Obstacles and opportunities in Chinese pharmaceutical innovation

A call to rethink the necessity of and challenges facing academic research organizations in the new era of drug innovation in China

The objectives of drug R&D in China have shifted toward innovation and globalization, highlighting the ecological imperative to involve innovative partner-like academic research organizations (AROs). AROs are led by academic institutions and, when compared to contract research organizations (CROs), their strengths lie in promoting academic excellence, knowledge sharing, independence, collaborative networks and industry partnerships. Our desk-based analysis shows that although the service scope of Chinese AROs is similar to that of AROs in the US, they lack experience in broad service provision for innovative drugs, institution-institutional platforms and industry partnerships. We make several suggestions about how to achieve the synergy of academic institutions and industry-based organizations in drug innovation by using a ARO-CRO hybrid service model.

Bridging the new drug access gap between China and the United States and its related policies

Introduction: The access gap for novel pharmaceuticals between China and the developed countries is a major public health issue in China. It is crucial to understand the determinants of this gap to ensure timely access to new drugs and enhance patient health. Methods: We included all new drugs approved by the US Food and Drug Administration (FDA) between 2012 and 2019, and collected their approval timings in China. Major factors of interest comprised orphan designation and expedited review pathways granted by the FDA, along with the proportion of Asian subjects in the pivotal trial supporting the FDA approval and whether the trial included study sites in China. The elapsed time from the FDA approval to the market authorization in China constituted the time-to-event outcome, and Cox proportional-hazards regression was used for multivariate analysis. Results: A total of 327 new drugs were approved by the FDA between 2012 and 2019, among which 41.3% were found to be authorized in China as of 1 November 2023. The median lag time for the mutually approved drugs was 3.5 years. The Cox model found that orphan drugs had lower likelihood of being approved in China (HR = 0.59, 95% CI 0.39-0.89; p = 0.011), while the FDA's Breakthrough-Therapy drugs (HR = 2.33, 95% CI 1.39-3.89; p = 0.001) and Fast-Track drugs (HR = 1.58, 95% CI 1.05-2.38; p = 0.028) had shorter lag times. In the pivotal trials that supported the FDA approvals, a higher proportion of Asian subjects was associated with faster drug entry into the Chinese market (HR = 1.02, 95% CI 1.01-1.03; p < 0.001), and the inclusion of study sites in China mainland was likewise conducive to reducing the drug lag (HR = 5.30, 95% CI 3.20-8.77; p < 0.001). After the trials with China-based sites supported the FDA approvals, 77.8% of the trials also supported the subsequent approvals in China. Discussion: China's involvement in global drug co-development can streamline clinical development, by reducing repeated trials solely in the Chinese population. This is primarily due to the openness of the Chinese drug agency towards overseas clinical data and is a positive sign that encourages global drug developers to include Chinese patients in their development plans as early as possible.

The reimbursement decision speed for oncology new drugs in China and its determinant factors

Introduction

China has initiated national price negotiations to improve access to innovative drugs. Learning the factors that contributed to the time gap from marketing authorization to reimbursement leads to more clarity to decision-making, which remains under-researched in China.

Methods

We collected new oncology drug approvals that were marketed before 30 Jun 2022, using the Listed Drug Database of the Chinese drug agency. Major information of each approval was obtained from the published review report, including the first approval region (China or the US) and the receipt of expedited review pathways (priority review and conditional approval). The reimbursement lists issued by China National Healthcare Security Administration from 2015 to 2023 were used to determine the reimbursement status of drugs. The duration from marketing authorization to reimbursement was defined as the reimbursement decision speed, and the Cox regression was performed to explore the underlying factors.

Results

A total of 186 oncology approvals were included. More than half of the approvals qualified for reimbursement (110[59.14%]), and the median reimbursement decision speed was accelerated from 540.5 days in the third-round negotiation to 448 days in the seventh-round. Domestic new drugs had a higher probability of being adopted by the Chinese payer than drugs developed by foreign companies (adjusted HR = 3.73, 95% CI 2.42 to 5.75; P < 0.001). Furthermore, new drug applications receiving the regular review pathway were more likely to be reimbursed (adjusted HR = 2.15, 95% CI 1.13 to 4.08; P = 0.020) compared to those approved under the conditional approval pathway.

