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Cao Z, Wang L, Ma R, Hu Y, Bao B, Liu X, Li M, Wang X, Liu P, Li X. Access to essential and innovative anti-cancer medicines: a longitudinal study in Nanjing, China. BMC Health Serv Res 2024; 24:802. [PMID: 38992687 PMCID: PMC11242009 DOI: 10.1186/s12913-024-11285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE To evaluate the availability, cost, affordability of anti-cancer medicines in Nanjing, Jiangsu. METHODS A longitudinal tracking investigation study was performed to collect information about 24 essential anti-cancer medicines (EAMs) and 17 innovative anti-cancer medicines (IAMs) in 26 healthcare institutions in Nanjing from 2016 to 2020. The availability, cost, drug utilization and affordability of EAMs and IAMs were investigated. RESULTS The availability of EAMs showed no significant changes in Nanjing, but the availability of IAMs showed a significant increase in 2018 and 2019 and tended to stabilize in 2020. For EAMs, the DDDc(Defined Daily Dose cost) of LPGs (Lowest-Priced Generics) showed no significant changes, and the DDDc of OBs (Originator Brands) and IAMs significantly decreased. The DDDs(Defined Daily Doses) of EAMs (LPGs) showed a decreasing trend since 2016 and rose again in 2019. Overall, the DDDs of EAMs (LPGs) decreased by 25.18% between 2016 and 2020, but the proportion selected for clinical treatment remained at 67.35% in 2020. The DDDs of EAMs (OBs) and IAMs both showed an increasing trend year by year, with a proportional increase of 207.72% and 652.68%, respectively; but the proportion selected for clinical treatment was only 16.09% and 16.56% respectively in 2020. EAMs (LPGs) had good affordability for urban residents but poor affordability for rural residents; the affordability of EAMs (OBs) and IAMs was poor for both urban and rural residents. CONCLUSIONS There were no significant changes in the availability and cost of EAMs (LPGs), whose lower prices showed better affordability. Although their relative change in drug utilization showed a decreasing trend, they still dominated clinical treatment. Driven by the national drug price negotiation (NDPN) policy, the availability of IAMs was on the rise. It is necessary to further develop and strengthen policies for essential medicines procurement assessment to improve the accessibility of EAMs.
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Affiliation(s)
- Zhaoliu Cao
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
- Nanjing City Qixia District Hospital, Nanjing, Jiangsu, 210046, China
| | - Lili Wang
- Nanjing City Qixia District Hospital, Nanjing, Jiangsu, 210046, China
| | - Rui Ma
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Yun Hu
- Essential Medicine Division of Qixia District Health Commission of Nanjing City, Nanjing, Jiangsu, 210046, China
| | - Baiyi Bao
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Xiaohua Liu
- Department of Pharmacy, Jiangsu Province Hospital, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Mengyuan Li
- Department of Pharmacy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China
| | - Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Pingyu Liu
- Department of Pharmacy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China.
| | - Xin Li
- School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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Li W, Lu W, Chen H, Zhang C, Wang M, Zheng F, Wu HH, Wan GW, Yang Q, Ye L. Access to innovative anticancer medicines in China: a national survey on availability, price and affordability. BMJ Open 2024; 14:e077089. [PMID: 38670605 PMCID: PMC11057311 DOI: 10.1136/bmjopen-2023-077089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the availability, price, and affordability of nationally negotiated innovative anticancer medicines in China. DESIGN Retrospective observational study based on data from a nationwide medical database. DATA SOURCES/SETTING Quarterly data about the use of innovative anticancer medicines from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. This study covered 895 public general hospitals in 30 provincial administrative regions in China. Of the total hospitals, 299 (33.41%) were secondary and 596 (66.59%) were tertiary. MAIN OUTCOME MEASURES The adjusted WHO and Health Action International methodology was used to calculate the availability and affordability of 33 nationally negotiated innovative anticancer medicines in the investigated hospitals. Price is expressed as the defined daily dose cost. RESULTS On average, the total availability of 33 innovative anticancer medicines increased annually from 2020 to 2022. The median availability of all investigated medicines in tertiary hospitals from 2020 to 2022 was 24.04%, 33.60% and 37.61%, respectively, while the indicators in secondary hospitals were 4.90%, 12.54% and 16.48%, respectively. The adjusted prices of the medicines newly put in Medicare (in March 2021) decreased noticeably, with the decline rate ranging from 39.98% to 82.45% in 2021 compared with those in 2020. Most generic brands were priced much lower than the originator brands. The affordability of anticancer medicines has improved year by year from 2020 to 2022. In comparison, rural residents had lower affordability than urban residents. CONCLUSIONS The overall accessibility of 33 nationally negotiated innovative anticancer medicines improved from 2020 to 2022. However, the overall availability of most anticancer medicines in China remained at a low level (less than 50%). Further efforts should be made to sufficiently and equally benefit patients with cancer.
