中国浙江省级医保报销对于靶向抗肿瘤药使用的影响: 一项带对照的间断时间序列分析

doi:10.5246/jcps.2021.07.047

中国药学(英文版) ›› 2021, Vol. 30 ›› Issue (7): 590-597.DOI: 10.5246/jcps.2021.07.047

中国浙江省级医保报销对于靶向抗肿瘤药使用的影响: 一项带对照的间断时间序列分析

黄聪¹, 吴霭琳², 海沙尔江·吾守尔¹^,³, 徐子悦¹, 张逸晨¹, 管晓东¹^,³^,^*(), 史录文¹^,³

1. 北京大学药学院药事管理与临床药学系, 北京 100191
2. 澳门大学中医药研究院中药质量研究国家重点实验室, 中国澳门 999078
3. 北京大学医药管理国际研究中心, 北京 100191

收稿日期:2020-10-26 修回日期:2020-12-12 接受日期:2021-01-24 出版日期:2021-07-27 发布日期:2021-07-27
通讯作者: 管晓东
作者简介:
+ Tel./Fax: +86-10-82805019, E-mail: guanxiaodong@pku.edu.cn

The impact of the provincial reimbursement scheme on the use of targeted anticancer medications in Zhejiang, China: a controlled interrupted time-series analysis

Cong Huang¹, Carolina Oi Lam Ung², Haishaerjiang Wushouer¹^,³, Ziyue Xu¹, Yichen Zhang¹, Xiaodong Guan¹^,³^,^*(), Luwen Shi¹^,³

1 Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
2 State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
3 International Research Center for Medicinal Administration, Peking University, Beijing 100191, China

Received:2020-10-26 Revised:2020-12-12 Accepted:2021-01-24 Online:2021-07-27 Published:2021-07-27
Contact: Xiaodong Guan

摘要/Abstract

摘要：

为了减轻昂贵的靶向抗肿瘤药物给患者带来的沉重经济负担, 浙江省在2015年2月将6个靶向抗肿瘤药纳入本省医保报销范围。本研究基于间断时间序列的方法, 利用浙江省22家三级医院2014年1月至2017年2月的药品采购数据, 分析省级医保政策对6个纳入医保的靶向药(研究组)与4个没纳入医保的靶向药(对照组)的影响。结果显示, 政策实施后6个研究组靶向药平均日费用有所降低, 每月各医院平均采购量增加34.6 DDDs (P < 0.001), 每月各医院平均采购金额增加6614.9美元 (P < 0.001); 4个对照组靶向药每月各医院平均采购量和采购金额均无显著变化。本研究表明, 浙江省级医保政策可以减轻患者的经济负担, 促进靶向药的可及。

关键词: 省级医保报销, 靶向抗肿瘤药, 间断时间序列分析

Abstract:

To alleviate problems with access and affordability, six targeted anticancer medications (TAMs) were listed in the Provincial Reimbursement Drug List (PRDL) for the first time in Zhejiang, China in February 2015. In the present study, we aimed to evaluate the implementation of the PRDL policy on TAMs use. Using the pharmaceutical procurement data of these six listed TAMs (study group) and four unlisted TAMs (control group) from 22 tertiary hospitals in Zhejiang, China dated between January 2014 and February 2017, interrupted time-series analysis was adopted to examine differences in the average hospital purchasing volume (HPV) and the average hospital purchasing spending (HPS) between the two groups. The average daily cost of listed TAMs in the study group was decreased after April 2015. After enlistment, the average HPV per month was significantly increased by 34.6 defined daily doses (DDDs) (P < 0.001), and the average HPS per month was significantly increased by USD 6614.9 (P < 0.001) for the listed TAMs in the study group (n = 6). Neither the average HPV nor the average HPS changed significantly for the unlisted TAMs in the control group (n = 4). The PRDL policy showed positive effects on improving patients’ affordability and promoting access to TAMs in Zhejiang. The government should conduct further price negotiations and include more TAMs with clinical benefits into reimbursement schemes to relieve patients’ financial burden and promote access.

Key words: Provincial reimbursement, Targeted anticancer medications, Interrupted time-series

Supporting:

黄聪, 吴霭琳, 海沙尔江·吾守尔, 徐子悦, 张逸晨, 管晓东, 史录文. 中国浙江省级医保报销对于靶向抗肿瘤药使用的影响: 一项带对照的间断时间序列分析[J]. 中国药学(英文版), 2021, 30(7): 590-597.

Cong Huang, Carolina Oi Lam Ung, Haishaerjiang Wushouer, Ziyue Xu, Yichen Zhang, Xiaodong Guan, Luwen Shi. The impact of the provincial reimbursement scheme on the use of targeted anticancer medications in Zhejiang, China: a controlled interrupted time-series analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2021, 30(7): 590-597.

图/表 4

Table 1. Descriptive information of six targeted anticancer medications listed (study group) and four targeted anticancer medications unlisted (control group) in PRDL of Zhejiang.

Figure 1. Changes in the average daily cost between the study group (n = 6) and the control group (n = 4), 2014–2016.

