scholarly journals Impact of the Pilot Volume-Based Drug Purchasing Policy in China: Interrupted Time-Series Analysis with Controls

2021 ◽  
Vol 12 ◽  
Author(s):  
Yilin Chen ◽  
Xu Ji ◽  
Hong Xiao ◽  
Joseph M Unger ◽  
Yi Cai ◽  
...  
Keyword(s):  
Time Series ◽  
Prescription Drugs ◽  
Economies Of Scale ◽  
Negative Binomial ◽  
Generic Drugs ◽  
Interrupted Time Series ◽  
Chinese Government ◽  
Drug Spending ◽  
Purchase Quantity ◽  
Purchasing Policy

Centralizing procurement for prescription drugs has the potential to reduce drug spending by creating economies of scale and by improving purchasing power. In March 2019, the Chinese government launched a volume-based purchasing (VBP) pilot program using a competitive bidding process to purchase accredited generic drugs for which branded drug substitutes were available. We performed an interrupted time-series design to estimate the change in monthly drug purchase quantity and spending comparing 14 months before and 7 months after the VBP pilot. We obtained monthly prescription drug purchase data for all purchases from public medical institutions in the three large pilot cities (Beijing, Shanghai and Xi’an) and two non-pilot cities (Changsha and Zhengzhou) between January 2018 to September 2019. We used negative binomial regression and log-linked Gamma Generalized Linear Model for purchase quantity and spending respectively. We evaluated heterogeneity of impact by pilot city, drug type (selected or non-selected drugs), and therapeutic class (cardiovascular disease, mental disorder and cancer) separately. The implementation of the pilot reform was associated with a 132% (95%-CI: 104–165%, p < 0.001) increase in the purchase quantity of selected drugs in pilot cities compared to an 17% decrease (95%-CI: 9–25%, p < 0.001) in control cities. In contrast, the purchase quantity of branded and other drugs in pilot cities decreased by 38% (95%-CI: 27–46%, p < 0.001) and 77% (95%-CI: 71–81%, p < 0.001), respectively; while in control cities, these remained at similar levels. Overall, in pilot cities, there was a 35% (95%-CI: 28–41%, p < 0.001) decrease in the purchase spending for all drugs in the first post-policy month, from 8.1 billion CNY estimated in the absence of VBP down to 5.3 billion CNY; in control cities, the change was negligible. The largest reduction in spending occurred for drugs for the treatment of cardiovascular diseases. The evidence suggests a positive impact of the VBP pilot in reducing overall drug spending and increasing the use of accredited generics in three pilot cities. This overall trend is not observed in two non-pilot cities. Assessments of long-term impact of the VBP policy on additional key outcomes including drug prescriptions, drug utilization, patients’ health outcomes and payments on drugs are needed.

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 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 Getting Beyond Interruptive Alerts: Reducing Unintentional Duplicate Orders using a Visual Aid

2019 ◽  
Author(s):  
Steven Horng ◽  
Joshua W Joseph ◽  
Shelley Calder ◽  
Jennifer P Stevens ◽  
Ashley L O’Donoghue ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Incidence Rate Ratio ◽  
Interrupted Time Series ◽  
Alert Fatigue ◽  
Visual Aid ◽  
Electronic Health

ABSTRACTImportanceElectronic health records (EHRs) allow teams of clinicians to simultaneously care for patients but an unintended consequence could result in duplicate ordering of tests and medications.ObjectiveWe asked if a simple visual aid would reduce duplicate ordering of tests and medications for busy teams of clinicians in our emergency department by placing a red highlight around the checkbox of a computer-based order if previously ordered.DesignWe performed an interrupted time series to analyze all patient visits 1 year before and 1 year after the intervention. Significance testing was performed using a negative binomial regression with Newey-West standard errors, correcting for patient level variables and environmental variables that might be associated with duplicate orders.SettingThe emergency department of an academic hospital in Boston, MA with 55,000 visits annually.Participants184,722 consecutive emergency department patients.ExposureIf an order had previously been placed during that ED visit, we cue the user by showing a red highlight around the checkbox of that order.Main OutcomeNumber of unintentional duplicate orders.ResultsAfter deployment of the non-interrupting nudge, the rate of unintentional duplicates for laboratory orders decreased 49% (incidence rate ratio 0.51, 95% CI 0.45-0.59) and for radiology orders decreased with an incidence rate ratio of 0.60 (0.44-0.82). There was no change in unintentional medication duplicate orders. We estimated that the nudge eliminated 17,936 clicks in our EHR.Conclusions and RelevancePassive visual queues that provide just-in-time decision support are effective, not disruptive of workflow, and may decrease alert fatigue in busy clinical environments.Key PointsQuestionCan a simple visual aid reduce duplicate ordering in an electronic health record?FindingsIn this interrupted time series, the rate of unintentional duplicates for laboratory orders decreased 49% and for radiology orders decreased 40%. There was no change in unintentional medication duplicate orders. We estimated that the nudge eliminated 17,936 clicks in our EHR.MeaningQuality improvement often relies on changing clinician behavior. We believe guiding clinicians to a right action is better than telling the clinician they have already made an error. Our approach will help reduce alert fatigue and lessen clinician complaints about EHRs.