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Affiliation(s)
- Wei Li
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Lu
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Hongdou Chen
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Chi Zhang
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Menglei Wang
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Fangfang Zheng
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Huan-Huan Wu
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Guang-Wen Wan
- Department of Pharmacy, Suqian Hospital of Traditional Chinese Medicine, Suqian, Jiangsu, China
| | - Qingqing Yang
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Lu Ye
- Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
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Yu Y, Zhong M, Quan C, Ma C. Treatment access and satisfaction on disease-modifying therapies of neuromyelitis optica spectrum disorder patients in China: a cross-sectional survey. Ther Adv Neurol Disord 2024; 17:17562864241239105. [PMID: 38525489 PMCID: PMC10960978 DOI: 10.1177/17562864241239105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare and debilitating disease that has become more widely recognized in China. Legislative measures have been implemented by the government to improve treatment access for rare diseases. Objectives To investigate the diagnostic journey, treatment status, treatment accessibility, and treatment satisfaction of the NMOSD patients on disease-modifying therapies (DMTs) in China. Design A patient online survey. Methods This cross-sectional online survey was conducted between November 2022 and January 2023. Patients over 18 years old and diagnosed with NMOSD were included. The questionnaire consisted of five sections covering demographics, diagnostic and treatment experiences, DMTs availability, cost and affordability, and treatment satisfaction using the Treatment Satisfaction Questionnaire for Medication (version II). Patient opinions and demands were also collected at the end of the survey. Results A total of 375 patients diagnosed with NMOSD were recruited, of which 321 patients used DMTs. It required 1.22 ± 3.22 years and 3.58 ± 4.24 hospital visits for a definitive diagnosis. One-third of the patients still needed to travel for over 2 h to access DMTs. The total treatment expenditure was estimated to be CNY 59,827.00 (USD 8315.95) a year. Drug expenses alone accounted for 52.22% of the average annual household income. The most common challenges perceived were the inability to afford treatment and a lack of effective options. No significant difference was found in treatment satisfaction among DMTs, except that rituximab scored lowest in convenience compared to other DMTs. Patients' age and travel time required to obtain medications were negatively associated with global treatment satisfaction. Conclusion In China, patients with NMOSD face challenges in obtaining proper treatment due to diagnostic difficulties, distant medication access, and high costs. Policies should prioritize improving disease education and alleviating financial burdens for the patients.
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Affiliation(s)
- Yue Yu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingkang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, National Center for Neurological Disorders, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunlai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
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Zhao Z, Pei Z, Hu A, Zhang Y, Chen J. Analysis of Incentive Policies and Initiatives on Orphan Drug Development in China: Challenges, Reforms and Implications. Orphanet J Rare Dis 2023; 18:220. [PMID: 37501126 PMCID: PMC10375655 DOI: 10.1186/s13023-023-02684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/02/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Rare diseases are a global public health issue with a more pressing situation in China. Unfortunately, the relevant research and development in this country are still in its infancy, leading to limited drug accessibility. In view of this, the Chinese government has taken a series of countermeasures to promote orphan drug R&D in recent years, which has presented encouraging results. This paper aims to review incentive policies and funding initiatives formulated by the Chinese government and examine their implications on orphan drug R&D. METHODS Policies targeting orphan drug R&D during 2012-2022 were retrieved from the relevant official websites, categorized into different themes and analyzed for the contents. Data on government funding, drug approval, clinical trial approval and orphan drug designation were collected through internet search to analyze the implications of those incentive policies and initiatives on orphan drug R&D in China. RESULTS A total of 20 relevant policy documents were identified and five major themes were revealed through content analysis, including national strategy, expedited approval, safety and efficacy requirements, data protection and technical support. The government input in orphan drug R&D has witnessed a steady annual increase. Driven by those incentives, the numbers of orphan drugs approved for marketing and drug candidates entering clinical studies are increasing year by year, and more domestic pharmaceutical companies are actively involved in the R&D of orphan drugs. CONCLUSIONS Orphan drug development in China is growing rapidly under the stimulation of incentive regulatory policies and more investment in researches. China is working toward a more standardized and comprehensive rare disease ecosystem. However, there are still some challenges, such as the lack of sufficient financial support and the call for systematic legislation on rare diseases, to be addressed for future success.
