PDF(Pubmed)
Abstract：
Introduction: Although persistent inhibition of HBV replication by antiviral therapy has shown to slow disease progression, cost-related access barriers to these essential medicines are becoming salient. The national volume-based procurement (NVBP) was piloted in China and led to substantial reduction in the list price of prescription drugs. To examine the impact of NVBP on selected antiviral medication costs per defined daily dose (DDD), procurement volumes, and spending. Methods: We employed an interrupted time series design to examine changes in cost per defined daily dose (DDD), procurement volumes, and spending for NVBP bid-winning antiviral medications (tenofovir disoproxil fumarate and entecavir) in 11 pilot cities from 2017 to 2020. Procurement transaction data were obtained from 9,454 hospitals in the Chinese Hospital Pharmaceutical Audit (CHPA) database. In the secondary analysis, the control group comprised two non-NVBP drugs (adefovir and lamivudine) procured in 11 cities not exposed to the NVBP. Results: Cost per DDD of the two hepatitis B virus (HBV) antiviral medications reduced by CNY1.598 (p = 0.002) immediately following the implementation of NVBP, dropping from an average cost of CNY16.483 per DDD at baseline to CNY6.420 at the end of the observation period. NVBP implementation resulted in a substantial reduction in daily costs of antivirals and an increase in monthly procurement volumes by 6.674 million DDDs (p = 0.017), while monthly spending was reduced by CNY138.26 million (p = 0.002). In the secondary ITS analysis with a control group, the average cost per DDD of the NVBP bid-winning antivirals declined by CNY4.537 (p < 0.001), monthly procurement volumes increased by 7.209 million DDDs (p = 0.002), and monthly spending dropped by CNY138.83 million (p < 0.001). Conclusion: Volume-based procurement piloted in China may be effective for reducing price and total expenditures and improving drug utilization, which is especially important for HBV patients who need constant access to antiviral therapies.
摘要：
简介：虽然通过抗病毒治疗持续抑制HBV复制已显示出减缓疾病进展，这些基本药物的成本相关获取障碍变得越来越突出。全国批量采购（NVBP）在中国试点，导致处方药标价大幅降低。为了检查NVBP对选定的抗病毒药物成本的影响，每个定义的每日剂量（DDD），采购量，和支出。方法：我们采用中断的时间序列设计来检查每定义的每日剂量（DDD）的成本变化，采购量，以及2017年至2020年在11个试点城市的NVBP中标抗病毒药物（富马酸替诺福韦酯和恩替卡韦）的支出。采购交易数据来自中国医院药品审核（CHPA）数据库中的9,454家医院。在次要分析中，对照组包括在11个未暴露于NVBP的城市采购的两种非NVBP药物(阿德福韦和拉米夫定).结果：两种乙型肝炎病毒（HBV）抗病毒药物的每DDD成本在NVBP实施后立即降低CNY1.598（p=0.002），从基线时每个DDD的平均成本16.483元下降到观察期结束时的6.420元。NVBP的实施导致抗病毒药物的日常成本大幅降低，每月采购量增加667.4万DDDs（p=0.017），而每月支出减少1.3826亿元人民币(p=0.002)。在对照组的次要ITS分析中，NVBP中标抗病毒药物的平均每DDD成本下降了4.537元(p<0.001)，每月采购量增加7209万DDDs(p=0.002)，每月支出减少1.3883亿元人民币（p<0.001）。结论:在中国试行批量采购可能对降低价格和总支出、提高药品利用率有效,这对于需要不断获得抗病毒治疗的HBV患者尤其重要。
