Hongdou Chen

Background: China is characterized by significant regional disparities in economic development levels. Accordingly, both the regional implementation effectiveness of the national centralized drug procurement (NCDP) policy and relevant influencing factors urgently require investigation, with the aim of providing evidence to optimize the policy’s implementation. Methods: The first to fifth batches of NCDP drugs were investigated on the basis of the adjusted standard survey methodology suggested by the World Health Organization/Health Action International. This study has assessed NCDP drug availability across over 900 secondary and tertiary public general hospitals in regions with varying levels of economic development in terms of both the procurement rate and the availability rate. Results: The availability of these five batches of NCDP drugs in regions with different economic development levels generally followed the pattern that their availability in developed regions is higher than that in moderately developed regions which is also higher than that in less developed regions. A significant difference was observed in the availability of different batches of NCDP drugs (P < 0.05). In developed regions, the average availability rate of each batch was relatively high (from 53.34% to 70.42%), and their procurement rates exceeded 50%. In moderately developed regions, all batches except the fourth exhibited relatively high average availability rates (from 50.08% to 65.14%), and their procurement rates all exceeded 50%. In less developed regions, only two batches (the first batch of “4 + 7” expansion and the second batch) exhibited relatively high average availability rates, and their procurement rates exceeded 50%. The availability of all types of NCDP drugs was also higher in more developed regions. Conclusion: The implementation of five batches of NCDP drugs has gained initial achievements, but differences persist among regions with varying economic development levels. Accordingly, relevant national departments should optimize the policy implementation mechanism, strengthen the construction of supply chains, and change the inertia of medical behaviour in these regions, aiming to promote the coordinated development of different regions, increase the availability of NCDP drugs and allow people to enjoy policy benefits.

Objective: This study aimed to evaluate the availability, price levels, affordability, and utilisation of targeted drugs for pulmonary arterial hypertension (PAH) in China. Methods: This study utilized a retrospective longitudinal design, based on drug procurement data from 859 public hospitals in China, covering the period from January 2019 to December 2023. Accessibility of 11 PAH-targeted therapies was evaluated across three key dimensions: availability (proportion of hospitals stocking the drug), price level (the Defined Daily Dose cost, namely, DDDc = Total annual drug expenditure/DDDs of the drug), and affordability (out-of-pocket expenses as a percentage of household disposable income). Results: While there was a significant overall improvement in the accessibility of PAH-targeted drugs, structural disparities in accessibility were evident across different drug types, hospital tiers, and between urban and rural areas, as well as among income groups. Availability data showed that tertiary hospitals had significantly better access to NMI-negotiated drugs than secondary hospitals (p = 0.006). Among all drugs, treprostinil had the highest availability (56.1% across hospitals), while newer drugs such as selexipag had very low availability (3,700 CNY). In terms of affordability, in 2023, all drugs were affordable for the highest-income urban groups, while no drugs were affordable for the lowest-income rural groups, with the cost burden of iloprost accounting for 8,454.8% of the disposable income of the rural population. Drug accessibility exhibited significant structural imbalances, with some drugs being “affordable but hard to obtain” (e.g., riociguat) and others “highly burdensome and poorly accessible” (e.g., treprostinil). Conclusion: The findings demonstrate significant improvements in the affordability and availability of PAH-targeted therapies over the study period; however, notable inequalities persist in accessibility improvements across urban and rural areas and income groups. Future policies should be tailored to address specific accessibility challenges for different drug categories and focus on overcoming medication access barriers for low-income rural populations to foster health equity.

The maintenance medicines for chronic obstructive pulmonary disease (COPD) include inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting β2-agonists (LABA). Budesonide/glycopyrronium/formoterol (BUD/GLY/FOR) and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) are two representative drugs for prefixed ICS/LAMA/LABA association in a single inhaler and have shown comparable efficacy and safety with other ICS/LAMA/LABA open combination therapies in patients with moderate-to-very severe COPD. This study aimed to investigate the availability, price, affordability, and utilisation of single-inhaler triple medicines for COPD in China. Quarterly data about the use of BUD/GLY/FOR and FF/UMEC/VI from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. We used the adjusted World Health Organization and Health Action International methodology to calculate the availability and affordability of the two investigated medicines in 596 tertiary general hospitals and 299 secondary general hospitals in 31 provincial administrative regions in China. The availability and consumption of BUD/GLY/FOR were significantly higher than those of FF/UMEC/VI during the study period. At the end of 2022, the availability of BUD/GLY/FOR and FF/UMEC/VI in tertiary general hospitals was 69.80% and 52.01% respectively, while in secondary general hospitals, it was 52.51% and 28.76% respectively. Both medications were equally affordable at 1.3 days of the minimum wage after reimbursement in 2022. In the first quarter of 2021, with the inclusion of both drugs in the Medicare catalog, their DDDc decreased significantly, which was accompanied by notable improvements in their availability, affordability and consumption. The overall accessibility and consumption of BUD/GLY/FOR and FF/UMEC/VI were improved in China from 2020 to 2022. The implementation of the national drug price negotiation policy reduces the cost of drugs in China and plays an important role in improving the availability of the investigated drugs.