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Affiliation(s)
- Zhiyao Zhao
- School of Foreign Languages, China Pharmaceutical University, Nanjing, China
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Zhongyang Pei
- School of Management, Shanxi Medical University, Taiyuan, China
- School of Health Services and Management, Shanxi University of Chinese Medicine, Taiyuan, China
| | - Anxia Hu
- School of Management, Shanxi Medical University, Taiyuan, China
- School of Health Services and Management, Shanxi University of Chinese Medicine, Taiyuan, China
| | - Yuhui Zhang
- School of Foreign Languages, China Pharmaceutical University, Nanjing, China.
| | - Jing Chen
- School of Foreign Languages, China Pharmaceutical University, Nanjing, China.
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Liu J, Yu Y, Zhong M, Ma C, Shao R. Long way to go: Progress of orphan drug accessibility in China from 2017 to 2022. Front Pharmacol 2023; 14:1138996. [PMID: 36969835 PMCID: PMC10031016 DOI: 10.3389/fphar.2023.1138996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction: Over 400 million patients worldwide suffer from rare diseases. Access to orphan drugs is, therefore, crucial for this population. China has been actively working on improving orphan drug accessibility in the past decades, especially since 2018 when the First National List of Rare Diseases was announced. This study aimed to evaluate the current status of orphan drug accessibility in China regarding availability, daily cost, and affordability.Methods: Market availability of orphan drugs in China was based on their approval status in China up to May 2022. Information on drug availability in hospitals and the cost of each drug from 2017 to 2021 was obtained from the database of the Science and Technology Development Center of the Chinese Pharmaceutical Association. Affordability was assessed by comparing the disposable daily income per capita to the cost of the defined daily dose of each drug.Results: Market availability rate was 44.3% by May 2022, and the average delay in drug approval in China compared to its orphan approval in the United States of America was 5.9 ± 6.07 years. Drug availability in hospitals showed an upward trend, with availability in tertiary hospitals significantly higher than in secondary hospitals (~20%, p <0.0001). The eastern area was significantly higher in availability from 2019 onwards. Fifty-eight percent of the orphan drugs were still considered to have very low availability (<30%). The national median cost of the defined daily dose across all available orphan drugs had increased to 254.97 RMB in 2021. Only 34.98% of the orphan drugs were considered affordable when compared with the national average disposable daily income in 2021, and drug affordability decreased during the past 5 years.Discussion: Changes in orphan drug regulations in China have enabled progress regarding the drugs’ market availability, but the current status of drug availability at hospitals, drug cost, and affordability were not optimal. Legislation for encouraging domestic drug development and novel payment schemes for high-value drugs are essential to further improve the availability and cost burden of orphan drugs in China
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Affiliation(s)
- Jia Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yue Yu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingkang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunlai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Chunlai Ma, ; Rong Shao,
| | - Rong Shao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- *Correspondence: Chunlai Ma, ; Rong Shao,
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Liu X, Chen H, Zhong Y, Lee TY, Han W, Yu D, Liu H, Ji J. Diet therapy in patients with rare diseases: a scoping review. J Hum Nutr Diet 2022; 36:742-753. [PMID: 36448617 DOI: 10.1111/jhn.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND This scoping review presents existing research evidence regarding diet therapy in patients with rare diseases (RDs). METHODS Using the five-stage scoping review framework proposed by Arksey, O'Malley and Levac, we searched the published literature in PubMed, Web of Science, Royal Society of Chemistry, China National Knowledge Infrastructure, VIP Database and Wan Fang Database from January 2010 to November 2022. We selected diet therapy studies on 121 RDs, as categorised by the National Health Commission of China in 2018. Charts for research analysis were developed and used to categorise the data. RESULTS We ultimately included 34 diet therapy studies from 19 countries and territories for 10 RDs and 3 RD groups. RD diet therapy studies have mainly focused on inborn errors of metabolism (92.3%) and are common in Western countries. Most studies focused on diet therapy methods for RDs (44%). In addition, 29% of studies included diet therapy management, 15% included guidelines for diet therapy and 12% included the impact of diet therapy on patients. CONCLUSIONS Current diet therapies for RDs lack specificity and present with limited characteristics. Therefore, it is necessary to expand the scope and depth of future research and explore evidence-based recommendations and new diet therapies focused on patient needs and family support to provide a reference for improving the efficacy and safety of diet therapies for RDs.
