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

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.

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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 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

10.1101/2021.06.21.21256568 ◽

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.

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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

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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The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249415 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9415

Author(s):

Lei Chen ◽

Ying Yang ◽

Mi Luo ◽

Borui Hu ◽

Shicheng Yin ◽

...

Keyword(s):

Drug Utilization ◽

System Analysis ◽

Mainland China ◽

Drug Expenditure ◽

Positive Influence ◽

Chinese Government ◽

Drug Procurement ◽

Leading Role ◽

Drug Expenditures ◽

Alternative Drugs

In 2019, the Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China, in which 25 drugs were included. We conducted this study to examine the impacts of NCDP policy on drug utilization and expenditures, and to clarify the main factors contributing to drug expenditure changes. This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019. Drugs related to the “4 + 7” policy were selected as study samples, including 23 “4 + 7” policy-related varieties and 15 basic alternative drugs. Driving factors for drug expenditures changes were analyzed using A.M. index system analysis (Addis A. & Magrini N.’ method). After the implementation of the NCDP policy, the volume of “4 + 7” policy-related varieties increased by 73.8%, among which winning products jumped by 1638.2% and non-winning products dropped by 70.8%; the expenditures of “4 + 7” policy-related varieties decreased by 36.9%. Structure effects (0.47) and price effects (0.78) negatively contributed to the increase in drug expenditures of “4 + 7” policy-related varieties, while volume effects (1.73) had positive influence. NCDP policy successfully decreased drug expenditures of “4 + 7” policy-related varieties with structure effects playing a leading role. However, total drug expenditures were not effectively controlled due to the increasing use of alternative drugs.

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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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Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2002616117 ◽

2020 ◽

Vol 117 (13) ◽

pp. 7504-7509 ◽

Cited By ~ 124

Author(s):

Chad R. Wells ◽

Pratha Sah ◽

Seyed M. Moghadas ◽

Abhishek Pandey ◽

Affan Shoukat ◽

...

Keyword(s):

Mainland China ◽

International Travel ◽

Control Measures ◽

Chinese Government ◽

Border Control ◽

The Novel ◽

Public Health Response ◽

Global Spread ◽

Travel Restrictions ◽

The Impact

The novel coronavirus outbreak (COVID-19) in mainland China has rapidly spread across the globe. Within 2 mo since the outbreak was first reported on December 31, 2019, a total of 566 Severe Acute Respiratory Syndrome (SARS CoV-2) cases have been confirmed in 26 other countries. Travel restrictions and border control measures have been enforced in China and other countries to limit the spread of the outbreak. We estimate the impact of these control measures and investigate the role of the airport travel network on the global spread of the COVID-19 outbreak. Our results show that the daily risk of exporting at least a single SARS CoV-2 case from mainland China via international travel exceeded 95% on January 13, 2020. We found that 779 cases (95% CI: 632 to 967) would have been exported by February 15, 2020 without any border or travel restrictions and that the travel lockdowns enforced by the Chinese government averted 70.5% (95% CI: 68.8 to 72.0%) of these cases. In addition, during the first three and a half weeks of implementation, the travel restrictions decreased the daily rate of exportation by 81.3% (95% CI: 80.5 to 82.1%), on average. At this early stage of the epidemic, reduction in the rate of exportation could delay the importation of cases into cities unaffected by the COVID-19 outbreak, buying time to coordinate an appropriate public health response.

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Prediction of the COVID-19 epidemic trends based on SEIR and AI models

PLoS ONE ◽

10.1371/journal.pone.0245101 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245101

Author(s):

Shuo Feng ◽

Zebang Feng ◽

Chen Ling ◽

Chen Chang ◽

Zhongke Feng

Keyword(s):

Mainland China ◽

Control Measures ◽

Chinese Government ◽

Epidemic Control ◽

Close Attention ◽

Intervention Measures ◽

The World ◽

The Impact ◽

The City

In December 2019, the outbreak of a new coronavirus-caused pneumonia (COVID-19) in Wuhan attracted close attention in China and the world. The Chinese government took strong national intervention measures on January 23 to control the spread of the epidemic. We are trying to show the impact of these controls on the spread of the epidemic. We proposed an SEIR(Susceptible-Exposed-Infectious-Removed) model to analyze the epidemic trend in Wuhan and use the AI model to analyze the epidemic trend in non-Wuhan areas. We found that if the closure was lifted, the outbreak in non-Wuhan areas of mainland China would double in size. Our SEIR and AI model was effective in predicting the COVID-19 epidemic peaks and sizes. The epidemic control measures taken by the Chinese government, especially the city closure measures, reduced the scale of the COVID-19 epidemic.

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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

BMC Health Services Research ◽

10.1186/s12913-021-06698-5 ◽

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.

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