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Yu W, Chen J, Fan L, Yan C, Zhu L. Cost-Effectiveness of Laparoscopic Sleeve Gastrectomy for Chinese Patients. Obes Surg 2024; 34:2828-2834. [PMID: 38981958 PMCID: PMC11289027 DOI: 10.1007/s11695-024-07330-1] [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: 04/11/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery procedure in China. However, its cost-effectiveness in Chinese patients is currently unknown. OBJECTIVES This study aims to assess the cost-effectiveness of LSG vs no surgery in Chinese patients with severe and complex obesity, taking into account both healthcare expenses and the potential improvement in health-related quality of life (HRQoL). METHODS A retrospective cohort study was conducted, encompassing 135 Chinese patients who underwent LSG between January 3, 2022 and December 29, 2022, at a major bariatric center. The study evaluated the cost-effectiveness from a healthcare service perspective, employing the incremental cost-effectiveness ratio (ICER) for quality-adjusted life years (QALYs) gained. The analyses compared LSG with the alternative of not undergoing surgery over a 1-year period, using actual data, and extended to a lifetime horizon by projecting costs and utilities at an annual discount rate of 3.0%. Subgroup analyses were undertaken to explore cost-effectiveness variations across different sex, age and BMI categories, and diabetes status, employing a one-way analysis of variance (ANOVA). To ensure the reliability of the findings, one-way and probabilistic sensitivity analyses were executed. RESULTS The results indicated that 1-year post-LSG, patients achieved an average total weight loss (TWL) of (32.7 ± 7.3)% and an excess weight loss (EWL) of (97.8 ± 23.1)%. The ICER for LSG compared to no surgery over a lifetime was $4,327/QALY, significantly below the willingness-to-pay (WTP) threshold for Chinese patients with severe and complex obesity. From a lifetime perspective, LSG proved to be cost-effective for all sex and age groups, across all BMI categories, and for both patients with and without diabetes. Notably, it was more cost-effective for younger patients, patients with higher BMI, and patients with diabetes. CONCLUSIONS LSG is a highly cost-effective intervention for managing obesity in Chinese patients, delivering substantial benefits in terms of HRQoL improvement at a low cost. Its cost-effectiveness is particularly pronounced among younger individuals, those with higher BMI, and patients with diabetes.
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Affiliation(s)
- Weihua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jionghuang Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Luqi Fan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenli Yan
- School of Business Administration, Capital University of Economics Business, Beijing, China
| | - Linghua Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Zhang X, Fan X, Zhang J, Jiang F, Wu Y, Yang B, Li X, Liu D. Cost-effectiveness analysis of the tislelizumab versus docetaxel for advanced or metastatic non-small-cell lung cancer in China. Front Public Health 2024; 12:1425734. [PMID: 39091529 PMCID: PMC11291238 DOI: 10.3389/fpubh.2024.1425734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Background Tislelizumab is the first PD-1 inhibitor in China to demonstrate superior efficacy in second-line or third-line treatment of patients with advanced or metastatic non-small-cell lung cancer (NSCLC). This study aimed to evaluate the cost-effectiveness of tislelizumab compared to docetaxel from a Chinese healthcare system perspective. Methods A dynamic Markov model was developed to evaluate the cost-effectiveness of tislelizumab in comparison to docetaxel in second or third-line treatment. The efficacy data utilized in the model were derived from the RATIONALE-303 clinical trial, while cost and utility values were obtained from the drug data service platform and published studies. The primary outcomes of the model encompassed quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to validate the robustness of the base case analysis results. Results The tislelizumab group demonstrated a cost increase of CNY 117,473 and a gain of 0.58 QALYs compared to the docetaxel group, resulting in an ICER value of CNY 202,927 per QALY gained. Conclusion The administration of tislelizumab in patients with advanced or metastatic NSCLC not only extends the progression-free survival (PFS) and overall survival (OS). Moreover, this treatment demonstrates a favorable cost-effectiveness profile across the Chinese population.
