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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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Suzuki F, Suzuki Y, Karino Y, Tanaka Y, Kurosaki M, Yatsuhashi H, Atarashi T, Atsukawa M, Watanabe T, Enomoto M, Kudo M, Maeda N, Kohno H, Joko K, Michitaka K, Miki K, Takahashi K, Ide T, Fujiyama S, Kohno T, Itoh H, Tsukamoto S, Suzuki Y, Kawano Y, Sugiura W, Kumada H. Switching from entecavir to tenofovir disoproxil fumarate for HBeAg-positive chronic hepatitis B patients: a phase 4, prospective study. BMC Gastroenterol 2021; 21:489. [PMID: 34930140 PMCID: PMC8686386 DOI: 10.1186/s12876-021-02008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is widely used and recommended as first-line treatment for patients infected with the hepatitis B virus (HBV). However, current data are limited regarding the efficacy and safety of switching to TDF for the treatment of chronic hepatitis B in hepatitis B e-antigen (HBeAg)-positive patients who are virologically suppressed with another nucleos(t)ide analogue. The primary objective of this study was to evaluate the hepatitis B surface antigen (HBsAg) reduction potential of switching from entecavir (ETV) to TDF at week 48 in HBeAg-positive chronic hepatitis B patients with undetectable serum HBV-DNA. METHODS In this multicenter, single-arm, open-label, phase 4 clinical study, 75 participants currently treated with ETV 0.5 mg once daily were switched to TDF 300 mg once daily for 96 weeks. RESULTS At week 48, 3/74 participants (4%) achieved 0.25 log10 reduction of HBsAg levels from baseline (the primary endpoint). Mean HBsAg reduction was -0.14 log10 IU/mL and 12% (9/74) achieved 0.25 log10 reduction by 96 weeks. No participants achieved HBsAg seroclearance. HBsAg reduction at weeks 48 and 96 was numerically greater in participants with higher alanine aminotransferase levels (≥ 60 U/L). Seventeen participants (25%) achieved HBeAg seroclearance up to week 96. No participants experienced viral breakthrough. All drug-related adverse events (18 participants [24%]) were mild in intensity, including an increase in urine beta-2-microglobulin (15 participants [20%]). CONCLUSIONS In conclusion, HBsAg reduction was limited after switching from ETV to TDF in this study population. Further investigation is warranted to better understand the clinical impact of switching from ETV to TDF. ClinicalTrials.gov: NCT03258710 registered August 21, 2017. https://clinicaltrials.gov/ct2/show/NCT03258710?term=NCT03258710&draw=2&rank=1.
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Affiliation(s)
- Fumitaka Suzuki
- Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu-ku, Kawasaki-city, Kanagawa, 213-8587, Japan
| | - Yoshiyuki Suzuki
- Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, 105-8470, Japan
| | - Yoshiyasu Karino
- Sapporo-Kosei General Hospital, 8-5, Kita 3-jo Higashi, Chuo-ku, Sapporo-city, Hokkaido, 060-0033, Japan.,Keiyukai Sapporo Hospital, 1-1, Kita, Hondori 14 chome, Shiroishi-ku, Sapporo-city, Hokkaido, 003-0027, Japan
| | - Yasuhito Tanaka
- Nagoya City University Hospital, 1, Aza-Kawasumi, Mizuho, Nagoya, Aichi, 467-8602, Japan.,Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masayuki Kurosaki
- Musashino Red Cross Hospital, 1-26-1, Kyonan-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Hiroshi Yatsuhashi
- National Hospital Organization Nagasaki Medical Center, 2-1001-1, Kubara, Omura-city, Nagasaki, 856-8562, Japan
| | - Tomofumi Atarashi
- Obihiro-Kosei General Hospital, 10-1, Nishi 14-jo Minami, Obihiro-city, Hokkaido, 080-0024, Japan
| | - Masanori Atsukawa
- Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai-City, Chiba, 270-1694, Japan
| | - Tsunamasa Watanabe
- St. Marianna University School of Medicine Hospital, 2-16-1, Sugao, Miyamae-ku, Kawasaki-city, Kanagawa, 216-8511, Japan
| | - Masaru Enomoto
- Osaka City University Hospital, 1-5-7, Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-8586, Japan
| | - Masatoshi Kudo
- Kindai University Hospital, 377-2, Ohnohigashi, Osakasayama-city, Osaka, 589-8511, Japan
| | - Naoto Maeda
- Sanin Rosai Hospital, 1-8-1, Kaikeshinden, Yonago-city, Tottori, 683-8605, Japan
| | - Hiroshi Kohno
- National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure-city, Hiroshima, 737-0023, Japan
| | - Kouji Joko
- Matsuyama Red Cross Hospital, 1, Bunkyo-cho, Matsuyama-city, Ehime, 790-8524, Japan
| | - Kojiro Michitaka
- Ehime Prefectural Central Hospital, 83, Kasugamachi, Matsuyama-city, Ehime, 790-0024, Japan
| | - Koichiro Miki
- Kitakyushu City Hospital Organization Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-city, Fukuoka, 802-0077, Japan.,Shin-Eikai Hospital, 12-11, Bentencho, Kokurakita-ku, Kitakyushu-city, Fukuoka, 803-0856, Japan
| | - Kazuhiro Takahashi
- Hamanomachi Hospital, 3-3-1, Nagahama, Chuo-ku, Fukuoka-city, Fukuoka, 810-8539, Japan
| | - Tatsuya Ide
- Kurume University Hospital, 67, Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Shigetoshi Fujiyama
- Kumamoto Shinto General Hospital, 3-2-65, Ooe, Chuo-ku, Kumamoto-city, Kumamoto, 862-8655, Japan
| | - Tomoko Kohno
- GlaxoSmithKline K.K., Akasaka Intercity AIR, 1-8-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Hiroshi Itoh
- GlaxoSmithKline K.K., Akasaka Intercity AIR, 1-8-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Sakiyo Tsukamoto
- GlaxoSmithKline K.K., Akasaka Intercity AIR, 1-8-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Yuko Suzuki
- GlaxoSmithKline K.K., Akasaka Intercity AIR, 1-8-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Yoshiaki Kawano
- GlaxoSmithKline K.K., Akasaka Intercity AIR, 1-8-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Wataru Sugiura
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hiromitsu Kumada
- Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, 105-8470, Japan
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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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