PDF(Pubmed)
Abstract：
BACKGROUND: The high costs of innovative anticancer drugs hinder a number of cancer patients\' access to these drugs in China. To address this problem, in 2018, the medical insurance access negotiation (MIAN) policy was implemented, when the prices of 17 innovative anticancer drugs were successfully negotiated and they were therefore included in the reimbursement list. This study aimed to explore the impact of the MIAN policy on the utilization of innovative anticancer drugs.
METHODS: With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs.
RESULTS: From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy.
CONCLUSIONS: The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.
METHODS: With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs.
RESULTS: From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy.
CONCLUSIONS: The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.
摘要：
背景：创新抗癌药物的高成本阻碍了许多癌症患者在中国获得这些药物。为了解决这个问题,2018年，医疗保险准入谈判(MIAN)政策实施，当17种创新抗癌药物的价格谈判成功后，它们被列入报销清单。本研究旨在探讨MIAN政策对创新抗癌药物利用的影响。
方法：根据2017年1月至2019年12月每种创新抗癌药物的药物支出和确定的每日剂量（DDDs）的月度数据，采用中断的时间序列分析来估计MIAN政策在药物支出和DDDs方面对药物利用的即时（结果水平变化）和长期（结果趋势变化）影响。我们的样本由12种创新抗癌药物组成。
结果：从2017年1月到2019年12月，12种创新抗癌药物的每月药物支出和DDDs增加了约573%（从8,931,809.30美元增加到51,138,331.09美元）和1400％（从47,785增加到668,754），分别。总的来说,MIAN政策的实施导致药物支出立即大幅增加8,734,414美元，DDDs增加158,192.5美元。此外，据报道，随着时间的推移，上升趋势更加明显，药物支出和DDDs的每月增长率分别增加了2,889,078美元和38,715.3美元，分别。关于个别创新抗癌药物，药物利用的即时变化和趋势变化最突出的是奥希替尼，克唑替尼,还有ibrutinib.相比之下,pegaspargase的利用几乎没有受到MIAN政策的影响。
结论：MIAN政策有效促进了创新抗癌药物的利用。确保效果的连续性,消除差异,应采取补充措施，例如精心选择医疗保险谈判的药物，卫生技术评估系统和多渠道筹资机制。
方法：根据2017年1月至2019年12月每种创新抗癌药物的药物支出和确定的每日剂量（DDDs）的月度数据，采用中断的时间序列分析来估计MIAN政策在药物支出和DDDs方面对药物利用的即时（结果水平变化）和长期（结果趋势变化）影响。我们的样本由12种创新抗癌药物组成。
结果：从2017年1月到2019年12月，12种创新抗癌药物的每月药物支出和DDDs增加了约573%（从8,931,809.30美元增加到51,138,331.09美元）和1400％（从47,785增加到668,754），分别。总的来说,MIAN政策的实施导致药物支出立即大幅增加8,734,414美元，DDDs增加158,192.5美元。此外，据报道，随着时间的推移，上升趋势更加明显，药物支出和DDDs的每月增长率分别增加了2,889,078美元和38,715.3美元，分别。关于个别创新抗癌药物，药物利用的即时变化和趋势变化最突出的是奥希替尼，克唑替尼,还有ibrutinib.相比之下,pegaspargase的利用几乎没有受到MIAN政策的影响。
结论：MIAN政策有效促进了创新抗癌药物的利用。确保效果的连续性,消除差异,应采取补充措施，例如精心选择医疗保险谈判的药物，卫生技术评估系统和多渠道筹资机制。