scholarly journals Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis

2019 ◽  
Vol 70 (11) ◽  
pp. 2306-2313 ◽  
Author(s):  
Grieven P Otieno ◽  
Christian Bottomley ◽  
Sammy Khagayi ◽  
Ifedayo Adetifa ◽  
Mwanajuma Ngama ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Negative Binomial ◽  
Substantial Reduction ◽  
Interrupted Time Series ◽  
Rotavirus Vaccine ◽  
Interrupted Time Series Analysis ◽  
Control Series ◽  
Vaccine Introduction ◽  
Series Analysis

Abstract Background Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs). Methods Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged &lt;5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre– and post–vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post–vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes). Results Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8–80%) reduction in RVHs observed in the first year post–vaccine introduction in Kilifi and a 59% (95% CI, 20–79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46–93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61–92%); this reduction was sustained at both sites into the third year. Conclusions A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.

scholarly journals Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e036858
Author(s):  
Zhengdong Zhong ◽  
Junnan Jiang ◽  
Shanquan Chen ◽  
Lu Li ◽  
Li Xiang
Keyword(s):  
Time Series ◽  
Critical Illness ◽  
Insurance Coverage ◽  
Interrupted Time Series ◽  
Medical Expenditures ◽  
Chinese Government ◽  
Health Coverage ◽  
Interrupted Time Series Analysis ◽  
Reimbursement Rate ◽  
Universal Health

ObjectiveThe objective of this study is to determine if critical illness insurance (CII) promotes the universal health coverage to reduce out-of-pocket (OOP) medical expenditures and improve the effective reimbursement rate (ERR) in rural China.Study designThe 5-year monthly hospitalisation data, starting 2 years before the CII (ie, the ‘intervention’) began, were collected. Interrupted time series analysis models were used to evaluate the immediate and gradual effects of CII on OOP payment and ERR.SettingThe study was conducted in Xiantao County, Hubei Province, China.ParticipantsA total of 511 221 inpatients within 5 years were included in the analysis.ResultsIn 2016, 100 288 patients received in-patient services, among which 4137 benefited from CII. After the implementation of CII, OOP expenses increased 32.2% (95% CI 24.8% to 39.5%, p<0.001). Compared with the preintervention periods, the trend changes decline at a rate of 0.7% per month after the implementation of CII. Similarly, a significant decrease was observed in log ERR after the intervention started. The rate of level change is 16% change (95% CI −20.0% to −12.1%, p<0.001).ConclusionCII did not decrease the OOP payments of rural inpatients in 2011–2016 periods. The limited extents of population coverage and financing resources can be attributed to these results. Therefore, the Chinese government must urgently raise the funds of CII and improve the CII policy reimbursement rate.

scholarly journals Estimating the effect of moving meat-free products to the meat aisle on sales of meat and meat-free products: A non-randomised controlled intervention study in a large UK supermarket chain

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003715
Author(s):  
Carmen Piernas ◽  
Brian Cook ◽  
Richard Stevens ◽  
Cristina Stewart ◽  
Jennifer Hollowell ◽  
...  
Keyword(s):  
Time Series ◽  
Phase I ◽  
Phase Ii ◽  
Intervention Study ◽  
Negative Binomial ◽  
Meat Products ◽  
Interrupted Time Series ◽  
Outcome Analysis ◽  
Free Products ◽  
Randomised Controlled