Discussion

These findings indicate that the Chinese government is actively working toward improving access to new oncology drugs. The faster reimbursement decision speed for domestic drugs might be attributed to their pricing advantages and the regulator's efforts to stimulate innovation in the domestic pharmaceutical industry. However, concerns about the uncertainty in drug benefits can affect the reimbursement decision-making, which suggests the delicate tradeoff between drug accessibility and risk involved in the reimbursement process.

Measure on innovation efficiency of China's pharmaceutical manufacturing industry

Pharmaceutical manufacturing industry is an important industry to ensure human life safety. The innovation efficiency is a significant factor to stimulate the development of pharmaceutical manufacturing industry. At present, there are few studies on the innovation efficiency of pharmaceutical manufacturing industry. To fill this gap, this paper estimates the innovation efficiency of China's pharmaceutical manufacturing industry in 23 provinces of China from 2010 to 2020 based on the super-network SBM model and Global-Malmquist index. The results show that: (1) From the perspective of efficiency of research and development stage (ERDS), the ERDS of China shows an increasing trend, with the most prominent growth in the western region. (2) From the perspective of efficiency of economic transformation stage (EETS), although there are fluctuations in the EETS, the overall development is good. The EETS of the central region and western region is better than that of the eastern region. (3) By comparing the efficiency of the two stages, it is found that the change direction of the efficiency of the two stages is not necessarily the same in some provinces.

The Financial Impact of Patents on SMEs in China: Empirical Evidence from Pharmaceutical Sector

With the disruptive technology innovation time arrival, small and medium-sized enterprises (SMEs) have been the motor of innovation and played an increasingly major role in national economic development. As the shift towards an ‘open innovation’ paradigm, awareness of intellectual property rights has increased, and patents have been an important tool for Chinese pharmaceutical enterprises. Considering its mass production of low-level generic drugs, there are still many arguments about its lack of innovation. This article aims to identify if and how patents, as essential indicators of innovation, generate financial performance measured by SMEs in the pharmaceutical sectors. Patent data are a vital source of competitive intelligence. A positive association was found between annually added patents and gross sales. Many other patent indicators, such as the number of forward citations and patent transfer, were statistically significant. Moreover, the results suggested that there was a one-year lag between patent publication and financial performance. A series of patent quantity and quality indicators have shown significant effects on the financial performance of Chinese pharmaceutical enterprises. These patents generate a positive financial impact, which builds up a solid basis for keeping sustainable innovation capability in the Chinese drug industry.

Future health spending forecast in leading emerging BRICS markets in 2030: health policy implications

Background

The leading emerging markets of Brazil, Russia, India, China and South Africa (BRICS) are increasingly shaping the landscape of the global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during the 2020s. The purpose of the current research was to examine the decades-long underlying historical trends in BRICS countries’ health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030.

Methods

BRICS’ health spending data spanning 1995–2017 were extracted from the Institute for Health Metrics and Evaluation (IHME) Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and gross domestic product (GDP) share of total health spending were forecasted for 2018–2030. Autoregressive integrated moving average (ARIMA) models were used to obtain future projections based on time series analysis.

Results

Per capita health spending in 2030 is projected to be as follows: Brazil, $1767 (95% prediction interval [PI] 1615, 1977); Russia, $1933 (95% PI 1549, 2317); India, $468 (95% PI 400.4, 535); China, $1707 (95% PI 1079, 2334); South Africa, $1379 (95% PI 755, 2004). Health spending as a percentage of GDP in 2030 is projected as follows: Brazil, 8.4% (95% PI 7.5, 9.4); Russia, 5.2% (95% PI 4.5, 5.9); India, 3.5% (95% PI 2.9%, 4.1%); China, 5.9% (95% PI 4.9, 7.0); South Africa, 10.4% (95% PI 5.5, 15.3).

Conclusions

All BRICS countries show a long-term trend towards increasing their per capita spending in terms of purchasing power parity (PPP). India and Russia are highly likely to maintain stable total health spending as a percentage of GDP until 2030. China, as a major driver of global economic growth, will be able to significantly expand its investment in the health sector across an array of indicators. Brazil is the only large nation whose health expenditure as a percentage of GDP is about to contract substantially during the third decade of the twenty-first century. The steepest curve of increased per capita spending until 2030 seems to be attributable to India, while Russia should achieve the highest values in absolute terms. Health policy implications of long-term trends in health spending indicate the need for health technology assessment dissemination among the BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources will remain a core challenge in 2030 as well.

