AUTHOR=Lu Jiancheng , Long Hongfei , Shen Yuan , Wang Jing , Geng Xin , Yang Ying , Mao Zongfu , Li Jinghua 

TITLE=The change of drug utilization in China’s public healthcare institutions under the “4 + 7” centralized drug procurement policy: Evidence from a natural experiment in China

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.923209

DOI=10.3389/fphar.2022.923209

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Improving drug accessibility and rational drug use are major challenges for China’s healthcare reform. In 2018, the Chinese government introduced a novel nationwide policy of centralized drug procurement for off-patent drugs, focusing on improving drug utilization patterns of public medical institutions.</p><p><bold>Objective:</bold> To estimate the impacts of the Chinese centralized drug procurement policy (the so-called “4 + 7” policy) on drug utilization in public medical institutions.</p><p><bold>Methods:</bold> A retrospective natural experimental design and difference-in-difference method were applied using cross-region data extracted from the national procurement database. Eleven “4 + 7” pilot cities (intervention group) and eleven non-pilot provinces (control group) were matched. In addition, “4 + 7” policy-related drugs (<italic>n</italic> = 116) were selected as study samples, including 25 drugs in the 4 + 7” procurement List (“4 + 7” List drugs) and their alternative drugs (<italic>n</italic> = 91) that have not yet been covered by centralized procurement policy. Then, the “4 + 7” List drugs were divided into bid-winning and non-winning drugs according to the bidding results, and they were sorted into generic and original drugs. Defined daily dose (DDD) was used to standardize the quantity of drugs used.</p><p><bold>Results:</bold> In the 1-year procurement period, the overall completion rate of agreed procurement volume reached 191.4% in pilot cities. Owing to policy impact, the consumption increased by 405.31% in bid-winning drugs (<italic>β</italic> = 1.62, <italic>p</italic> &lt; 0.001) and decreased by 62.28% (<italic>β</italic> = −0.98, <italic>p</italic> &lt; 0.001) in non-winning drugs. The overall use proportion of bid-winning drugs increased from 17.03% to 73.61% with statistical significance (<italic>β</italic> = 1.48, <italic>p</italic> &lt; 0.001), and increments were also detected in all healthcare settings, regions, and anatomical therapeutic chemical (ATC) categories (all <italic>p</italic>-values &lt; 0.05). Generics and originators were detected with 67.53% increment (<italic>β</italic> = 0.52, <italic>p</italic> &lt; 0.001) and 26.88% drop (<italic>β</italic> = −0.31, <italic>p</italic> = 0.006) in consume volume. The use proportion of generics increased from 59.23% to 78.44% with significance (<italic>β</italic> = 0.24, <italic>p</italic> &lt; 0.001), as well as in tertiary hospitals (<italic>β</italic> = 0.31), secondary hospitals (<italic>β</italic> = 0.23), and primary healthcare centers (<italic>β</italic> = 0.11) (all <italic>p</italic>-values &lt; 0.001). The use proportion of relatively quality-guaranteed drugs (i.e. bid-winning and original drugs) increased from 56.69% to 93.61% with significance (<italic>β</italic> = 0.61, <italic>p</italic> &lt; 0.001), and similar increments were also detected in all healthcare settings, regions, and ATC categories (all <italic>p</italic>-values &lt; 0.05).</p><p><bold>Conclusion:</bold> Healthcare providers demonstrated good compliance with the “4 + 7” policy in completing contracted procurement volume. Centralized drug procurement policy promoted drug consumption gradually concentrated on bid-winning drugs, generic drugs, and more importantly, quality-guaranteed drugs.</p>