Figure 2. Changes in the average HPV per month (A) and the average HPS per month (B) for the study group (n = 6) and the control group (n = 4), 2014–2016.

Table 2. Estimates from ITS models of changes in the average HPV and HPS for two groups.

参考文献 40

[1]	National Health Commission, China health statistical yearbook 2018. National Health Commission of the People’s Republic of China: Beijing: China Union Medical University Press. 2019, 281–308.
[2]	Chen, W.Q.; Zheng, R.S.; Baade, P.D.; Zhang, S.W.; Zeng, H.M.; Bray, F.; Jemal, A.; Yu, X.Q.; He, J. Cancer statistics in China, 2015. CA Cancer J. Clin. 2016, 66, 115–132.
[3]	Zheng, R.S.; Sun, K.X.; Zhang, S.W.; Zeng, H.M.; Zou, X.N.; Chen, R.; Gu, X.Y.; Wei, W.W.; He, J. [Report of cancer epidemiology in China, 2015] Chin. J. Oncol. 2019, 41, 19–28.
[4]	National Health Commission, China health statistical yearbook 2016. National Health Commission of the People’s Republic of China: Beijing: China Union Medical University. 2017, 281–306.
[5]	Carrera, P.M.; Kantarjian, H.M.; Blinder, V.S. The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J. Clin. 2018, 68, 153–165.
[6]	Shih, Y.C.T.; Xu, Y.; Liu, L.; Smieliauskas, F. Rising prices of targeted oral anticancer medications and associated financial burden on medicare beneficiaries. J. Clin. Oncol. 2017, 35, 2482–2489.
[7]	Zhang, X.; Liu, S.; Liu, Y.; Du, J.; Fu, W.Q.; Zhao, X.W.; Huang, W.D.; Zhao, X.M.; Liu, G.X.; Mao, Z.Z.; Hu, T.W. Economic burden for lung cancer survivors in urban China. Int. J. Environ. Res. Public Heal. 2017, 14, 308.
[8]	Li, X.; Cai, H.; Wang, C.Y.; Guo, C.H.; He, Z.H.; Ke, Y. Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey. Trop. Med. Int. Heal. 2016, 21, 907–916.
[9]	Huang, H.Y.; Shi, J.F.; Guo, L.W.; Bai, Y.N.; Liao, X.Z.; Liu, G.X.; Mao, A.Y.; Ren, J.S.; Sun, X.J.; Zhu, X.Y.; Wang, L.; Song, B.B.; Du, L.B.; Zhu, L.; Gong, J.Y.; Zhou, Q.; Liu, Y.Q.; Cao, R.; Mai, L.; Lan, L.; Sun, X.H.; Ren, Y.; Zhou, J.Y.; Wang, Y.Z.; Qi, X.; Lou, P.A.; Shi, D.; Li, N.; Zhang, K.; He, J.; Dai, M. Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey. Chin. J. Cancer. 2017, 36, 41.
[10]	Shi, J.F.; Mao, A.Y.; Qiu, W.Q.; Guo, L.W.; Huang, H.Y.; Hu, G.Y.; Dong, P.; Bai, F.Z.; Yan, X.L.; Liao, X.Z.; Liu, G.X.; Bai, Y.N.; Ren, J.S.; Sun, X.J.; Zhu, X.Y.; Zhou, J.Y.; Gong, J.Y.; Zhu, L.; Mai, L.; Du, L.B.; Zhou, Q.; Xing, X.J.; Song, B.B.; Liu, Y.Q.; Lou, P.A.; Sun, X.H.; Wu, S.L.; Cao, R.; Qi, X.; Lan, L.; Ren, Y.; Zhang, K.; He, J.; Qu, C.F.; Dai, M. Medical expenditure for liver cancer in urban China: a 10-year multicenter retrospective survey (2002–2011). J. Cancer Res. Ther. 2018, 14, 163.
[11]	Ward, E.; Halpern, M.; Schrag, N.; Cokkinides, V.; DeSantis, C.; Bandi, P.; Siegel, R.; Stewart, A.; Jemal, A. Association of insurance with cancer care utilization and outcomes. CA Cancer J. Clin. 2008, 58, 9–31.
[12]	Lee, C.; Sun, H.; Guan, Q.; Wasserman, M. The effect of China’s basic medical insurance schemes on health service utilization. Value Heal. 2014, 17, A428.
[13]	Yörük, B.K. Health insurance coverage and health care utilization: Evidence from the Affordable Care Act’s dependent coverage mandate. Forum Heal. Econ. Policy. 2018, 21, 1–24.
[14]	Ministry of Human Resources and Social Security National Reimbursement Drug List (NRDL) (2009 Edition). http://www.gov.cn/gzdt/2009-11/30/content_1476934.htm (accessed September 23, 2019).
[15]	Guan, X.D.; Zhang, Y.C.; Wushouer, H.; Shi, L.W.; Ross-Degnan, D.; Wagner, A.K. Differences in reimbursement listing of anticancer therapies in China: an observational study. BMJ Open. 2020, 10, e031203.
[16]	Human Resources and Social Security Department Inclusion of expensive medicines by the catastrophic health insurance program in Zhejiang. http://www.zjhrss.gov.cn/art/2015/2/5/art_1442944_18305524.html (accessed September 23, 2019).
[17]	Wagner, A.K.; Soumerai, S.B.; Zhang, F.; Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J. Clin. Pharm. Ther. 2002, 27, 299–309.
