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Vargas López LC, Chávez Gallegos D, Blanco Borjas DM, Wirtz VJ. Medicines policy, access and use in Mexico: a systematic literature review 2000-2022. Drugs Context 2024; 13:2023-7-3. [PMID: 38384930 PMCID: PMC10881114 DOI: 10.7573/dic.2023-7-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
Background Research on medicines access and use is heterogeneous and can be challenging for decision-makers to interpret. Pharmaceutical policy is an additional component for study and is the foundation for the promotion of access and use of medicines. This systematic review summarizes findings from the literature on medicines policy, access and use over the past two decades in Mexico and identifies research gaps that should be addressed. Methods A systematic review of the literature published between 2000 and 2022 was conducted to identify publications on medicines policy, access and use in Mexico. The study followed PRISMA Statement guidelines 2020. A narrative review including content analysis was conducted. Results A total of 5057 articles were reviewed, of which 77 fit the inclusion criteria. Studies described the lack of an explicit national policy, a misalignment between the legal framework and reinforcement incentives, deficient policy documentation at the national level, and the absence of necessary medicines regulation and transparency. In terms of access to medicines, challenges related to supply, selection, acquisition, distribution and expenditure were noted. Regarding medicine use, key study findings included a lack of adherence to standard treatment guidelines, dispensing, lack of reliable information on medicines, lack of treatment adherence and harmful self-medication. Conclusion The appropriate use of medicines and adequate access to them are priority topics for the formulation of Mexican pharmaceutical policy. It is critical that further research includes longitudinal studies of medicine access and use, and the consideration of studying the private sector as well as new methodological approaches. Many reported challenges related to access to and use of medicines have persisted across decades, suggesting a lack of effective research-to-practice knowledge transfer and policy implementation.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.
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Affiliation(s)
| | | | | | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Ma Y, Peng J, Yao X, Feng L, Shi X, Jiang M. Access to anticancer medicines in public hospitals of Northwestern China. Front Public Health 2023; 11:1182617. [PMID: 37275477 PMCID: PMC10235455 DOI: 10.3389/fpubh.2023.1182617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Objective We aimed to evaluate the accessibility of anticancer medicines in public hospitals of Shaanxi, a representative province of Northwestern China. Methods Thirty-one anticancer medicines were investigated in 146 designated public hospitals in 10 cities of Shaanxi Province. We used medicine procurement data from the Shaanxi Drug Centralized Purchasing Platform during 2019-2021. Primary outcomes included the availability, drug utilization, and affordability of anticancer medicines. Results The mean availability of 31 anticancer medicines increased significantly from 5.45% in 2019 to 14.72% in 2021. The mean availability of nationally negotiated medicines was significantly lower than that of Class B medicines (8.72% vs. 12.85%, p = 0.048), whilst the availability of injectable medicines was significantly greater than that of oral medicines (13.66% vs. 8.77%, p = 0.007). In 2019-2021, the annual mean amount purchased increased significantly from CNY 6.51 million to CNY 18.56 million (p = 0.007). The mean defined daily doses of 31 medicines significantly rose from 225.50 to 1019.50 (p = 0.008) whereas their defined daily drug cost significantly decreased from CNY 551.15 to CNY 404.50 (p < 0.001). The percentage of catastrophic health expenditure decreased from 71.0 to 51.65% and from 90.30 to 80.60% for urban and rural residents, respectively. The affordability of nationally negotiated medicines was significantly lower than that of Class B medicines (p = 0.032), and the affordability of injectable medicines had no significant difference compared to that of oral medicines (p = 0.124) for both urban and rural residents. Conclusion The accessibility of anticancer medicines improved dramatically in public hospitals of Northwestern China during the period 2019-2021.
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Affiliation(s)
- Yue Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Jin Peng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Xuelin Yao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Liuxin Feng
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xinke Shi
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
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Rosselli D. High cost drugs in Latin America: access and barriers. Expert Rev Pharmacoecon Outcomes Res 2023. [PMID: 37185151 DOI: 10.1080/14737167.2023.2207825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Latin America comprises a large set of culturally diverse middle-income countries sharing an inequality gap and a rapidly ageing population. A better informed growing middle class adds to the pressure on fragmented health systems that strive to attain universal coverage. Cost containment becomes crucial for sustainability. AREAS COVERED Using "high cost" as free term, together with individual country names, a search was performed in Pubmed and Scopus databases for relevant documents centered on pharmaceutical products. References of selected articles were also reviewed. EXPERT OPINION In the region as elsewhere improving health information systems has been the starting point. Official health technology assessment agencies have been established in several countries, supporting decisions on best available evidence. A few centralized procurement and price regulation schemes using international reference pricing have been successful. Fast-track approval of generics and biosimilars, or establishing a separate funding source for high cost technologies are other options that, with varying degrees of success, have been. Since Latin America is characterized by its social, geographical and political diversity, each health system needs to recognize its individual priorities, learn from successful experiences elsewhere, and adapt possible alternative interventions to the different local contexts.
