy.Conclusions: These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

scholarly journals Influence of Chinese National Centralized Drug Procurement on the Price of Policy-Related Drugs: An Interrupted Time Series Analysis

2021 ◽  
Author(s):  
Ni Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Zongfu Mao ◽  
Dan Cui
Keyword(s):  
Time Series ◽  
Price Change ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Price Behavior ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Significant Difference ◽  
The Impact ◽  
Pharmaceutical Enterprises

In 2019, Chinese government implemented the first round of National Centralized Drug Procurement (NCDP) pilot (so-called "4+7" policy) in mainland China, achieved a prominent price reduction of 52% on average for 25 bidding winning products. Under cross-price elasticity theory, the price behavior of pharmaceutical enterprises for policy-related drugs might change. This study used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, and applied single-group Interruption Time Series (ITS) design to examine the impact of "4+7" policy on the drug price index (DPI) of policy-related drugs. The ITS analysis showed that the DPI of winning (-0.183 per month, p&amp;lt;0.0001) and non-winning (-0.034 per month, p=0.046) products significantly decreased after the implementation of "4+7" policy. No significant difference was found for the immediate change of DPI for alternative drugs (p=0.537), while a significant decrease in change trend was detected in the post-"4+7" policy period (-0.003 per month, p=0.014). The DPI of the overall policy-related drugs significantly decreased (-0.261 per month, p&amp;lt;0.0001) after "4+7" policy. These findings indicate that the price behavior of pharmaceutical enterprises changed under NCDP policy, while the price linkage effect is still limited. It is necessary to further expand the scope of centralized purchased drugs and strengthen the monitoring of related drugs regarding price change and consumption structure.

scholarly journals 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

2021 ◽  
Author(s):  
Ying Yang ◽  
Ruiwen Tong ◽  
Shicheng Yin ◽  
Lining Mao ◽  
Luxinyi Xu ◽  
...  
Keyword(s):  
Time Series ◽  
Antihypertensive Drugs ◽  
Linear Regression Analysis ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Policy Intervention ◽  
Interrupted Time Series Analysis ◽  
Drug Procurement ◽  
Defined Daily Doses ◽  
The Impact

Abstract Background: On January 2019, Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot of 25 drugs in 4 municipalities and 7 sub-provincial cities in mainland China, referred to as “4+7” policy. In the “4+7” policy, 7 antihypertensive drugs were included. This study was conducted to evaluate the impact of “4+7” policy on the use of policy-related antihypertensive drugs. Method: This study applied single-group Interrupted Time Series (ITS) design. We used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Antihypertensive drugs related to “4+7” policy were selected as study samples, including 7 antihypertensive drugs in the “4+7” List and 17 antihypertensive drugs that have an alternative relationship with the “4+7” List drugs in clinical use. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc), respectively. Segmented linear regression analysis was employed to examine the change of outcome variables before and after the policy intervention. Results: As of December 31, 2019, the completion rate of the agreed purchase volume of the 7 bid-winning antihypertensive drugs reached 173.42% in Shenzhen. After “4+7” policy, the DDDc of bid-winning antihypertensive drugs significantly decreased by 63.79% (-1.30 CNY, 95% CI= -1.43 to -1.18, p<0.001), while the DDDc of non-winning (0.28 CNY, 95% CI= 0.11 to 0.46, p<0.01) and alternative (0.14 CNY, 95% CI= 0.03 to 0.25, p<0.05) antihypertensive drugs increased markedly. The volume of bid-winning antihypertensive drugs significantly increased by 1311.76% (3.12 million DDD, 95% CI= 2.14 to 4.10, p<0.001). The overall costs of the seven “4+7” List antihypertensive drugs significantly declined by 101.34% (-5.96 million CNY, 95% CI= -7.87 to -4.04, p<0.001) after policy intervention, with an absolute reduction of 36.37 million CNY compared with the pre-“4+7” period. Conclusion: An overall satisfying implementation effect was observed in Shenzhen. A preliminary positive policy effect of price cut and cost-saving was observed in the antihypertensive drug category. However, the DDDc of non-winning and alternative drugs increased after policy intervention, suggesting that the price monitoring and drug use management regarding NCDP policy-related drugs should be strengthened. Keywords: National Centralized Drug Procurement (NCDP); "4+7"; volume-based procurement; antihypertensive drugs; China