R&D Investments, Debt Capital, and Ownership Concentration: A Three-Way Interaction and Lag Effects on Firm Performance in China's Pharmaceutical Industry

The existing literature has yet to provide consistent evidence on the relationship between R&D investments and firm performance. The current study attempted to fill this gap in the literature by examining the effect of lag structure and the moderating role of financial governance, in terms of debt capital and ownership concentration, on the returns of R&D. Analyzing a sample of China's pharmaceutical firms from 2009 to 2018, we found that the effect of R&D upon growth begins in the second year after R&D spending and increases thereafter. There exists a vigorous debate about the choice between debt and ownership structure. To fill this gap, we proposed a three-way interactive effect. The results suggest that firms that invest heavily in R&D may achieve their highest performance when the use of debt capital and the extent of ownership concentration are both low. This study contributes to the R&D investments and financial governance literature by reconciling previous mixed evidence about the returns of R&D and the debt-equity choices on R&D investment decisions.

Research capacity of global health institutions in China: a gap analysis focusing on their collaboration with other low-income and middle-income countries

Introduction

This paper presented qualitative and quantitative data collected on the research capacity of global health institutions in China and aimed to provide a landscaping review of the development of global health as a new discipline in the largest emerging economy of the world.

Methods

Mixed methods were used and they included a bibliometric analysis, a standardised survey and indepth interviews with top officials of 11 selected global health research and educational institutions in mainland China.

Results

The bibliometric analysis revealed that each institution had its own focus areas, some with a balanced focus among chronic illness, infectious disease and health systems, while others only focused on one of these areas. Interviews of key staff from each institution showed common themes: recognition that the current research capacity in global health is relatively weak, optimism towards the future, as well as an emphasis on mutual beneficial networking with other countries. Specific obstacles raised and the solutions applied by each institution were listed and discussed.

Conclusion

Global health institutions in China are going through a transition from learning and following established protocols to taking a more leading role in setting up China’s own footprint in this area. Gaps still remain, both in comparison with international institutions, as well as between the leading Chinese institutions and those that have just started. More investment needs to be made, from both public and private domains, to improve the overall capacity as well as the mutual learning and communication within the academic community in China.

Can locally developed me-too drugs aid price negotiation? An example of cancer therapies from China

Rapid growth in pharmaceutical expenditures and high prices have greatly hampered access to medicines, especially targeted anticancer medicines. Confronted with such difficulties, the Chinese government has put more effort into supporting local research and development of cancer medicines, resulting in locally developed me-too drugs. Since 2016, the government has implemented a central reimbursement-linked drug price negotiation policy aimed at reducing the prices of expensive medicines. Locally developed me-too drugs marketed at lower prices may inject price competition and help negotiate reduced prices of similar internationally-developed products. As an example, we selected 3 tyrosine kinase inhibitors (TKIs) developed for the therapy of advanced non-small cell lung cancer harboring mutations in the epidermal growth factor receptor (EGFR). Descriptive analysis was applied to data from the Chinese Medical Economic Information database to describe the impact on the price and utilization of three TKIs after the introduction of icotinib, a locally developed me-too TKI and two national negotiations regarding the price of EGFR-TKIs in China. After two national negotiations, the daily costs of all three EGFR-TKIs were reduced to around $30. From the first quarter of 2013 to the second quarter of 2016, the market share of the purchasing volume of icotinib, China's locally developed TKI, increased from 13% to 40%, while the market shares of two internationally developed TKIs decreased from 35% to 15% and from 52% to 45%, for erlotinib and gefitinib, respectively. The prices of EGFR-TKIs decreased and China's locally developed TKI accounted for a considerable proportion of market share. Locally developed me-too drugs aid price negotiation by injecting price competition and helping negotiate reduced prices of similar internationally-developed products. Through efforts to develop me-too drugs, combined with national drug price negotiation and reimbursement policies, developing countries might improve access to more affordable targeted cancer therapies.

Challenges and growth opportunities: the landscape of Chinese medical publication professionals in the global context: a questionnaire-based survey

OBJECTIVE

The Chinese healthcare industry has immense potential for innovation and requires competent publication professionals for global reach. Changes in regulatory landscape of China necessitates pharmaceutical industries to collaborate with medical professionals who are capable of keeping up with both changes in regulations and innovative medicine.