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Affiliation(s)
- Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogota, Colombia
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Ding Y, Zheng C, Wei X, Zhang Q, Sun Q. The impacts of the National Medication Price-Negotiated Policy on the financial burden of cancer patients in Shandong province, China: an interrupted time series analysis. BMC Public Health 2022; 22:2363. [PMID: 36527037 PMCID: PMC9756446 DOI: 10.1186/s12889-022-14525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In order to further regulate the price of anticancer medication and alleviate the financial burden of cancer patients, the Chinese government implemented the National Medication Price-Negotiated Policy (NMPNP) in 2017. This study aims to assess the impacts of implementation of the NMPNP on the access of anticancer medication and the financial burden for cancer patients in Shandong province, and to provide evidence to inform the design of similar policies in other developing countries. METHODS A quasi-experiment design of an interrupt time series analysis was conducted. The month of September 2017 was taken as the intervention point when the Shandong Provincial Reimbursement Drug Lists was updated based on the result of the NMPNP in 2017. The data used were the aggregated monthly claim data of cancer patients from 2016 to 2021, which were obtained from four cities in Shandong province. The outpatient and inpatient care visits per capita, proportion of OOP expenditure and medication costs in outpatient and inpatient medical costs were used as outcome variables. A segmented regression model was used to analyze the change of the access of anticancer medication and the financial burden for cancer patients. RESULTS The outpatient care visits per capita significantly decreased after the intervention. Compared to preintervention trend, the proportion of OOP expenditure in outpatient medical costs decreased by average 0.25 percentage point per month (p < 0.0001) after the intervention, however the proportion of OOP expenditure in inpatient medical costs increased by 0.02 percentage point per month (p = 0.76). Since the intervention, the proportion of medication costs in outpatient medical costs averagely rose by 0.28 percentage point (p < 0.0001), and its implementation caused the proportion of medication costs in inpatient medical costs averagely decreased 0.2 percentage point (p < 0.0001). CONCLUSIONS The NMPNP improved the access of anticancer medication, and relieved the financial burden of outpatient care. However, it did not effectively alleviate the financial burden of inpatient care. Additionally, the NMPNP impacted the behavior of the healthcare providers. The policymakers should closely monitor the change of providers behaviors, and dynamically adjust financial incentives policies of healthcare providers during the implementation of similar medication price negotiated policies.
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Affiliation(s)
- Yi Ding
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research (Shandong University), 44 Wen Hua Xi Road, 250012 Jinan, China
| | - Chao Zheng
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research (Shandong University), 44 Wen Hua Xi Road, 250012 Jinan, China
| | - Xiaolin Wei
- grid.17063.330000 0001 2157 2938Division of Clinical Public Health and Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T3M7 Canada
| | - Qi Zhang
- grid.17063.330000 0001 2157 2938Division of Clinical Public Health and Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T3M7 Canada
| | - Qiang Sun
- grid.27255.370000 0004 1761 1174Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research (Shandong University), 44 Wen Hua Xi Road, 250012 Jinan, China
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Huang C, Ung COL, Wushouer H, Bai L, Li X, Guan X, Shi L. Trends of Negotiated Targeted Anticancer Medicines Use in China: An Interrupted Time Series Analysis. Int J Health Policy Manag 2022; 11:1489-1495. [PMID: 34273922 PMCID: PMC9808358 DOI: 10.34172/ijhpm.2021.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/18/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In order to relieve the financial burden of the patients in China, the Ministry of Health (MoH) conducted the first national price negotiation and successfully negotiated three expensive medicines including 2 targeted anticancer medicines (TAMs), icotinib and gefitinib. However, little evidence was available to demonstrate the impact of the national negotiation on TAMs use. The purpose of the study is to evaluate the implementation of the national price negotiation policy in China on TAMs use. METHODS We used interrupted time series (ITS) design to examine the changes in the daily cost, the monthly hospital purchasing volume and spending of icotinib and gefitinib with pharmaceutical procurement data from 594 tertiary hospitals in 29 provinces of mainland China between January 2015 and July 2017. The period between May and July 2016 was applied to assess the impact of policy. RESULTS The daily cost of icotinib and gefitinib decreased by 50.08% (P<.001) and 53.89% (P<.001) 12 months after the national negotiation, respectively. In terms of volume, the negotiation was associated with increases in the trend of the monthly hospital purchasing volume of icotinib and gefitinib by 4.87 thousand defined daily doses (DDDs) (P<.001) and 6.89 thousand DDDs (P<.001). However, the monthly hospital purchasing spending of icotinib and gefitinib decreased rapidly by US$0.51 million (P<.010) and US$0.82 million (P<.050) following policy implementation, respectively. CONCLUSION The first national negotiation had successfully cut off the price of two negotiated TAMs and promoted TAMs use in China. In the future, government should conduct further price negotiations and include more medicines with clinical benefits into reimbursement schemes to alleviate patients' financial burden and promote their access to essential treatment.
