scholarly journals Implementation and Impact of National Centralized Drug Procurement Policy in China: Evidence from the National Drug Procurement Database

2021 ◽  
Author(s):  
Jiancheng Lu ◽  
Ying Yang ◽  
Xiaotong Wen ◽  
Jing Wang ◽  
Yuan Shen ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Completion Rate ◽  
Chinese Government ◽  
Clinical Use ◽  
Drug Procurement ◽  
Information Platform ◽  
Defined Daily Doses ◽  
National Drug ◽  
Implementation Progress ◽  
Supply Information

Abstract Background Chinese government implemented the first round of National Centralized Drug Procurement pilot in 4 municipalities and 7 sub-provincial cities in 2019, so called "4 + 7" policy. This study evaluated the implementation and impact of “4 + 7” policy. Methods This study used drug purchase data from China Drug Supply Information Platform (CDSIP) database. “4 + 7” policy-related drugs were selected as study samples, including 25 drugs in the “4 + 7” List and 92 alternative drugs that have an alternative relationship with “4 + 7” List drugs in clinical use. “4 + 7” List drugs were divided into bid-winning and non-winning products. We applied Defined Daily Doses (DDDs), DDDs per 1000 inhabitants per day (DID), purchase expenditures, and Defined Daily Drug cost (DDDc) as outcome variables. Interrupted time-series was adopted to quantity policy effect. Results As of December 2019, the completion rate of overall bid-winning drugs in 9 pilot cities reached 154.40%, and the completion rate of 25 bid-winning drugs ranged between 74.77% and 477.75%. After policy intervention, the DID of bid-winning drugs, “4 + 7” List drugs, alterative drugs, as well as the overall policy-related drugs increased by 545.18%, 14.03%, 12.21%, and 13.04% in pilot cities. Bid-winning drugs significantly increased 132.84 million DDDs (p < 0.001) in volume and 48.95 million CNY (p < 0.05) in expenditures, and dropped 6.35 CNY (p < 0.001) in DDDc. The volume proportion of bid-winning products increased from 12.67–71.66%. The DDDc of non-winning drugs increased 0.94 CNY (p < 0.001). Overall, the DDDc of policy-related drugs dropped 1.38 CNY (p < 0.001), and the expenditures decreased 634.68 million CNY (p < 0.001). Conclusion An overall satisfying implementation progress of “4 + 7” policy was observed in pilot cities. The policy alleviated the medication burdens of patients, which is supported by the significant reduction in DDDc and costs of policy-related drugs. The accessibility and consumption of policy-related drugs improved. However, monitoring regarding the clinical use of policy-related drugs will still be necessary in the future.

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 The impact of National Centralized Drug Procurement policy on the use of policy-related original and generic drugs in public medical institutions in China: A difference-in-difference analysis based on national database

2021 ◽  
Author(s):  
Jing Wang ◽  
Ying Yang ◽  
Luxinyi Xu ◽  
Yuan Shen ◽  
Xiaotong Wen ◽  
...  
Keyword(s):  
Generic Drugs ◽  
National Database ◽  
Quality Level ◽  
Difference In Difference ◽  
P Values ◽  
Drug Procurement ◽  
Information Platform ◽  
Defined Daily Doses ◽  
Medical Institutions ◽  
The Impact