scholarly journals Hospitalization for ischemic stroke was affected more in independent cases than in dependent cases during the COVID-19 pandemic: An interrupted time series analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261587
Author(s):  
Hiroyuki Nagano ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Daisuke Takada ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Time Series ◽  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
State Of Emergency ◽  
Its Analysis ◽  
Care Systems ◽  
The Impact

Background The pandemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study is to assess the impact of the COVID-19 pandemic on the number of hospital admissions for ischemic stroke by severity in Japan. Methods We analysed administrative (Diagnosis Procedure Combination—DPC) data for cases of inpatients aged 18 years and older who were diagnosed with ischemic stroke and admitted during the period April 1 2018 to June 27 2020. Levels of change of the weekly number of inpatient cases with ischemic stroke diagnosis after the declaration of state of emergency were assessed using interrupted time-series (ITS) analysis. The numbers of patients with various characteristics and treatment approaches were compared. We also performed an ITS analysis for each group (“independent” or “dependent”) divided based on components of activities of daily living (ADL) and level of consciousness at hospital admission. Results A total of 170,294 cases in 567 hospitals were included. The ITS analysis showed a significant decrease in the weekly number of ischemic stroke cases hospitalized (estimated decrease: −156 cases; 95% confidence interval (CI): −209 to −104), which corresponds to −10.4% (95% CI: −13.6 to −7.1). The proportion of decline in the independent group (−21.3%; 95% CI: −26.0 to −16.2) was larger than that in the dependent group (−8.6%; 95% CI: −11.7 to −5.4). Conclusions Our results show a marked reduction in hospital admissions due to ischemic stroke after the declaration of the state of emergency for the COVID-19 pandemic. The independent cases were affected more in proportion than dependent cases.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Yang ◽  
Ruiwen Tong ◽  
Shicheng Yin ◽  
Lining Mao ◽  
Luxinyi Xu ◽  
...  
Keyword(s):  
Time Series ◽  
Drug Use ◽  
Antihypertensive Drugs ◽  
Interrupted Time Series ◽  
Future Price ◽  
Policy Intervention ◽  
Hypertensive Patients ◽  
Drug Procurement ◽  
The Impact ◽  
Alternative Drugs

Abstract Background In 2019, Chinese government launched a nationwide volume-based drug procurement aiming at reducing drug prices and saving drug costs through economies of scale, which aroused widespread attention. The first round of the policy pilot was implemented in 4 municipalities and 7 sub-provincial cities, referred to as “4 + 7” policy. In the “4 + 7” policy, 7 antihypertensive drugs were included. This study was conducted to evaluate the impact of “4 + 7” policy on the use of policy-related antihypertensive drugs. Method This study applied single-group Interrupted Time Series (ITS) design. We used drug purchasing data from the Centralized Drug Procurement Survey in Shenzhen 2019, covering 24 months from January 2018 to December 2019. Antihypertensive drugs related to “4 + 7” policy were selected as study samples, including 7 drugs in the “4 + 7” List and 17 alternative drugs. Alternative drugs refer to antihypertensive drugs that have an alternative relationship with “4 + 7” List drugs in clinical use and have not yet been covered by the policy. “4 + 7” List drugs were then divided into bid-winning and bid-non-winning products according to the bidding results. Purchase volume, expenditures, and daily costs were selected as outcome variables, and were measured using Defined Daily Doses (DDDs), Chinese Yuan (CNY), and Defined Daily Drug cost (DDDc). Results After “4 + 7” policy intervention, the procurement volume of bid-winning antihypertensive drugs significantly increased (3.12 million DDD, 95 % CI = 2.14 to 4.10, p < 0.001), while the volume of non-winning drugs decreased (-2.33 million DDD, 95 % CI= -2.83 to -1.82, p < 0.01). The use proportion of bid-winning antihypertensive drugs increased from 12.31 to 87.74 % after policy intervention. The overall costs of the seven “4 + 7” List antihypertensive drugs significantly declined (-5.96 million CNY, 95 % CI= -7.87 to -4.04, p < 0.001) after policy intervention, with an absolute reduction of 36.37 million CNY compared with the pre-“4 + 7” period. The DDDc of bid-winning antihypertensive drugs significantly decreased (-1.30 CNY, 95 % CI= -1.43 to -1.18, p < 0.001), while the DDDc of non-winning (0.28 CNY, 95 % CI = 0.11 to 0.46, p < 0.01) and alternative (0.14 CNY, 95 % CI = 0.03 to 0.25, p < 0.05) antihypertensive drugs increased markedly. Conclusions The implementation of “4 + 7” policy promoted the drug use hypertensive patients gradually concentrated on the quality-guaranteed bid-winning drugs, which might be conducive to improve the overall quality level of drug use of Chinese hypertensive patients. Besides, a preliminary positive policy effect of price cut and cost-saving was observed in the antihypertensive drug category. In the future, price monitoring and drug use management regarding policy-related drugs should also be strengthened.

