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

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.

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

10.21203/rs.3.rs-143454/v1 ◽

2021 ◽

Author(s):

Ying Yang ◽

Lei Chen ◽

Xinfeng Ke ◽

Zongfu Mao ◽

Bo Zheng

Keyword(s):

Linear Regression ◽

Antibiotic Use ◽

Cefuroxime Axetil ◽

P Value ◽

Chinese Government ◽

Oral Antibiotic ◽

Drug Procurement ◽

Procurement Policy ◽

Antibiotic Drugs ◽

Alternative 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.

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

BMC Public Health ◽

10.1186/s12889-021-11882-7 ◽

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.

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Influence of Government Price Regulation on the Price, Volume and Spending of Antibiotics in China: A Controlled Interrupted Time Series Study

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.113 ◽

2020 ◽

Author(s):

Haishaerjiang Wushouer ◽

Zhenhuan Luo ◽

Xiaodong Guan ◽

Luwen Shi

Keyword(s):

Time Series ◽

Interrupted Time Series ◽

Price Regulation ◽

Chinese Government ◽

Positive Trend ◽

Daily Cost ◽

Average Hospital ◽

Intervention Point ◽

The Impact ◽

Average Daily Cost

Background: Chinese government established maximum retail prices for antibiotics listed in China’s National Reimbursement List in February 2013. This study aimed to analyze the impact of pharmaceutical price regulation on the price, volume and spending of antibiotics in China. Methods: An interrupted time series design with comparison series was used to examine impacts of the policy changes on average daily cost, monthly hospital purchase volume and spending of the 11 price-regulated antibiotics and 40 priceunregulated antibiotics in 699 hospitals. One intervention point was applied to assess the impact of policy. Results: After government price regulation, compared to price-unregulated antibiotics, the average daily cost of the price-regulated group declined rapidly (β=-5.68, P<.001). The average hospital monthly purchase spending of priceregulated antibiotics also decreased rapidly (β=-0.49, P<.010) and a positive trend change (β=0.04, P<.001) in average hospital spending of price-unregulated antibiotics was found. Conclusion: Government regulation can reduce the prices and spending of price-regulated antibiotics. To control increasing expenditure, besides price caps regulation, factors determining drug utilization also need to be considered in policy designing.

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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

10.21203/rs.3.rs-583026/v1 ◽

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

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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

BMC Health Services Research ◽

10.1186/s12913-021-07143-3 ◽

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.

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

10.21203/rs.3.rs-403627/v1 ◽

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.

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

10.20944/preprints202104.0157.v1 ◽

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&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&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.

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The Impact of Lockdown in England on Daily Confirmed Cases of COVID-19 and Related Deaths Compared to Sweden: A Comparative Interrupted Time Series Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3629457 ◽

2020 ◽

Author(s):

Moaath Mustafa Ali ◽

Yazan Samhouri ◽

Marwa Sabha ◽

Lynna Alnimer

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

The Impact

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Análise da relação entre O3, NO e NO2 usando técnicas de regressão linear múltipla.

GEOgraphia ◽

10.22409/geographia.v20i43.1065 ◽

2018 ◽

Vol 20 (43) ◽

pp. 124

Author(s):

Amaury De Souza ◽

Priscilla V Ikefuti ◽

Ana Paula Garcia ◽

Debora A.S Santos ◽

Soetania Oliveira

Keyword(s):

Time Series ◽

Linear Regression ◽

Nitrogen Dioxide ◽

Multiple Linear Regression ◽

Quality Parameters ◽

Environmental Pollutant ◽

Environmental Research ◽

Linear Regression Models ◽

Mato Grosso ◽

The Impact

Análise e previsão de parâmetros de qualidade do ar são tópicos importantes da pesquisa atmosférica e ambiental atual, devido ao impacto causado pela poluição do ar na saúde humana. Este estudo examina a transformação do dióxido de nitrogênio (NO2) em ozônio (O3) no ambiente urbano, usando o diagrama de séries temporais. Foram utilizados dados de concentração de poluentes ambientais e variáveis meteorológicas para prever a concentração de O3 na atmosfera. Foi testado o emprego de modelos de regressão linear múltipla como ferramenta para a predição da concentração de O3. Os resultados indicam que o valor da temperatura e a presença de NO2 influenciam na concentração de O3 em Campo Grande, capital do Estado do Mato Grosso do Sul. Palavras-chave: Ozônio. Dióxido de nitrogênio. Séries cronológicas. Regressões. ANALYSIS OF THE RELATIONSHIP BETWEEN O3, NO AND NO2 USING MULTIPLE LINEAR REGRESSION TECHNIQUES.Abstract: Analysis and prediction of air quality parameters are important topics of current atmospheric and environmental research due to the impact caused by air pollution on human health. This study examines the transformation of nitrogen dioxide (NO2) into ozone (O3) in the urban environment, using the time series diagram. Environmental pollutant concentration and meteorological variables were used to predict the O3 concentration in the atmosphere. The use of multiple linear regression models was tested as a tool to predict O3 concentration. The results indicate that the temperature value and the presence of NO2 influence the O3 concentration in Campo Grande, capital of the State of Mato Grosso do Sul.Keywords: Ozone. Nitrogen dioxide. Time series. Regressions. ANÁLISIS DE LA RELACIÓN ENTRE O3, NO Y NO2 UTILIZANDO MÚLTIPLES TÉCNICAS DE REGRESIÓN LINEAL.Resumen: Análisis y previsión de los parámetros de calidad del aire son temas importantes de la actual investigación de la atmósfera y el medio ambiente, debido al impacto de la contaminación atmosférica sobre la salud humana. Este estudio examina la transformación del dióxido de nitrógeno (NO2) en ozono (O3) en el entorno urbano, utilizando el diagrama de series de tiempo. Las concentraciones de los contaminantes ambientales de datos y variables climáticas fueron utilizadas para predecir la concentración de O3 en la atmósfera. El uso de múltiples modelos de regresión lineal como herramienta para predecir la concentración de O3 se puso a prueba. Los resultados indican que el valor de la temperatura y la presencia de NO2 influyen en la concentración de O3 en Campo Grande, capital del Estado de Mato Grosso do Sul.Palabras clave: Ozono. Dióxido de nitrógeno. Series de tiempo. Regresiones.

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