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Affiliation(s)
- Xuehua Liu
- College of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Huifang Chen
- College of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yaping Zhong
- College of Nursing and Midwifery, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Tsorng-Yeh Lee
- College of Nursing, York University, Toronto, Ontario, Canada
| | - Wenxuan Han
- College of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Dafang Yu
- Department of Nursing, Jinan Maternal and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Huaxia Liu
- College of Nursing, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ji Ji
- College of Nursing, Guangzhou Medical University, Guangzhou, China.,Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Mu Y, Song K, Song Y. A Cross-Sectional Study of Price and Affordability of Drugs for Rare Diseases in Shandong Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13319. [PMID: 36293897 PMCID: PMC9602851 DOI: 10.3390/ijerph192013319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The affordability of rare disease drugs has become a social issue that cannot be ignored. This study aims to evaluate the current price and affordability of rare disease drugs in China, with evidence from Shandong province. METHODS Data on prices and affordability of 50 drugs for 22 rare diseases were collected from secondary and tertiary public hospitals in Shandong Province, using an adaptation of the World Health Organization/Health Action International (WHO/HAI) methodology. Prices were measured as Median Price Ratios (MPRs). Affordability was measured as days of daily per capita disposable income required for the cost of one month's treatment. RESULTS Out of the 50 rare disease drugs, 11 drugs had MSH reference prices and 34 had PBS reference prices. Median prices of 11 drugs were higher than MSH reference prices (median 1.33), and median prices of 34 drugs were higher that Australian PBS prices (median 1.97). Thirty-six (72.00%) and forty-four (88.00%) drugs were unaffordable for urban and rural residents, respectively. Thirty-four (68.00%) and thirty-eight (76.00%) drugs were unaffordable for urban and rural residents even after reimbursement by the health insurance schemes of China, respectively. CONCLUSIONS The affordability of some rare disease drugs remained poor with their relatively high prices in Shandong Province. Sustainable mechanisms are needed to reduce the price of rare disease drugs and to improve the affordability of rare disease patients.
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Affiliation(s)
- Yan Mu
- School of Healthcare Security, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China
- Shandong Institute of Medicine and Health Information, Jinan 250117, China
| | - Kuimeng Song
- School of Healthcare Security, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China
- Shandong Institute of Medicine and Health Information, Jinan 250117, China
| | - Yan Song
- School of Healthcare Security, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China
- Shandong Institute of Medicine and Health Information, Jinan 250117, China
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Qiao L, Liu X, Shang J, Zuo W, Xu T, Qu J, Jiang J, Zhang B, Zhang S. Evaluating the national system for rare diseases in China from the point of drug access: progress and challenges. Orphanet J Rare Dis 2022; 17:352. [PMID: 36088349 PMCID: PMC9463840 DOI: 10.1186/s13023-022-02507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are about 7000 rare diseases worldwide, of which only 5% of the diseases can be treated with medicines, showing that it’s important to improve patient access to orphan drugs. Recently, China has actively worked to set up a national system for rare diseases to improve the diagnosis and treatment capabilities and ensure the accessibility of drugs. However, the benefits of the system have yet not to be measured. This study aimed to provide an overview of orphan drug access based on the Compendium of China’s First List of Rare Diseases and National Network to Collaborate on Diagnosis and Treatment of Rare Diseases, expecting to map a blueprint for orphan drug access in China. Methods Framework of China’s national system for rare diseases was summarized. We surveyed the availability and affordability of 79 approved orphan drugs based on the Compendium of China’s First List of Rare Diseases in 30 leading provincial institutions from 2017 to 2020. The availability was measured annually at 3 levels (market, hospital and drug), and affordability was reflected by comparing costs of daily defined dose with per capita income of urban and rural residents, with the National Basic Medical Insurance considered. Results The market availability of orphan drugs in China showed an upward trend. As of 2020, the median hospital-level availability was 41.1% (increased by 1.5 times), highly available drugs increased by 16.5%. There were 64/74 orphan drugs that were affordable to rural/urban residents with the National Basic Medical Insurance considered (an increase of 14.1%), and the urban–rural gap of affordability ratio was narrowed (down by 6.0%). Comprehensive analysis showed the proportions of drugs with better availability and affordability in urban and rural areas by 2020 were 39.4% and 32.3%, respectively, which had increased but were still at a low level. Conclusions China’s national system for rare diseases has made great progress in orphan drug access, indicating that it’s been functioning under the joint reformation of medical treatment, medical insurance and medicines supply. The list of rare diseases will be updated and collaboration in networks will be enhanced to further improve the system. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02507-2.