Objective: To evaluate the impact of the first round of the National Centralized Drug Procurement (NCDP) pilot (referred to as "4+7" policy) on the use of policy-related original and generic drugs. Methods: Drug purchase data from the China Drug Supply Information Platform (CDSIP) database were used, involving nine "4+7" pilot cities and 12 non-pilot provinces in China. "4+7" policy-related drugs were included, which consisted of 25 "4+7" List drugs and 97 alternative drugs that have an alternative relationship with "4+7" List drugs in clinical use. "4+7" List drugs were divided into bid-winning and non-winning products according to the bidding results. Purchase volume, purchase expenditures, 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. Difference-in-Difference (DID) method was employed to estimate the net effect of policy impact. Results: After policy intervention, the DDDs of original drugs among "4+7" List drugs significantly reduced by 124.59%, while generic drugs increased by 52.12% (all p-values <0.01). 17.08% of the original drugs in DDDs were substituted by generic drugs. Prominent reductions of 121.69% and 80.54% were observed in the expenditure of original and generic drugs, with a total cost-saving of 5036.78 million CNY for "4+7" List drugs. The DDDc of bid-winning original and generic drugs, as well as non-winning original drugs, significantly decreased by 33.20%, 75.74%, and 5.35% (all p-values <0.01), while the DDDc of non-winning generic drugs significantly increased by 73.66% (p<0.001). The use proportion of bid-winning products and non-winning original drugs raised prominently from 39.66% to 91.93% Conclusions: "4+7" policy promoted the substitution use of generic drugs against original drugs, which conducive to drug costs saving. The overall quality level of drug use of public medical institutions significantly increased after "4+7" policy, especially in primary medical institutions.

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 ◽  
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.

Clinical Use of Toxic Proteins and Peptides from Tian Hua Fen and Scorpion Venom

2019 ◽  
Vol 20 (3) ◽  
pp. 285-295
Author(s):  
Chen Ling ◽  
Yuanhui Zhang ◽  
Jun Li ◽  
Wenli Chen ◽  
Changquan Ling
Keyword(s):  
Herbal Medicines ◽  
Scorpion Venom ◽  
The Other ◽  
Western World ◽  
Chinese Government ◽  
Clinical Use ◽  
Potential Benefits ◽  
Scientific Results ◽  
Proteins And Peptides ◽  
Toxic Proteins

Traditional Chinese Medicine (TCM) has been practiced in China for thousands of years. As a complementary and alternative treatment, herbal medicines that are frequently used in the TCM are the most accepted in the Western world. However, animal materials, which are equally important in the TCM practice, are not well-known in other countries. On the other hand, the Chinese doctors had documented the toxic profiles of hundreds of animals and plants thousand years ago. Furthermore, they saw the potential benefits of these materials and used their toxic properties to treat a wide variety of diseases, such as heavy pain and cancer. Since the 50s of the last century, efforts of the Chinese government and societies to modernize TCM have achieved tremendous scientific results in both laboratory and clinic. A number of toxic proteins have been isolated and their functions identified. Although most of the literature was written in Chinese, this review provide a summary, in English, regarding our knowledge of the clinical use of the toxic proteins isolated from a plant, Tian Hua Fen, and an animal, scorpion, both of which are famous toxic prescriptions in TCM.

scholarly journals Improving Quinolone Use in Hospitals by Using a Bundle of Interventions in an Interrupted Time Series Analysis

2010 ◽  
Vol 54 (9) ◽  
pp. 3763-3769 ◽  
Author(s):  
Ina Willemsen ◽  
Ben Cooper ◽  
Carin van Buitenen ◽  
Marjolein Winters ◽  
Gunnar Andriesse ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Interrupted Time Series ◽  
Resistance Rate ◽  
Hospitalized Patients ◽  
Quinolone Resistance ◽  
Interrupted Time Series Analysis ◽  
Active Monitoring ◽  
Targeted Interventions ◽  
Defined Daily Doses ◽  
Stepwise Reduction

ABSTRACT The objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coli isolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coli isolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] = 47 to 95 PDDs/month, P < 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI = 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI = 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.

scholarly journals Influence of government price regulation and deregulation on the price of antineoplastic medications in China: a controlled interrupted time series study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031658 ◽  
Author(s):  
Xiaodong Guan ◽  
Haishaerjiang Wushouer ◽  
Mingchun Yang ◽  
Sheng Han ◽  
Luwen Shi ◽  
...  
Keyword(s):  
Time Series ◽  
Price Change ◽  
Interrupted Time Series ◽  
Price Regulation ◽  
Relative Price ◽  
Chinese Government ◽  
Policy Changes ◽  
Price Caps ◽  
The Government ◽  
Comparison Series