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Affiliation(s)
- Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xinyi Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Sun Y, Zhu Z, Zhang J, Han P, Qi Y, Wang X, Yang L. Impacts of National Drug Price Negotiation on Expenditure, Volume, and Availability of Targeted Anti-Cancer Drugs in China: An Interrupted Time Series Analysis. Int J Environ Res Public Health 2022; 19:ijerph19084578. [PMID: 35457445 PMCID: PMC9025142 DOI: 10.3390/ijerph19084578] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022]
Abstract
The Chinese government has launched six rounds of national drug price negotiation since 2016 to lower the price and expand access to innovative drugs, many of which are anticancer drugs. This study aims to examine the effect of the second round of negotiation at the provincial level on the expenditure, volume, and availability of anti-cancer drugs. Procurement data at the provincial level from January 2017 to September 2018 were extracted from the China Drug Supply Information Platform (CDSIP). The volume, expenditure, and availability of three targeted anti-cancer drugs, rituximab, trastuzumab, and recombinant human endostatin (RHE), in 11 provinces that implemented the policy in September 2017 were analyzed through a controlled interrupted time series (ITS) analysis. A significant 6.0% increase (p < 0.1) in monthly average expenditure, an increase in the volume of 99.51 DDDs (defined daily doses) (p < 0.1), and a 0.24% (p < 0.1) increase in availability were observed for rituximab following the implementation of the policy. The volume and availability of rituximab increased by 949.6 DDDs (p < 0.05) and 1.56%, respectively, immediately after implementation. The availability of trastuzumab increased by 5.14% (p < 0.01) immediately after the implementation while no instant changes in expenditure and volume were observed. A 15% (p < 0.01) increase in monthly expenditure, 3673.17 DDDs increase in volume, and 0.66% increase in availability were observed after the inclusion of Trastuzumab. However, for RHE, only a 0.32% (p < 0.01) increase was observed after its inclusion. Eastern and middle provinces benefited more than western provinces. National negotiation related to the drug price significantly increased the volume and expenditure of anti-cancer drugs and improved their availability. The effect of the policy might be different across different regions and across different anticancer drugs.
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Affiliation(s)
| | | | | | | | | | | | - Li Yang
- Correspondence: ; Tel.: +86-108-280-5650
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Diao Y, Lin M, Xu K, Huang J, Wu X, Li M, Sun J, Li H. Impact of public health insurance coverage of novel anticancer medication on medical expenditure and patient affordability in a provincial medical centre of China: a propensity score-matching analysis with the quasi-experimental design. BMJ Open 2022; 12:e054713. [PMID: 35173004 PMCID: PMC8852767 DOI: 10.1136/bmjopen-2021-054713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Little is known about the impact of the government's efforts in having novel anticancer medicines covered by the public health insurance system in China. This study targeted the above policy implemented in Fujian province in 2017, analysed the policy impact on the medical expenditure of cancer treatment and patient affordability based on the clinical data of Fujian provincial medical centre. METHODS The study included 253 human epidermal growth factor receptor 2-positive patients with breast cancer who completed at least one course of trastuzumab treatment extracted from the hospital health information system of the provincial medical centre of Fujian. We adopted the propensity score-matching method to mimic a quasi-experimental design to estimate the impact of the public health insurance coverage policy on all the indicated patients with a before-after comparison of the total breast cancer-associated direct medical expenditures for a standard course of treatment or maintenance treatment and the proportionate patient out-of-pocket (OOP) expenditure based on the real clinical data. RESULTS We found evidence of an association between the public health insurance coverage of novel breast cancer medication and the reductions of the medical expenditure by US$18661.02 (95% CI 13 836.57 to 28 201.45), and the proportionate patient OOP expenditure by 24% (95% CI0.20 to 0.27). The medical expenditure and the proportionate patient OOP expenditure might be generally reduced. CONCLUSIONS The coverage of innovative antibreast cancer medicines by the public health insurance was found to be associated with a reduction of the medical expenditure and share of patient OOP expenditure for cancer treatment of the indicated patients. Patients with lower ability-to-pay did not benefit well from the coverage policy. To maximise the welfare of the public health insurance coverage of novel anticancer medication, the study called for strengthened health insurance benefit packages of the rural patient and the patient enrolled in the urban and rural resident health insurance programme, who might have lower ability-to-pay and need more support from the public security system.