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Zhu H, Zhu J, Zhou Y, Shan L, Li C, Cui Y, Kang Z, Jiao M, Liu H, Gao L, Wu Q, Hao Y. Impact of the National Reimbursement Drug List Negotiation Policy on Accessibility of Anticancer Drugs in China: An Interrupted Time Series Study. Front Public Health 2022; 10:921093. [PMID: 35844892 PMCID: PMC9283976 DOI: 10.3389/fpubh.2022.921093] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveSince 2016, the Chinese government has been regularly implementing the National Reimbursement Drug List Negotiation (NRDLN) to improve the accessibility of drugs. In the second round of NRDLN in July 2017, 18 anticancer drugs were included. This study analyzed the impact of the NRDLN on the accessibility of these 18 anticancer drugs in China.MethodsNational hospital procurement data were collected from 2015 to 2019. As measurements of drug accessibility, monthly average of drug availability or defined daily dose cost (DDDc) was calculated. Interrupted time series (ITS) analysis was employed to evaluate the impact of NRDLN on drug accessibility. Multilevel growth curve models were estimated for different drug categories, regions or levels of hospitals.ResultsThe overall availability of 18 anticancer drugs increased from about 10.5% in 2015 to slightly over 30% in 2019. The average DDDc dropped from 527.93 CNY in 2015 to 401.87 CNY in 2019, with a reduction of 23.88%. The implementation of NRDLN was associated with higher availability and lower costs for all 18 anticancer drugs. We found an increasing level in monthly drug availability (β2 = 2.1126), which ascended more sharply after the implementation of NRDLN (β3 = 0.3656). There was a decreasing level in DDDc before July 2017 (β2 = −108.7213), together with a significant decline in the slope associated with the implementation of NRDLN (β3 = −4.8332). Compared to Traditional Chinese Medicines, the availability of Western Medicines was higher and increased at a higher rate (β3 = 0.4165 vs. 0.1108). Drug availability experienced a larger instant and slope increase in western China compared to other regions, and in secondary hospitals than tertiary hospitals. Nevertheless, regional and hospital-level difference in the effect of NRDLN on DDDc were less evident.ConclusionThe implementation of NRDLN improves the availability and reduces the cost of some anticancer drugs in China. It contributes to promoting accessibility of anticancer drugs, as well as relieving regional or hospital-level disparities. However, there are still challenges to benefit more patients sufficiently and equally. It requires more policy efforts and collaborative policy combination.