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Affiliation(s)
- Xiaoyu Zhang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Xiongxiong Fan
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Jin Zhang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
- Department of Pharmacy, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Fengli Jiang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
- Department of Pharmacy, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yiping Wu
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Beibei Yang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Xinghuan Li
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Dong Liu
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji, Shaanxi, China
- Department of Pharmacy, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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Wang Z, Wang K, Hua Y, Dong X, Zhang L. Impact and implications of national centralized drug procurement in China. Int J Clin Pharm 2024:10.1007/s11096-024-01767-1. [PMID: 38990456 DOI: 10.1007/s11096-024-01767-1] [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: 04/25/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
The national centralized drug procurement (NCDP) policy, known as the "4 + 7" policy in China, has transformed pharmaceutical procurement and access by leveraging healthcare institutions' collective buying power to reduce drug prices substantially. This policy has profoundly impacted drug pricing mechanisms, healthcare expenditures, market dynamics, and the quality of available drugs. This commentary evaluates the efficacy, challenges, and broader implications of the NCDP, summarizes the current state of post-marketing monitoring of selected generic drugs for centralized procurement, and presents relevant considerations.
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Affiliation(s)
- Zhizhou Wang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Ke Wang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yiming Hua
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xianzhe Dong
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital, The First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
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Lu S, Liu X, Huang Z, Zhou Z, Feng Z. Administrative regulation-informed analysis of the developmental path of national volume-based procurement to improve drug accessibility in China. Front Public Health 2024; 12:1342632. [PMID: 39050613 PMCID: PMC11266034 DOI: 10.3389/fpubh.2024.1342632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction The procurement of medicines via China's national volume-based procurement (NVBP) necessitates collaboration among various entities. This paper highlights the legal significance of the engagement of pharmaceutical companies, hospitals, and the National Healthcare Security Administration (NHSA) in improving drug accessibility. Methods We conducted a numerical simulation using MATLAB to develop an evolutionary game model involving these three participants in NVBP. Results Our findings indicate that the final evolutionary stabilization strategies are pharmaceutical companies actively participating, hospitals using bid-winning medicines, and the NHSA implementing a low-intensity intervention. The study reveals that the evolutionary outcomes for hospitals and pharmaceutical companies are significantly affected by factors such as NHSA's subsidy level and pharmaceutical companies' level of participation. However, NHSA's decision-making process is less influenced by these factors. Discussion From a legal perspective, the successful implementation of NVBP, ensuring fairness and legality, requires adherence to relevant policies and regulations. The NHSA should employ statutory incentives and regulatory methods in formulating and adjusting NVBP policy to enable pharmaceutical companies, hospitals, and the NHSA to exercise their rights rationally within the legal framework of the game process.
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Affiliation(s)
- Songxin Lu
- School of Economic, Shenzhen Polytechnic University, Shenzhen, China
| | - Xiangdong Liu
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, China
| | - Zhengzong Huang
- College of Humanities and Social Sciences, Shenzhen Technology University, Shenzhen, China
| | - Zhiheng Zhou
- Pingshan Hospital, Southern Medical University, Shenzhen, China
| | - Zehua Feng
- School of Law, Guangdong University of Technology, Guangzhou, China
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Tian S, Zhong H, Yin M, Jiang P, Liu Q. A China-Based Cost-Effectiveness Analysis of Novel Oral Anticoagulants versus Warfarin in Patients with Left Ventricular Thrombosis. Risk Manag Healthc Policy 2024; 17:945-953. [PMID: 38633670 PMCID: PMC11022874 DOI: 10.2147/rmhp.s454463] [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: 01/08/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose This study aims to conduct a comprehensive cost-effectiveness comparison between novel oral anticoagulants (NOACs) and warfarin in Chinese patients with left ventricular thrombosis (LVT). By incorporating the impact of volume-based procurement (VBP) policy for pharmaceuticals in China, this analysis intends to provide crucial insights for informed healthcare decision-making. Patients and Methods A Markov model was employed to simulate the disease progression of LVT over a 54-week time horizon, using weekly cycles and six mutually exclusive health states. The model incorporated transition probabilities between health states calculated based on clinical trial data and literature sources. Various cost and utility parameters were also included. Additionally, a series of sensitivity analyses were conducted to address parameter variations and associated uncertainties. Results The study finding suggest that from the perspective of Chinese healthcare, the majority of brand-name drug (BND) NOACs generally lack cost-effectiveness when compared to warfarin. However, when considered the VBP policy, NOACs, particularly rivaroxaban, prove to be more cost-effective than warfarin. Rivaroxaban provided an additional 0.0304 quality-adjusted life years (QALYs) per patient and reduced overall medical costs by 9095.73 CNY, resulting in an incremental cost-effectiveness ratio (ICER) of -298,786.20 CNY/QALY. Sensitivity analysis indicated a 78.4% probability of any NOACs being more cost-effective compared to warfarin. However, specifically considering NOACs under the VBP policy, the likelihood of them being more cost-effective approached 90%. Conclusion Taking into account Chinese pharmaceutical procurement policies, the findings highlight the superior efficacy of NOACs, especially rivaroxaban, in enhancing both the quality of life and economic benefits for Chinese LVT patients. NOACs present a more cost-effective treatment option, improving patient quality of life and healthcare cost efficiency compared to warfarin.