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Affiliation(s)
- Yifan Diao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mengbo Lin
- Affiliated Clinical Medical Institute of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Kai Xu
- Affiliated Clinical Medical Institute of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Ji Huang
- Affiliated Clinical Medical Institute of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Xiongwei Wu
- Affiliated Clinical Medical Institute of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Mingshuang Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hong Li
- Affiliated Clinical Medical Institute of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Moye-Holz D, Vogler S. Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America. Appl Health Econ Health Policy 2022; 20:67-77. [PMID: 34228312 PMCID: PMC8752537 DOI: 10.1007/s40258-021-00670-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability. METHODS For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria, France, Germany, Greece, Hungary, the Netherlands, Poland, Romania, Spain, Sweden, and the UK). Price data (public procurement prices in LATAM and ex-factory prices in Europe) in US dollar purchasing power parities (PPP) were analyzed per defined daily dose. Affordability was measured by setting medicines prices in relation to national minimum wages. RESULTS The prices of cancer medicines varied considerably between countries. In European countries with higher levels of income, PPP-adjusted prices tended to be lower than in European countries of lower income and LATAM countries. Except for one medicine, all surveyed medicines were considered unaffordable in most countries. In European countries of lower income and LATAM countries, more than 15 days' worth of minimum wages would be required by a worker to purchase one defined daily dose of several of the studied medicines. CONCLUSIONS The high prices and large unaffordability of cancer medicines call for strengthening pricing policies with the aim of ensuring affordable treatment in cancer care.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - S. Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG/Austrian National Public Health Institute), Stubenring 6, 1010 Vienna, Austria
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Zhang Y, Wushouer H, Han S, Fu M, Guan X, Shi L, Wagner A. The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China. BMJ Glob Health 2021; 6:bmjgh-2021-006196. [PMID: 34266848 PMCID: PMC8286756 DOI: 10.1136/bmjgh-2021-006196] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION New targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending. METHODS Using a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017. RESULTS After the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146). CONCLUSIONS The 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.
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Affiliation(s)
- Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing, China .,International Research Center for Medicinal Administration, Peking University, Beijing, China.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, Peking University School of Pharmaceutical Sciences, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Anita Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Ferrario A, Stephens P, Guan X, Ross-Degnan D, Wagner A. Sales of anti-cancer medicines; China, Indonesia, Kazakhstan, Malaysia, Philippines and Thailand. Bull World Health Organ 2020; 98:467-474. [PMID: 32742032 PMCID: PMC7375213 DOI: 10.2471/blt.19.243998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess sales of anti-cancer medicines in the 2017 World Health Organization's WHO Model list of essential medicines in China, Indonesia, Kazakhstan, Malaysia, Philippines and Thailand from 2007 (2008 for Kazakhstan and Malaysia) to 2017. METHODS We extracted sales volume data for 39 anti-cancer medicines from the IQVIA database. We divided the total quantity sold by the reference defined daily dose to estimate the total number of defined daily doses sold, per country per year, for three types of anti-cancer therapies (traditional chemotherapy, targeted therapy and endocrine therapy). We adjusted these data by the number of new cancer cases in each country for each year. FINDINGS We observed an increase in sales across all types of anti-cancer therapies in all countries. The largest number of defined daily doses of traditional chemotherapy per new cancer case was sold in Thailand; however, the largest relative increase per new cancer case occurred in Indonesia (9.48-fold). The largest absolute and relative increases in sales of defined daily doses of targeted therapies per new cancer case occurred in Kazakhstan. Malaysia sold the largest number of adjusted defined daily doses of endocrine therapies in 2017, while China and Indonesia more than doubled their adjusted sales volumes between 2007 and 2017. CONCLUSION The use of sales data can fill an important knowledge gap in the use of anti-cancer medicines, particularly during periods of insurance coverage expansion. Combined with other data, sales volume data can help to monitor efforts to improve equitable access to essential medicines.
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Affiliation(s)
- Alessandra Ferrario
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215United States of America
| | | | - Xiaodong Guan
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215United States of America
| | - Anita Wagner
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215United States of America
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