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Affiliation(s)
- Hong Zhu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Department of Pharmacy Administration, Humanities and Social Science College, Harbin Medical University, Harbin, China
| | - Jingmin Zhu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Yingyu Zhou
- Science and Technology Development Center, Chinese Pharmaceutical Association, Beijing, China
| | - Linghan Shan
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Cui Li
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Department of Medical Procurement, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yu Cui
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Huan Liu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Qunhong Wu
| | - Yanhua Hao
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Yanhua Hao
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Zheng A, Zhu Y, Wang Y, Liu F, Jin F, Zang S, Wang X. Assessment of Medical Expenditure for Patients With Breast Cancer in China: Evidence From Current Curative Expenditure by System of Health Accounts 2011. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:77-83. [PMID: 35031102 DOI: 10.1016/j.jval.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The incidence and mortality of breast cancer have been increasing in China and bring heavy economic burdens to patients, families, and society. This study aimed to analyze the structure and influencing factors of inpatient expenditures of patients with breast cancer and put forward suggestions for insurance management. METHODS A multistage stratified random sampling method was used to investigate 379 medical institutions and 7366 pieces of inpatient records of patients with breast cancer in Dalian in 2018. Under the framework of "System of Health Accounts 2011," the current curative expenditure (CCE) and its distribution were calculated. The relationships between hospitalization expenditure and factors were analyzed by multiple stepwise regression and structural equation modeling. RESULTS The CCE of patients with breast cancer in Dalian in 2018 was ¥273.38 million, accounting for 10.66% of the total expenditure on cancer. The majority of the CCE flowed to large general hospitals. The CCE was concentrated in patients aged 40 to 69 years (23.46%). The hospitalization expenditure correlated positively with length of stay, surgery, and drug expenses (rs = 0.586-0.754, P < .01) and negatively associated with age (rs = -0.074, P < .01). The length of stay mediated the relationship between surgery and hospitalization expenses for patients with breast cancer. The factors that affected the hospitalization expenditure were the drug expenses, surgery, length of stay, insurance status, and institution level. CONCLUSIONS The cost control for CCE of breast cancer inpatient treatment is crucial in China. Promoting hierarchical diagnosis and treatment, reducing the length of stay, and improving medical insurance depth would be effective measures to reduce the financial burden of patients.
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Affiliation(s)
- Ang Zheng
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yalan Zhu
- College of Health Management, China Medical University, Research Center for Health Development - Liaoning New Type Think Tank for University, Shenyang, China
| | - Yuhang Wang
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fang Liu
- School of Public Health, China Medical University, Shenyang, China
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuang Zang
- School of Nursing, China Medical University, Shenyang, China
| | - Xin Wang
- College of Health Management, China Medical University, Research Center for Health Development - Liaoning New Type Think Tank for University, Shenyang, China.
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11
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Qi X, Xu J, Shan L, Li Y, Cui Y, Liu H, Wang K, Gao L, Kang Z, Wu Q. Economic burden and health related quality of life of ultra-rare Gaucher disease in China. Orphanet J Rare Dis 2021; 16:358. [PMID: 34380529 PMCID: PMC8356434 DOI: 10.1186/s13023-021-01963-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study described the health care service utilization through participants’ perspective and estimated the cost of illness (COI), and patients with Gaucher disease (GD)’s/caregivers’ health-related quality of life in China. Method An online retrospective survey of patients with GD and their caregivers was conducted during May–June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual COI, including direct healthcare, direct non-healthcare, and indirect costs. Results Forty patients and their 49 caregivers were surveyed. The patients’ onset age of GD was 9.3 ± 10.9; their disease course was 3.5 ± 3.1 years. 21 (42.9%) patients had ≥ 2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9 ± 3.1 (max = 20) hospitals and took 1.2 ± 1.7 (max = 6.6) years for confirmed diagnosis. On average, 5.0 ± 9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8 ± 9.1 times/annually), and 37 (77.5%) received inpatient service (4.0 ± 3.5 times/annually). Annual per-patient COI was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct healthcare cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6 ± 19.6). Both patients/caregivers reported lower social support (32.4 ± 7.4, 34.9 ± 7.6), two times higher PSQI (7.9 ± 2.9, 8.7 ± 3.6), and half lower SF-36 (41.3 ± 18.6, 46.5 ± 19.3) than those reported for healthy Chinese individuals. Conclusions The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01963-6.
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Affiliation(s)
- Xinye Qi
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiao Xu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Linghan Shan
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ye Li
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Cui
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Huan Liu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Kexin Wang
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lijun Gao
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qunhong Wu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China. .,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China.