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Affiliation(s)
- Shuo Tian
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Central South University, Changsha, Hunan, People’s Republic of China
- Department of Clinical Pharmacy, Jining First People’s Hospital, Shandong First Medical University, Jining, Shandong, People’s Republic of China
| | - Haitao Zhong
- Translational Pharmaceutical Laboratory, Jining First People’s Hospital, Shandong First Medical University, Jining, Shandong, People’s Republic of China
- Institute of Translational Pharmacy, Jining Medical Research Academy, Jining, Shandong, People’s Republic of China
| | - Mengyue Yin
- The Affiliated Taian City Central Hospital of Qingdao University, Taian, Shandong, People’s Republic of China
| | - Pei Jiang
- Translational Pharmaceutical Laboratory, Jining First People’s Hospital, Shandong First Medical University, Jining, Shandong, People’s Republic of China
| | - Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Central South University, Changsha, Hunan, People’s Republic of China
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Shao Z, Lu D, Wang Y, Xue D. The effect of coronary stent policies on the risk of percutaneous coronary intervention among acute coronary syndrome patients in Shanghai: Real-world evidence. PLoS One 2024; 19:e0301448. [PMID: 38557900 PMCID: PMC10984406 DOI: 10.1371/journal.pone.0301448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE This study aimed to analyze the effect of coronary stent policies implemented in Shanghai on the risk of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) inpatients based on real-world data. METHODS Two retrospective cohorts of inpatients with a first diagnosis of ACS who had undergone PCI for the first time in the previous year in Shanghai hospitals were examined (one for the postpolicy period and the other for the prepolicy period). χ2 tests were used to compare categorical variables between the two cohorts. Single- and multivariate Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two cohorts. RESULTS A total of 31,760 ACS patients were included in this study. The proportion of ACS inpatients who had at least one bid-winning stent and 3 or more coronary stents implanted for first-time PCI in the postpolicy cohort was higher than that in the prepolicy cohort (86.52% vs. 55.67% and 6.27% vs. 4.39%, respectively; all p values < 0.0001). The single- and multivariate Cox proportional hazards models revealed that the unadjusted and adjusted hazard ratios for MACEs at 1 year after PCI for the postpolicy cohort relative to the prepolicy cohort were 0.869 (P<0.0001) and 0.814 (P = 0.0007), respectively. CONCLUSIONS The implementation of coronary stent policies changed coronary stent utilization but had no significant adverse effects on the risk of PCI among ACS patients in Shanghai in the short term. However, the reasons for changes in the number of coronary stents implanted should be analyzed and addressed in the future.