Background Reducing meat consumption could bring health and environmental benefits, but there is little research to date on effective interventions to achieve this. A non-randomised controlled intervention study was used to evaluate whether prominent positioning of meat-free products in the meat aisle was associated with a change in weekly mean sales of meat and meat-free products. Methods and findings Weekly sales data were obtained from 108 stores: 20 intervention stores that moved a selection of 26 meat-free products into a newly created meat-free bay within the meat aisle and 88 matched control stores. The primary outcome analysis used a hierarchical negative binomial model to compare changes in weekly sales (units) of meat products sold in intervention versus control stores during the main intervention period (Phase I: February 2019 to April 2019). Interrupted time series analysis was also used to evaluate the effects of the Phase I intervention. Moreover, 8 of the 20 stores enhanced the intervention from August 2019 onwards (Phase II intervention) by adding a second bay of meat-free products into the meat aisle, which was evaluated following the same analytical methods. During the Phase I intervention, sales of meat products (units/store/week) decreased in intervention (approximately −6%) and control stores (−5%) without significant differences (incidence rate ratio [IRR] 1.01 [95% CI 0.95–1.07]. Sales of meat-free products increased significantly more in the intervention (+31%) compared to the control stores (+6%; IRR 1.43 [95% CI 1.30–1.57]), mostly due to increased sales of meat-free burgers, mince, and sausages. Consistent results were observed in interrupted time series analyses where the effect of the Phase II intervention was significant in intervention versus control stores. Conclusions Prominent positioning of meat-free products into the meat aisle in a supermarket was not effective in reducing sales of meat products, but successfully increased sales of meat-free alternatives in the longer term. A preregistered protocol (https://osf.io/qmz3a/) was completed and fully available before data analysis.

scholarly journals The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis

2021 ◽  
Vol 1 (11) ◽  
pp. e0000029
Author(s):  
Steven Wambua ◽  
Lucas Malla ◽  
George Mbevi ◽  
Amen-Patrick Nwosu ◽  
Timothy Tuti ◽  
...  
Keyword(s):  
Time Series ◽  
Negative Binomial ◽  
Interrupted Time Series ◽  
Public Hospitals ◽  
Hospital Ownership ◽  
Private Hospitals ◽  
Live Births ◽  
Inpatient Services ◽  
First Case ◽  
The Impact

The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five’s admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.

scholarly journals Impact of free maternity policies in Kenya: an interrupted time-series analysis

2021 ◽  
Vol 6 (6) ◽  
pp. e003649
Author(s):  
Stacey Orangi ◽  
Angela Kairu ◽  
Lucas Malla ◽  
Joanne Ondera ◽  
Boniface Mbuthia ◽  
...  
Keyword(s):  
Time Series ◽  
Maternal Health ◽  
Time Series Analysis ◽  
Negative Binomial ◽  
Health Information System ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Faith Based ◽  
Public Facilities ◽  
Series Analysis

BackgroundUser fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama programme to expand access to private sector, expand the benefit package and change its management.MethodsAn interrupted time-series analysis on facility deliveries, antenatal care (ANC) and postnatal care (PNC) visits data between 2012 and 2019 was used to determine the effect of the two free maternity policies. These data were from 5419 public and 305 private and faith-based facilities across all counties, with data sourced from the health information system. A segmented negative binomial regression with seasonality accounted for, was used to determine the level (immediate) effect and trend (month-on-month) effect of the policies.ResultsThe 2013 free-maternity policy led to a 19.6% and 28.9% level increase in normal deliveries and caesarean sections, respectively, in public facilities. There was also a 1.4% trend decrease in caesarean sections in public facilities. A level decrease followed by a trend increase in PNC visits was reported in public facilities. For private and faith-based facilities, there was a level decrease in caesarean sections and ANC visits followed by a trend increase in caeserean sections following the 2013 policy.Furthermore, the 2017 Linda Mama programme showed a level decrease then a trend increase in PNC visits and a 1.1% trend decrease in caesarean sections in public facilities. In private and faith-based facilities, there was a reported level decrease in normal deliveries and caesarean sections and a trend increase in caesarean sections.ConclusionThe free maternity policies show mixed effects in increasing access to maternal health services. Emphasis on other accessibility barriers and service delivery challenges alongside user fee removal policies should be addressed to realise maximum benefits in maternal health utilisation.

Sign in / Sign up

Export Citation Format

Share Document