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12
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Zimmermann BM, Eichinger J, Baumgartner MR. A systematic review of moral reasons on orphan drug reimbursement. Orphanet J Rare Dis 2021; 16:292. [PMID: 34193232 PMCID: PMC8247078 DOI: 10.1186/s13023-021-01925-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective. RESULTS With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status. CONCLUSION Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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13
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Zhu Y, Xu X, Fang W, Wang Y, Dai H, Li X. Availability, cost and affordability of selected antibiotics and antiviral medicines against infectious diseases from 2013 to 2019 in Nanjing, China. Trop Med Int Health 2021; 26:518-529. [PMID: 33539605 DOI: 10.1111/tmi.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES As economic globalisation develops in-depth, infectious diseases that occur in a country or region no longer remains a regional issue. Antibiotics and antiviral medicines are essential medicines for the therapy of infectious diseases. This study aims to evaluate their availability, cost and affordability of AaAMs against infectious diseases in 41 public hospitals from 2013 to 2019 in Nanjing, China. METHODS Data on the availability and price of 17 antibiotics and 6 antiviral medicines in 41 public hospitals were obtained from the Jiangsu Institute of Medicine Information. We adopted the WHO/Health Action International method to measure the availability, cost and affordability of these medicines. RESULTS The availability of selected medicines against infectious diseases was relatively low; the median availability of originator brands was near-zero and that of lowest-priced generics during the survey period less than 50%. The total availability of medicines was poor in primary hospitals as compared to secondary and tertiary hospitals. The median daily-defined dose cost of originator brands was expensive (range from 66.11 RMB to 107.83 RMB), whereas that of lowest price generics was fairly acceptable at < 8 RMB. The affordability of most surveyed medicines was reasonable, which showed significant improvement over time, but the daily cost of a few medicines for originator brands exceeded the average daily wage. CONCLUSIONS In general, the affordability of medicines surveyed was acceptable, while the availability was too low. There should be a great concern for improving the reserve system of anti-infective medicines in healthcare institutions. Policy should focus on improving the availability of generic drugs in hospitals and encouraging preferentially prescribed.
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Affiliation(s)
- Yulei Zhu
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xinglu Xu
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Wenqing Fang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Ying Wang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Huizhen Dai
- Jiangsu Institute of Medicine Information, Nanjing, China
| | - Xin Li
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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14
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Choudhury MC, Saberwal G. The work, goals, challenges, achievements, and recommendations of orphan medicinal product organizations in India: an interview-based study. Orphanet J Rare Dis 2019; 14:241. [PMID: 31684990 PMCID: PMC6829914 DOI: 10.1186/s13023-019-1224-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Orphan medicinal products (OMPs) are intended for the diagnosis, prevention, management or treatment of rare diseases (RDs). Each RD affects only a small fraction of the population, and therefore, historically, industry hesitated to undertake relevant research and development (R&D). In response, the governments of many countries came up with orphan drug policies and RD policies which were hugely successful in incentivizing companies to do so. In India, in the absence of any such policy until recently, there are very few organizations involved in RD R&D. OBJECTIVES We wished to understand (i) the OMP Organizations' (OMPOs') areas of work and the nature of their work, (ii) their goals, (iii) the challenges they faced and how they were overcoming them, (iv) their achievements, and (v) their recommendations to the government to help their R&D, their success as commercial entities (where applicable), and patients' access to their products or services. RESULTS Ten of the 14 OMPOs are companies, whereas four are not-for-profit organizations. Almost all of the OMPOs are heavily into R&D. Six have already made their products or services available to patients. Four plan to out-license their products after the pre-clinical phase or phase 1 trials, eight plan to cater to patients directly and two of the OMPOs have been established only recently and thus do not yet have any product or service to offer patients. Nine OMPOs import about 90% of the components in the production process, which comprises either capital or recurrent expenditure. For most, locally manufactured alternatives are not available or are of inadequate quality. Most of the OMPOs have had productive collaborations with local or foreign academics or hospitals for R&D, animal efficacy studies, clinical trials or providing services to patients. The main challenges for the OMPOs are the lack of adequate funding, supportive government policies, and a conducive ecosystem. CONCLUSIONS These OMPOs are pioneers in their respective fields in India, and despite the challenges, have achieved new levels of innovation. With suitable government policies, they could scale up and provide relevant products and services to the large number of RD patients in the country whose medical needs are largely unmet.
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Affiliation(s)
- Mohua Chakraborty Choudhury
- Institute of Bioinformatics and Applied Biotechnology, Biotech Park, Electronics City Phase 1, Bengaluru, Karnataka, 560100, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Biotech Park, Electronics City Phase 1, Bengaluru, Karnataka, 560100, India.