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Affiliation(s)
- Zhenyi Shao
- Health Statistics Department, Shanghai Statistics Center for Health, Shanghai, People’s Republic of China
| | - Dongzhe Lu
- School of Public Health, NHC Key Laboratory of Health Technology Assessment (Fudan University), Fudan University, Shanghai, People’s Republic of China
| | - Yue Wang
- Health Statistics Department, Shanghai Statistics Center for Health, Shanghai, People’s Republic of China
| | - Di Xue
- School of Public Health, NHC Key Laboratory of Health Technology Assessment (Fudan University), Fudan University, Shanghai, People’s Republic of China
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Shang L, Cheng Y, Zhou J, Bao Y, Kong D, Huang R, Chen Y, Wang H, Gu N, Ma A. Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients. Front Pharmacol 2024; 15:1302154. [PMID: 38389928 PMCID: PMC10881800 DOI: 10.3389/fphar.2024.1302154] [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: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives: The study aimed to estimate the effects of National Volume-based Drug Procurement (NVBP) policy on drug utilization and medical expenditures of hypertension patients in public medical institutions in mainland China. Methods: This study used patient-level data based on electronic health records retrieved from the hospital information system of Nanjing Hospital of Chinese Medicine. Data on patients with hypertension who received care at this institution between 2016 and 2021 was used for analysis. Segmented linear regression models incorporating Interrupted Time Series (ITS) analysis were adopted to examine the effects of NVBP policy on drug utilization and health expenditures of eligible patients. Drug utilization volume and health expenditures were the primary outcomes used to assess the policy effects, and were measured using the prescription proportion of each drug class and the overall per-encounter treatment costs. Results: After the implementation of NVBP policy, the volume of non-winning drugs decreased from 54.42% to 36.25% for outpatient care and from 35.62% to 15.65% for inpatient care. The ITS analysis showed that the volume of bid-winning drugs in outpatient and inpatient settings increased by 9.55% (p < 0.001) and 6.31% (p < 0.001), respectively. The volume changes in non-volume based purchased (non-VBP) drugs differed between outpatients and inpatients. The proportion of non-VBP drugs immediately increased by 5.34% (p = 0.002) overall, and showed an upward trend in the outpatient setting specially (p < 0.001) during the post-intervention period. However, no significant differences were observed in the proportion of non-VBP drugs in inpatient setting (p > 0.05) in term of level change (p > 0.05) or trend change (p > 0.05). The average per-visit expenditures of outpatients across all drug groups exhibited an upward trend (p < 0.05) post policy intervention. In addition, a similar increase in the overall costs for chemical drugs were observed in inpatient settings (coefficient = 2,599.54, p = 0.036), with no statistically significant differences in the regression slope and level (p = 0.814). Conclusion: The usage proportion of bid-winning drugs increased significantly post policy intervention, indicating greater use of bid-winning drugs and the corresponding substitution of non-winning hypertensive drugs. Drug expenditures for outpatients and health expenditures per visit for inpatients also exhibited an upward trend, suggesting the importance of enhanced drug use management in Traditional Chinese Medicine hospital settings.
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Affiliation(s)
- Lili Shang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Department of Discipline Construction, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Cheng
- Department of Pharmacy, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yuqing Bao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Desong Kong
- Chinese Medicine Modernization and Big Data Research Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruijian Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yanfei Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Hao Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ning Gu
- Cardiovascular Department, Nanjing Hospital of Chinese Medicine, Nanjing, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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Yuan J, Li M, Jiang X, Lu ZK. National Volume-Based Procurement (NVBP) exclusively for insulin: towards affordable access in China and beyond. BMJ Glob Health 2024; 9:e014489. [PMID: 38232994 PMCID: PMC10806927 DOI: 10.1136/bmjgh-2023-014489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Universal access to insulin remains a global public health challenge mainly due to its high price. After unsuccessful healthcare reforms attempting to lower insulin prices over the past several decades, the novel pooled procurement-also known as the national volume-based procurement (NVBP)was initiated exclusively for insulin in China. The NVBP exclusively for insulin represents a unique approach to conquering the challenges in the pooled procurement many low-income and middle-income countries face. In this paper, we described how the pooled procurement mechanism was implemented for insulin in China. Forty-two insulin products from 11 companies were procured, with a median price reduction of 42.08%. The procurement price ranged from US$0.35 to US$1.63 (¥2.35-¥10.97) per defined daily dose (DDD). The median procurement price per DDD was US$$0.54 (¥3.63) for human insulins and US$0.92 (¥6.18) for analogue insulin (p<0.001), respectively. A total of 32 000 medical facilities participated in the procurement, and the pooled demand for insulin was 1.61 billion daily doses, with an estimated saving of US$2.85 billion (¥19 billion) for the first year of the procurement agreement. Insulin affordability and accessibility improved substantially. This study reveals that the NVBP exclusively for insulin could effectively reduce insulin prices and improve access to this essential medicine. Even though the pooled procurement option looks efficient, its long-term impacts on the healthcare system should be closely monitored.