METHODS

We initiated an online questionnaire-based survey via WeChat from August 3 to August 14, 2019 which focused on experience level, challenges, career development, and training requirements of survey participants.

RESULTS

A total of 53 medical publication professionals participated in this survey. Contrary to global trends, 77% of participants had <5 years of professional experience in publication, although only 36% of participants had <5 years of experience in healthcare industry. In all, 63% of respondents spent <50% of their time in publication-related activities, contributing to <10 manuscripts per year. Their expertise in manuscripts spanned clinical studies (68%), post-marketing studies (62%), and reviews (38%). Poor research design and data quality, limited medical writing skill, and inefficient communication with authors were major challenges for developing high-quality publications. Awareness of good publication practices guidelines was high (49%) and 15% of respondents were Certified Medical Publication Professionals. Strategic publication planning (72%), industry trends (66%), and best practices (55%) were some of training requirements identified to increase competencies among respondents.

CONCLUSIONS

Although the Chinese medical publication professional industry is at a nascent stage, an attempt is being made to provide opportunities for its publication professionals to develop their competencies to match global standards.

Will Innovation of Pharmaceutical Manufacturing Improve Perceived Health?

By taking 22 OECD countries from 2010 to 2017 as sample, we study the effect of pharmaceutical manufacturing innovation on perceived health by using the panel Tobit model from the entire sample and sub-samples, respectively, as well as analyze their transmission channels by adding moderating effect. Based on the above, we get the following results: first, the pharmaceutical manufacturing innovation 4 years ago has a positive influence on perceived health, which means the improvement of perceived health is closely related to pharmaceutical manufacturing innovation 4 years ago. Second, pharmaceutical manufacturing innovation has a heterogeneous impact on perceived health, which, including the size and direction of the impact effect, is mainly reflected in different pharmaceutical manufacturing innovation levels, population aging degrees, and education levels. Third, income level can positively regulate the impact of pharmaceutical manufacturing innovation on perceived health.

Policy Analysis Of Iranian Pharmaceutical Sector; A Qualitative Study

Introduction

Improving public health through providing affordable and accessible pharmaceuticals is among the concerns of governments worldwide. This study aimed to analyze Iran’s pharmaceutical sector policies in order to identify the challenges and suggest some strategic solutions to overcome such challenges.

Methods

Top managers (15), middle managers (10), and operational managers (5) working in the Food and Drug Administration of Iranian Ministry of Health along with community pharmacists (5) participated in a qualitative study using semi-structured in-depth interviews. Data were recorded, transcribed, and then analyzed via MAXQDA 10 software.

Results

Policies for national pharmaceutical sector were divided into four groups of “research & development”, “import & export”, “pharmaceutical procurement”, and “pharmaceutical supply and distribution”. Then, the challenges faced by each sector were extracted. Considering the challenges, some policy options were recommended for growth and development of national pharmaceutical sector.

Conclusion

Iran’s pharmaceutical sector has managerial and administrative differences compared with overseas pharmaceutical sectors. These differences are the main reasons for the current status of Iran’s pharmaceutical sector and have put Iran behind foreign pharmaceutical sectors. Iran’s pharmaceutical sector has endured many critical periods during recent decades and has gained great experience during these stages. Therefore, it is believed that Iran’s pharmaceutical sector, with its experience and potential, is capable of producing world-level medicines.

Gap analysis for drug development policy-making: An attempt to close the gap between policy and its implementation

Introduction

Most drug development policies in developing countries are enacted without achieving the desired results. This study aims to determine the prioritization of drug development in Indonesia through the evidence-based policymaking process in order to close the distance between stated policy goals and the realization of planned goals.

Methods

A quantitative approach in the form of cross-sectional research using a structured survey was adopted and validated using a set of techniques involved in the calculation of a structural equation model. An independent samples t-test was used to test the significance of the differences between two views: pharmaceutical industries and the government of Indonesia.

Findings

The study reveals that pharmaceutical industries and governments were highly consistent in their perceived challenges in facing the drug development. It also reveals drivers and weaknesses of drug development, including market opportunities, push-pull-regulatory pull factors and regulation, as priorities for improvement.

Conclusions

Gap analysis based on a structural model was borne out to address gap challenges between policy and its implementation, with the use of evidence-based policymaking.