BackgroundIn October 2012, the Chinese government established maximum retail prices for specific products, including 30 antineoplastic medications. Three years later, in June 2015, the government abolished price regulation for most medications, including all antineoplastic medications. This study examined the impacts of regulation and subsequent deregulation of prices of antineoplastic medications in China.MethodsUsing hospital procurement data and an interrupted time series with comparison series design, we examined the impacts of the policy changes on relative purchase prices (Laspeyres price index) and volumes of and spending on 52 antineoplastic medications in 699 hospitals. We identified three policy periods: prior to the initial price regulation (October 2011 to September 2012); during price regulation (October 2012 to June 2015); and after price deregulation (July 2015 to June 2016).ResultsDuring government price regulation, compared with price-unregulated cancer medications (n=22, mostly newer targeted products), the relative price of price-regulated medications (n=30, mostly chemotherapeutic products) decreased significantly (β=−0.081, p<0.001). After the government price deregulation, no significant price change occurred. Neither government price regulation nor deregulation had a significant impact on average volumes of or average spending on all antineoplastic medications immediately after the policy changes or in the longer term (p>0.05).ConclusionCompared with unregulated antineoplastics, the prices of regulated antineoplastic medications decreased after setting price caps and did not increase after deregulation. To control the rapid growth of oncology medication expenditures, more effective measures than price regulation through price caps for traditional chemotherapy are needed.

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

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.

scholarly journals Immediate and lasting impact of combining restrictive and enabling interventions to reduce aztreonam consumption in a community hospital

2021 ◽  
Author(s):  
Dviti Mody ◽  
Christopher Burke ◽  
Quentin Minson
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Community Hospital ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Beta Lactams ◽  
Post Intervention ◽  
Adult Intensive Care Unit ◽  
Defined Daily Doses ◽  
Long Term Impact

Abstract Background. Antimicrobial stewardship initiatives combining restrictive and enabling components may be an effective strategy to achieve short- and long-term objectives. Aztreonam, a relatively high-cost antipseudomonal antibiotic, is an appropriate target for stewardship initiatives based on propensity for overuse in penicillin allergy, an activity profile often warranting additional empiric gram-negative and gram-positive coverage, and a unique durability to Ambler class B metallo-beta-lactamases.Objective. Analyze the immediate and long-term impact on aztreonam prescribing of combining restrictive and enabling interventions.Setting. Single 233-bed community hospital with 45 adult intensive care unit beds in Nashville, Tennessee.Method. Retrospective, interrupted time series analysis comparing all patients receiving aztreonam prior to intervention between January 1, 2010 and September 30, 2011 and following intervention between October 1, 2011 and September 30, 2019. Quarterly defined daily doses/1000 adjusted patient days and microbiology laboratory annual surveillance data were utilized for analysis. Main outcome measure. Post-intervention change in trend of aztreonam consumption. Results. Following intervention, a significant decline in aztreonam consumption was observed (-1.97 defined daily doses/1000 adjusted patient days; p = 0.003) resulting in a sustained decrease in aztreonam consumption from 2011 (3rd quarter) to 2019 (3rd quarter) from 15.2 to 0.26 defined daily doses/1000 adjusted patient days. Short-term group 2 carbapenem consumption increased (p = 0.044). Pseudomonas aeruginosa susceptibility to aztreonam improved from 2011 to 2018 (72% vs. 84%; p = 0.0004) without deleterious effects to alternative antipseudomonal beta-lactams. Conclusion. Combining restrictive and enabling interventions had immediate and sustained impact on aztreonam consumption with Pseudomonas aeruginosa susceptibility improvement.Impacts on practice: ● A pharmacist-driven intervention combining restrictive and enabling strategies produced an immediate and sustained decrease in aztreonam prescribing at a community hospital.● Following the sustained reduction of aztreonam consumption, susceptibility rates for Pseudomonas aeruginosa improved without producing deleterious effects on alternative antipseudomonal beta-lactams.

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

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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