[18]	Guan, X.D.; Tian, Y.; Ross-Degnan, D.; Man, C.X.; Shi, L.W. Interrupted time-series analysis of the impact of generic market entry of antineoplastic products in China. BMJ Open. 2018, 8, e022328.
[19]	WHO, New ATC codes 2019. WHO Collaborating Centre for Drug Statistics Methodology: 2019, Vol. 2019.
[20]	National Medical Products Administration, Collection of Drugs Marketed in China. National Medical Products Administration of the People’s Republic of China: 2019.
[21]	National Bureau of Staatistics, Time Series Data -- Annual Data: Exchange Rate. National Bureau of Staatistics of China: 2019.
[22]	National Bureau of Staatistics, Time Series Data -- Monthly Data: Consumer Price Index. National Bureau of Staatistics of China: 2019.
[23]	Durbin, J.; Watson, G.S. Testing for serial correlation in least squares regression. I. Biometrika. 1950, 37, 409–428.
[24]	Kutner, M.; Nachtsheim, C.; Neter, J. Applied Linear Regression Models (4th edn). Irwin/McGraw-Hill: Chicago: 2004.
[25]	Lewin, J.; Siu, L.L. Cancer genomics: the challenge of drug accessibility. Curr. Opin Oncol. 2015,27, 250–257.
[26]	Morgan, S.; Kennedy, J. Prescription drug accessibility and affordability in the United States and abroad. Issue Brief Commonw. Fund. 2010, 89, 1–12.
[27]	Hsu, J.C.; Wei, C.F.; Yang, S.C. Effects of removing reimbursement restrictions on targeted therapy accessibility for non-small cell lung cancer treatment in Taiwan: an interrupted time series study. BMJ Open. 2019, 9, e022293.
[28]	National Cancer Institute Targeted Cancer Therapies 2019. https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet (accessed September 23, 2019).
[29]	Sledge, G.W. Jr. What is targeted therapy? J. Clin. Oncol. 2005, 23, 1614–1615.
[30]	Gyawali, B.; Sullivan, R. Economics of cancer medicines: for whose benefit? New Bioeth. 2017, 23, 95–104.
[31]	Leukemia Experts in Chronic Myeloid. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood. 2013, 121, 4439–4442.
[32]	Diao, Y.F.; Qian, J.; Liu, Y.; Zhou, Y.P.; Wang, Y.; Ma, H.; Wang, X.Y.; Luo, R.; Wagner, A.; Sun, J.; Liu, Y.L. How government insurance coverage changed the utilization and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study. J. Glob. Heal. 2019, 9, 020702.
[33]	Massard da Fonseca, E.; Bastos, F.I.; Lopes, G. Increasing access to oral anticancer medicines in middle-income countries: a case study of private health insurance coverage in Brazil. J. Glob. Oncol. 2016, 2, 39–46.
[34]	Mihajlović, J.; Dolk, C.; Tolley, K.; Simoens, S.; Postma, M.J. Reimbursement of targeted cancer therapies within 3 different European health care systems. Clin. Ther. 2015, 37, 474–480.
[35]	Human Resource and Social Security Bureau Inclusion of expensive medicines by the catastrophic health insurance program in Hangzhou. http://hrss.hangzhou.gov.cn/art/2015/9/10/art_1587913_28276248.html (accessed September 23, 2019).
[36]	Hangzhou Government Statistical Communiqué of Hangzhou National Economy and Social Development in 2015. http://www.hangzhou.gov.cn/art/2016/3/24/art_805865_663727.html.
[37]	Hu, S., The Theory and practice of "Two-Invoice System" in the drug procurement. China Academic Journal Electronic Publishing House. 2017, 8–10.
[38]	Provincial Center for Drug & Medical Device Procurement Inclusion of medicines listed in catastrophic health insurance program by online procurement catalog. http://www.zjyxcg.cn/detail.html?infoId=1897&CatalogId=3 (accessed September 23, 2019).
[39]	Meng, Q.Y.; Mills, A.; Wang, L.D.; Han, Q. What can we learn from China’s health system reform? BMJ Clin. Res. Ed. 2019, 365, l2349.
[40]	China Charity Federation Iressa Means–Tested Drug Donation. http://www.iressaccf.org.cn/Index.aspx (accessed September 23, 2019).

中国浙江省级医保报销对于靶向抗肿瘤药使用的影响: 一项带对照的间断时间序列分析

The impact of the provincial reimbursement scheme on the use of targeted anticancer medications in Zhejiang, China: a controlled interrupted time-series analysis

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