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Wen X, Xu L, Chen X, Wu R, Luo J, Wan Y, Mao Z. A quasi-experimental study of the volume-based procurement (VBP) effect on antiviral medications of hepatitis B virus in China. Front Pharmacol 2023; 14:984794. [PMID: 37731741 PMCID: PMC10507907 DOI: 10.3389/fphar.2023.984794] [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: 07/02/2022] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background: The Pilot Plan of National Centralized Volume-Based Procurement (NCVBP) was adopted to cope with the rapid increase in drug expenditures. This research aimed to quantitatively evaluate the impact of the NCVBP on antiviral medications for the hepatitis B virus. Methods: Data on nucleoside analogs (NAs) medications of hepatitis B virus monthly procurement records in the pilot cities from January 2018 to December 2019 were extracted from the China Drug Supply Information Platform (CDSIP). The impacts of the NCVBP on purchased volumes, expenditures, and pre-defined daily dose costs were evaluated by interrupted time-series (ITS) analysis using Stata 16.0. We constructed two segments with one interruptive point (March 2019). Results: Compared to the same period between pre-and post-intervention, the purchased volume of NAs medications were increased by 92.85%, and selected medications were increased by 119.09%. Analysis of changes in the level of NAs medication followed a decrease in purchased expenditure (coefficient: 5364.88, p < 0.001), meanwhile, the purchased volume was increased with statistical significance (coefficient:605.49, p < 0.001). The Defined Daily Dose cost (DDDc) of NAs medication followed a decrease (coefficient: 8.90, p < 0.001). The NCVBP reform was followed by an increase of 618.41 ten thousand Defined Daily Dose (DDD) (p < 0.001) in purchased volume and a reduction of 5273.84 ten thousand Chinese Yuan (CNY) (p < 0.001) in the purchased expenditure of selected medications in the level. The DDDc of selected medications decreased in the level (coefficient: 9.87, p < 0.001), while the DDDc of alternative medications increased in the slope (coefficient:0.07, p = 0.030). The purchased volume and expenditure of bid-winning products increased by 964.08 ten thousand DDD and 637.36 ten thousand CNY in the level (p < 0.001). An increase of 633.46 ten thousand DDD (p < 0.001) in purchased volume and a reduction of 4285.32 ten thousand CNY (p < 0.001) in the purchased expenditure of generic drugs in the level was observed. Conclusion: The NCVBP reduced the DDDc of NAs medication, improved the utilization of the selected medications, and promoted the usage of generic products.
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Affiliation(s)
- Xiaotong Wen
- Department of Hospital Infection Management, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Luxinyi Xu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaoze Chen
- School of Public Health, Xi’an Jiao Tong Liverpool University, Suzhou, China
| | - Ruonan Wu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Jia Luo
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Yuying Wan
- Department of Hospital Infection Management, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zongfu Mao
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
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The Application of Focused Care Model in the Management of Hepatitis B Patients in a Tertiary Care Hospital and the Impact on Patients’ Quality of Life. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7770955. [PMID: 36132545 PMCID: PMC9484946 DOI: 10.1155/2022/7770955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022]
Abstract
Chronic hepatitis B is one of the common infectious diseases in the world, with a wide epidemic range and strong contagiousness, which is difficult to completely eradicate. From July 2020 to April 2022, 142 patients with hepatitis B who were admitted to tertiary hospitals were selected and randomly divided into 2 cases, with 71 cases per case. The control group adopts a conventional model, and the observation group implements a nursing model based on the control group. The management capacity and quality of life before and after the two groups of care were compared. 94 patients with chronic hepatitis B who were admitted to the hospital from July 2020 to April 2022 were selected, and 47 cases were divided into the control group and observation group according to the admission time. The control group is given a conventional model, and the observation group is given a nursing model on the basis of the control group. Both groups of patients observed anxiety self-assessment scale (SAS), depression self-assessment scale (SDS), short life span scale (SF-36) scores, and treatment conditions before and after the intervention, to explore the application of nursing model in the management of hepatitis B patients in tertiary hospitals and its impact on patient quality of life. Based on study's precare outcomes, there was no statistically significant difference between the self-administered scale (PIH) score and the quality of life measurement summary scale (QOL-BREF) score (P > 0.05) between the two groups. After one month of care, both groups had lower PIH scores than before care, and QOL-BREF scores were higher than before care (P < 0.05). After one month of treatment, the PIH score of the observation group was significantly reduced, and the QOL-BREF score after one month of treatment was significantly higher than that of the control group (P < 0.05). The SAS and SDS scores in the observation group were lower than those in the control group, and the quality of life scores and treatment compliance were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusions. The nursing model can effectively improve the management and quality of life of hepatitis B patients. It also had a significant positive effect on the therapeutic capacity and quality of life of patients with hepatitis B and improved patient compliance behavior and quality of life.