scholarly journals The impacts of Chinese drug volume-based procurement policy on the use of policy-related antibiotic drugs in Shenzhen, 2018–2019: an interrupted time-series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Yang ◽  
Lei Chen ◽  
Xinfeng Ke ◽  
Zongfu Mao ◽  
Bo Zheng
Keyword(s):  
Time Series ◽  
Linear Regression ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Chinese Drug ◽  
Oral Antibiotic ◽  
Procurement Policy ◽  
Antibiotic Drugs ◽  
The Impact ◽  
Alternative Drugs

Abstract Background In 2019, Chinese government implemented volume-based procurement of 25 drugs in 4 municipalities and 7 sub-provincial cities, i.e. “4 + 7” policy. Competitive bidding was conducted by the government based on the annual agreed procurement volume submitted by each public medical institution in pilot cities. Pilot cities were required to implement bid winning results in March 2019 and the use volume of bid winning products was examined to ensure the completion of agreed procurement volume. In the policy, an oral antibiotic (cefuroxime) was included. Given the current condition of the irrational use of antibiotics in China, this study aims to evaluate the impact of “4 + 7” policy on the use of policy-related antibiotics. Methods This study used drug purchase 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 and 12 antibiotic drugs that have an alternative relationship with cefuroxime in clinical use. Purchase volume and expenditures were selected as outcome variables, and were measured using Defined Daily Doses (DDDs) and Chinese yuan, respectively. Segmented linear regression analysis with interrupted time series was adopted to examine the effect of “4 + 7” policy. Results After the implementation of “4 + 7” policy, the overall volume of cefuroxime and its alternative drugs increased from 9.47 million DDDs to 13.42 million DDDs, with an increase of 41.8 %. The results of segmented linear regression showed that the volume of cefuroxime significantly increased 161.16 thousand DDDs after “4 + 7” policy (95 % CI: 59.43 to 262.90, p-value = 0.004). The volume of alternative drugs significantly increased 273.65 thousand DDDs (95 % CI: 90.17 to 457.12, p-value = 0.006). The overall “4 + 7” policy-related antibiotics significantly increased 436.31 thousand DDDs (95 % CI: 190.81 to 681.81, p-value = 0.001) after “4 + 7” policy. Conclusions This study provides evidence that the implementation of “4 + 7” volume-based procurement policy was associated with significant increases in the volume of policy-related antibiotic drugs. The increase in antibiotic use after the policy needs special attention and vigilance.

scholarly journals Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis (Preprint)

2018 ◽  
Author(s):  
Meredith Elana Giuliani ◽  
Geoffrey Liu ◽  
Wei Xu ◽  
Mihaela Dirlea ◽  
Peter Selby ◽  
...  
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Cancer Patients ◽  
Screening Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Effective Manner ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

BACKGROUND Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. OBJECTIVE The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. METHODS A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. RESULTS A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). CONCLUSIONS CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

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