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Affiliation(s)
- Jing Yuan
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Xiangxiang Jiang
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
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Wang Q, Liu S, Nie Z, Zhu Z, Fu Y, Zhang J, Wei X, Yang L, Wei X. The pan-Canadian Tiered Pricing Framework and Chinese National Volume-Based Procurement: A comparative study using Donabedian's structure-process-outcome framework. J Glob Health 2023; 13:04137. [PMID: 37947028 PMCID: PMC10636597 DOI: 10.7189/jogh.13.04137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background Generic drugs have been seen as a potentially powerful way to alleviate the financial burden on patients and health care systems. Two strategies for achieving rational prices of generic drugs are tiered pricing framework and pooled purchasing power. We compare the pan-Canadian Tiered Pricing Framework (TPF) and the Chinese National Volume-Based Procurement (NVBP) as comparators to explore the similarities and differences between the two mechanisms and summarise lessons for other jurisdictions. Methods This comparative study applies Donabedian's structure-process-outcome framework to systematically analyse the macro contexts, procedures, and long- and short-term results of each pricing mechanism, and the interactions between them. Results Structure: TPF is an upstream initiative aimed at lowering the prices of generic drugs and increasing coverage and price consistency. NVBP is a downstream national initiative prioritised for reducing drug prices to achieve value-based purchasing. Process: By associating the number of manufacturers with price cuts, TPF leaves the choice to manufacturers to decide if they want to enter a specific market. In contrast, the Chinese government determines NVBP list and has the authority to choose manufacturer(s) with the lowest price(s). TPF provides clear price information to potential suppliers with unclear order quantity. The NVBP drug price is determined by tendering, while procurement volume is clear and massive. Outcome: The effectiveness of TPF and NVBP is similar, with both achieving a 53% price cut. Both TPF and NVBP experienced efficiency improvement since their establishment, with 98 and 86 drugs priced per year. By comparing 60 drugs covered by both programmes, the NVBP price is 57% of that of the TPF counterpart on average (1.1 to 301.6%), by purchase power parity. Conclusions The tiered pricing scheme is feasible in regions with a stable and mature pharmaceutical market, typically seen in high-income countries, while tendering is more workable in low- and middle-income countries where the pharmaceutical market is weak and unstable. Experience in the two countries shows that a coordinated pricing mechanism involves many piecemeal interactive problems, which a sophisticated system with a robust long-range plan may address better.
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Affiliation(s)
- Quan Wang
- School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Zhijie Nie
- School of Public Health, Peking University, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University, Beijing, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wang L, Yu Y, Zhou L, Xu P, Guo X, Xie Y, Cai J, Pan M, Tang J, Gong Q, Su R, Lou Y, Liu Y. Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis. Front Neurol 2023; 14:1267554. [PMID: 37928158 PMCID: PMC10623329 DOI: 10.3389/fneur.2023.1267554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system. Methods We conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective. Results The meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold. Conclusion Compared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone.
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Affiliation(s)
- Li Wang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ying Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Limei Zhou
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ping Xu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Xianbin Guo
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yu Xie
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Junxiu Cai
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Min Pan
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Jie Tang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Qingtao Gong
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Rong Su
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Liu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
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Wang H, Huo YT, Zhuang Q. Does China improve social welfare after implementing the national volume-based procurement? Front Pharmacol 2023; 14:1178026. [PMID: 37886133 PMCID: PMC10598760 DOI: 10.3389/fphar.2023.1178026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Objective: To explore the changes in social welfare before and after the implementation of the national volume-based procurement (NVBP). Explore whether the NVBP promotes the healthy development of manufacturers under the premise of benefiting patients. Then put forward relevant suggestions on how to effectively intervene the government in the pharmaceutical market. Methods: Starting with consumer surplus and producer surplus, social welfare was studied from the three perspectives of price, supply, and demand. Results: Consumer surplus was significantly increased, and the drug welfare of patients was significantly improved. The profits of the whole pharmaceutical industry have decreased but will increase in the future. The welfare of individual pharmaceutical enterprises varies. Overall social welfare has been significantly improved. Conclusion: The core purpose of the NVBP is to improve the medication welfare of patients, and through the increase of consumer surplus, it can affect the increase of producer surplus. Under such a linkage mechanism, the diversified linkage system of "price, demand, and supply" will achieve the effect of "1 + 1+1 > 3".
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Affiliation(s)
| | | | - Qian Zhuang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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