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Zhao X, Li M, Wang H, Xu X, Wu X, Sun Y, Ning C, Wang B, Chen S, You H, Jia J, Kong Y. Impact of National Centralized Drug Procurement Policy on Antiviral Utilization and Expenditure for Hepatitis B in China. J Clin Transl Hepatol 2022; 10:420-428. [PMID: 35836769 PMCID: PMC9240235 DOI: 10.14218/jcth.2022.00167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS The National Centralized Drug Procurement (NCDP) policy was launched in mainland China in April 2019, with entecavir (ETV) and tenofovir disoproxil fumarate (TDF) being included in the procurement list. We conducted the current study to investigate the impact of the NCDP policy on the utilization and expenditures of antiviral therapy for chronic hepatitis B (CHB) in China. METHODS Procurement records, including monthly purchase volume, expenditure, and price of nucleos(t)ide analogs (NAs), were derived from the National Healthcare Security Administration from April 2018 to March 2021. The changes in volumes and expenditures of the first-line NAs and bid-winning products were calculated. The effects of price, volume, and structure related to drug expenditure were calculated by the Addis and Magrini (AM) Index System Analysis. RESULTS The purchase volume of NAs significantly increased from 134.3 to 318.3 million DDDs, whereas the expenditure sharply decreased from 1,623.41 to 490.43 million renminbi (RMB) or 241.94 to 73.09 million US dollars (USD). The proportions of first-line NAs rose from 72.51% (ETV: 69.00%, TDF: 3.51%) to 94.97% (ETV: 77.42%, TDF: 17.55%). AM analysis showed that the NCDP policy decreased the expenditure of all NAs (S=0.91) but increased that of the first-line NAs in the bid-winning list (S=1.13). Assuming the population size of CHB patients remains stable and a compliance rate of ≥75%, the proportion of CHB patients receiving first-line antiviral therapy would increase from 6.36-8.48% to 11.56-15.41%. CONCLUSIONS The implementation of the NCDP policy significantly increased the utilization of first-line NAs for CHB patients at a lower expenditure. The findings provided evidence for optimizing antiviral therapy strategy and allocating medical resources in China.
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Affiliation(s)
- Xinyu Zhao
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Min Li
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Hao Wang
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiaoqian Xu
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiaoning Wu
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Yameng Sun
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Canjian Ning
- Human resources and Social Security Bureau of Jiangsu Taizhou Medical High-tech Zone (Gaogang District) Management Committee, Taizhou, Jiangsu, China
| | - Bingqiong Wang
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Shuyan Chen
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
- Correspondence to: Yuanyuan Kong, Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China. ORCID: https://orcid.org/0000-0002-2586-1443. Tel: +86-10-63139362, Fax: +86-10-63139246, E-mail: ; Jidong Jia, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China. ORCID: https://orcid.org/0000-0002-4673-8890. Tel: +86-10-63139816, Fax: +86-10-63139246, E-mail:
| | - Yuanyuan Kong
- Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing, China
- Correspondence to: Yuanyuan Kong, Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China. ORCID: https://orcid.org/0000-0002-2586-1443. Tel: +86-10-63139362, Fax: +86-10-63139246, E-mail: ; Jidong Jia, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China. ORCID: https://orcid.org/0000-0002-4673-8890. Tel: +86-10-63139816, Fax: +86-10-63139246, E-mail:
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Wen X, Yin S, Cui L, Mao L, Lin Z, Yaermaimaiti Z, Geng X, Li Y, Yang Y, Cui D, Mao Z. The Effects of the National Centralized Drug Purchasing Pilot Program on Nucleos(t)ide Analogs in Shenzhen City: An Interrupted Time Series Analysis. Front Public Health 2021; 9:718013. [PMID: 34760861 PMCID: PMC8572971 DOI: 10.3389/fpubh.2021.718013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: To assess the effects of the National Centralized Drug Purchasing Pilot Program on nucleos(t)ide analogs (NAs) in Shenzhen city. Methods: Drugs procurement records in medical institutions were analyzed covering the period from January 2018 to December 2019. An interrupted time series (ITS) analysis was used to evaluate the impact of the "4+7" pilot policy on NAs in Shenzhen city. The outcome measures were usage volume, expenditures, daily cost, and distribution structure of NAs. Findings: After the introduction of the "4+7" pilot policy, the defined daily doses (DDDs) of NA drugs increased by 76.48%, the expenditures and defined daily dose cost (DDDc) of NAs decreased by 45.43 and 69.08%, respectively. The proportion of winning products in Entecavir and Tenofovir Fumarate DDDs was increased by 64.21 and 19.20%, respectively. The post-intervention period witnessed a significant increase in the regression level for NAs DDDs (level coefficient: β2 = 631.87, p < 0.05). The expenditures (trend coefficient: β3 = 392.24, p < 0.05) and DDDc (level coefficient: β2 = -6.17, p < 0.001; trend coefficient: β3 = -0.21, p < 0.05) of NAs showed decreasing trend in the post-intervention period. The expenditures of original products and generic products both showed a decreasing trend in the post-intervention period (trend coefficient: β3 = -372.78, p < 0.05, trend coefficient: β3 = -130.78, p < 0.05, respectively). The DDDc of original products in the policy-related varieties was a significant decrease in the regression slope and level (level coefficient: β2 = -2.18, p < 0.05; trend coefficient: β3 = -0.32, p < 0.01). Conclusion: After the implementation of the"4+7" policy, the DDDc of NAs decreased, the accessibility of policy-related drugs was improved, and the usage of generic medicine was promoted.
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Affiliation(s)
- Xiaotong Wen
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Shicheng Yin
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Lanyue Cui
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lining Mao
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zhaoyu Lin
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zilalai Yaermaimaiti
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Xin Geng
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Yingxia Li
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Ying Yang
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
| | - Zongfu Mao
- Department of Social Medicine and Health Service Management, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Global Health, Global Health Institute, Wuhan University, Wuhan, China
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