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 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 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 Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea L. Schaffer ◽  
Timothy A. Dobbins ◽  
Sallie-Anne Pearson
Keyword(s):  
Time Series ◽  
Large Scale ◽  
Moving Average ◽  
Interrupted Time Series ◽  
Health Interventions ◽  
Policy Intervention ◽  
Arima Models ◽  
Interrupted Time Series Analysis ◽  
Autoregressive Integrated Moving Average ◽  
The Impact

Abstract Background Interrupted time series analysis is increasingly used to evaluate the impact of large-scale health interventions. While segmented regression is a common approach, it is not always adequate, especially in the presence of seasonality and autocorrelation. An Autoregressive Integrated Moving Average (ARIMA) model is an alternative method that can accommodate these issues. Methods We describe the underlying theory behind ARIMA models and how they can be used to evaluate population-level interventions, such as the introduction of health policies. We discuss how to select the shape of the impact, the model selection process, transfer functions, checking model fit, and interpretation of findings. We also provide R and SAS code to replicate our results. Results We illustrate ARIMA modelling using the example of a policy intervention to reduce inappropriate prescribing. In January 2014, the Australian government eliminated prescription refills for the 25 mg tablet strength of quetiapine, an antipsychotic, to deter its prescribing for non-approved indications. We examine the impact of this policy intervention on dispensing of quetiapine using dispensing claims data. Conclusions ARIMA modelling is a useful tool to evaluate the impact of large-scale interventions when other approaches are not suitable, as it can account for underlying trends, autocorrelation and seasonality and allows for flexible modelling of different types of impacts.

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 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

2021 ◽  
Author(s):  
Jiancheng Lu ◽  
Ying Yang ◽  
Hongfei Long ◽  
Jing Wang ◽  
Yuan Shen ◽  
...  
Keyword(s):  
Mainland China ◽  
Outcome Variable ◽  
Chinese Government ◽  
Policy Intervention ◽  
Difference In Difference ◽  
Drug Procurement ◽  
Period 2 ◽  
Medical Institutions ◽  
The Impact ◽  
Alternative Drugs

Abstract Background In 2019, the Chinese government implemented the first round pilot of volume-based drug procurement in 4 municipalities and 7 sub-provincial cities, i.e. “4+7” policy. This study evaluated the impact of “4+7” policy on the use structure of policy-related drugs. Methods Data of China Drug Supply Information Platform (CDSIP) database was used, covering 18,636 public medical institutions from 9 pilot cities and 12 non-pilot provinces in mainland China. “4+7” policy-related drugs were selected as study samples, including 25 drugs in the “4+7” procurement List and 83 alternative drugs that have an alternative relationship with “4+7” List drugs. “4+7” List drugs were divided into bid-winning and bid-non-winning products. Drug Structure Index (DSI) was employed as the outcome variable, and higher DSI refers to the use proportion of higher-DDDc (Defined Daily Drug cost) drugs increased. Difference-in-difference (DID) method was employed to estimate the net effect of “4+7” policy. Results After policy intervention, the DSI of bid-winning drugs significantly decreased (β=-0.233, p<0.0001), while non-winning drugs (β = 0.177, p<0.001) and “4+7” List drugs (β = 0.050, p<0.01) increased. No significant change was found for the overall DSI of alternative drugs (β = 0.013, p>0.05), while a remarkable increase was found in primary healthcare settings (β = 0.033, p<0.05). In three post-“4+7” periods, the increments of DSI for non-winning products were 17.54% (period 1), 18.35% (period 2), and 19.66% (period 3). The DSI of “4+7” List drugs significantly increased in post-“4+7” period 2 and 3 (all p-values<0.05). Conclusions The use proportion of higher-DDDc bid-winning drugs significantly decreased after policy intervention. However, among drugs not involved by NCDP policy, the use proportion of higher-DDDc drugs significantly increased after policy intervention, moreover, the increment was more pronounced at the later periods of policy implementation. The clinical use monitoring and the physician’s prescription behavior supervision should 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 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 Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth A. Brown ◽  
Brandi M. White ◽  
Walter J. Jones ◽  
Mulugeta Gebregziabher ◽  
Kit N. Simpson
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Medicaid Expansion ◽  
Time Series Approach ◽  
Access To Primary Care ◽  
The Impact

An amendment to this paper has been published and can be accessed via the original article.

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.

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