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15
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Analysis of economic burden and its associated factors of twenty-three rare diseases in Shanghai. Orphanet J Rare Dis 2019; 14:233. [PMID: 31640704 PMCID: PMC6806581 DOI: 10.1186/s13023-019-1168-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background It is estimated that at present there are over 10 million rare disease patients in China. Recently an increased focus from policy perspective has been placed on rare diseases management. Improved disease definitions and the releases of local and national rare disease lists are some of the steps taken already. Despite these developments, few Chinese rare disease-related epidemiology and economic studies exist, thus hindering assessment of the true burden of rare diseases. For a rare disease with an effective treatment, this is a particularly important aspect due to the often-high cost associated. Objective The goal of this study is to address the data scarcity on the subject of rare diseases economic impact in China. We aim to address an existing knowledge gap and to provide a timely analysis of the economic burden of 23 rare diseases in Shanghai, China. Methods We utilized the data from the Health Information Exchange system of Shanghai and employed statistical modeling to analyze the economic burden of rare diseases with an effective treatment in Shanghai. Results First, we described the actual direct medical expenditure and analyzed its associated factors. Second, we found age, disease type, number of complications, and payment type were significantly associated with rare disease medical direct costs. Third, a generalized linear model was employed to estimate the annual direct cost. The mean direct medical cost was estimated as ¥9588 (US$1521) for inpatients and ¥1060 (US$168) for outpatients, and was over ¥15 million (~US$2.4 million) per year overall. Conclusion Our study is one of the first quantifying the economic burden of an extensive set of rare diseases in Shanghai and China. Our results can serve to inform healthcare-focused policy making, contribute to the increase of public awareness, and incentivize development of rare-disease strategies and treatments specific to the Chinese context. Electronic supplementary material The online version of this article (10.1186/s13023-019-1168-4) contains supplementary material, which is available to authorized users.
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16
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Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193728. [PMID: 31623326 PMCID: PMC6801951 DOI: 10.3390/ijerph16193728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 01/15/2023]
Abstract
Objectives: With the increasing incidence of cancer, poor access to affordable anticancer medicines has been a serious public health problem in China. To help address this issue, we assessed the availability, price and affordability of pharmacotherapy for cancer in public hospitals in the Jiangsu Province, China. Methods: In 2012 and 2016, anticancer medicine availability and price information in the capital and five other cities was collected. A total of six cancer care hospitals, 26 tertiary general hospitals and 28 secondary general hospitals were sampled, using an adaptation of the World Health Organization/Health Action International methodology. Data was collected for the anticancer medicines in stock at the time of the surveys. Prices were expressed as inflation-adjusted median unit prices (MUPs). Medicine was affordable if the overall cost of all the prescribed anticancer medicines was less than 20% of the household’s capacity to pay. We used generalized estimating equations to estimate the significance of differences in availability from 2012 to 2016 and the Wilcoxon rank test to estimate the significance of differences in MUPs. Multivariate logistic regression was computed to measure predictors of affordability. Results: From 2012 to 2016 there was a significant decrease in the mean availability of originator brands (OBs) (from 7.79% to 5.71%, p = 0.012) and lowest-priced generics (LPGs) (36.29% to 32.67%, p = 0.009). The mean availability of anticancer medicines in secondary general hospitals was significantly lower than the cancer care, as well as in tertiary general hospitals. The MUPs of OBs (difference: −21.29%, p < 0.01) and their LPGs (−22.63%, p < 0.01) decreased significantly from 2012 to 2016. The OBs (16.67%) of all the anticancer medicines were found to be less affordable than LPGs (34.62% for urban residents and 30.77% for rural residents); their affordability varied among the different income regions. From 2012 to 2016, the proportion of LPGs with low availability and low affordability dropped from 30.77% to 19.23% in urban areas and 34.62% to 26.92% in rural areas, respectively. Generic substitution and medicine covered by basic medical insurance are factors facilitating affordability. Conclusion: There were concerning decreases in the availability of anticancer medicines in 2016 from already low availability in 2012. Anticancer medicines were more affordable for the patients in high-income regions than the patients in low-income regions. Governments should consider using their bargaining power to reduce procurement prices and abolish taxes on anticancer medicines. Policy should focus on the special health insurance plan for low-income patients with cancer. The goal of drug policy should ensure that first-line generic drugs are available for cancer patients and preferentially prescribed.
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