Objective: To analyze and predict the dynamic influence trends and degrees caused by various factors that may affect the expansion of the hospital pharmacist team in China. Methods: Time series data including the number of hospital visits in all hospitals in China, the total number of pharmacists, per capita health expenditure, and per capita GDP from 2002 to 2022 were collected at the national level. A vector autoregressive (VAR) model was constructed, and methods such as the Granger causality test, impulse response analysis, and variance decomposition were employed to explore the influence process and direction of various influencing factors on the number of pharmacists in China. Results: The Augmented Dickey-Fuller (ADF) test indicates the first-order difference series of the time series is stationary (P< 0.05). The model stability test shows the modulus of all specific root reciprocals falls within the unit circle, indicating model stability and credible results. The cointegration test reveals a cointegration relationship among the number of hospital visits, per capita health expenditure, per capita GDP, and the number of pharmacists (P< 0.05). The Granger causality test indicates a unidirectional Granger causality relationship between the number of hospital visits, per capita health expenditure, and the number of pharmacists. The impulse response function indicates that the number of pharmacists shows an upward trend after being impacted by one unit of the number of hospital visits and per capita GDP, while the positive impact of per capita health expenditure on the number of pharmacists turns into a negative impact in the third stage. Variance decomposition shows that the contribution rate of the number of hospital visits to the number of pharmacists is 12%, the contribution rate of per capita health expenditure to the number of pharmacists is 57%, and the contribution rate of per capita GDP to the number of pharmacists is 80%. Conclusion: The number of hospital visits, per capita health expenditures, and per capita GDP all positively contribute to the development of the pharmacist workforce. Per capita health expenditures lead to an increase in the number of pharmacists in the short term. Among the selected indicators, the primary drivers of pharmacist workforce development are per capita health expenditures and per capita GDP. Hospital visits have a relatively minor contribution to the growth in the number of pharmacists.

Objective: The supply and demand theory is used as a perspective to analyze the impact and prediction of factors such as the number of consultations in medical institutions on the number of hospital pharmacists in China. Methods: A total of 21 years of time-series data on the number of pharmacists, doctors and nurses in China’s hospitals, the number of consultations, the per capita health cost and the per capita GDP were collected from 2002 to 2022, and a vector auto-regressive model influencing the number of pharmacists in China was established to analyze the dynamic process of the influence of the number of consultations, the per capita health cost and the per capita GDP on the number of pharmacists and the direction of the influence in China. Results: There is a unidirectional Granger causality and long-term cointegration relationship between the number of consultations and the number of pharmacists, and the number of consultations will have a greater impact on the number of pharmacists in the long run and will be more stable in the later period; there is also a unidirectional Granger causality and long-term cointegration relationship between the per capita health cost and the number of pharmacists, and the per capita health cost will have a greater impact on the number of pharmacists in the short run. Conclusion: The rise in the number of pharmacists will occur along with increases in the number of visits, health costs per capita, and GDP per capita, with health costs per capita having a greater impact on the number of pharmacists in the short term, and visits and GDP per capita having a greater impact on the number of pharmacists in the long term and being more stable in the later years. Key words: number of pharmacists, vector auto-regressive model, number of consultations, per capita health costs, GDP per capita

Objectives This study aimed to investigate the availability, price, and affordability of nationally negotiated innovative anticancer medicines in China. Design Retrospective observational study based on data from a nationwide medical database. Data sources/setting Quarterly data about the use of innovative anticancer medicines from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. This study covered 895 public general hospitals in 30 provincial administrative regions in China. Of the total hospitals, 299 (33.41%) were secondary and 596 (66.59%) were tertiary. Main outcome measures The adjusted WHO and Health Action International methodology was used to calculate the availability and affordability of 33 nationally negotiated innovative anticancer medicines in the investigated hospitals. Price is expressed as the defined daily dose cost. Results On average, the total availability of 33 innovative anticancer medicines increased annually from 2020 to 2022. The median availability of all investigated medicines in tertiary hospitals from 2020 to 2022 was 24.04%, 33.60% and 37.61%, respectively, while the indicators in secondary hospitals were 4.90%, 12.54% and 16.48%, respectively. The adjusted prices of the medicines newly put in Medicare (in March 2021) decreased noticeably, with the decline rate ranging from 39.98% to 82.45% in 2021 compared with those in 2020. Most generic brands were priced much lower than the originator brands. The affordability of anticancer medicines has improved year by year from 2020 to 2022. In comparison, rural residents had lower affordability than urban residents. Conclusions The overall accessibility of 33 nationally negotiated innovative anticancer medicines improved from 2020 to 2022. However, the overall availability of most anticancer medicines in China remained at a low level (less than 50%). Further efforts should be made to sufficiently and equally benefit patients with cancer.

Objective: To analyse the relationship between the adverse drug reactions (ADRs) of essential drugs and visits, based on the recorded annual increase in ADRs associated with essential medicines in China, to provide a reliable theoretical basis for further analysis and optimization of the safety of essential drugs. Methods: The data of adverse reactions of essential drugs in China from 2011 to 2020, time series analysis was conducted, and vector autoregressive (VAR) model was established. The relationship between the number of ADRs and visits was explored empirically through Granger causality test, impulse response function and variance decomposition. Results: There was a long-term cointegration relationship and one-way causality between the number of visits and ADRs caused by essential medicines. In the initial stage, the ADR response to the number of visits increased sharply, but with an increase in the number of lag periods, the impact remained basically stable, even showing a slight decreasing trend. Conclusion: The number of visits impacts ADRs caused by essential medicines, but this impact remains basically stable after reaching a certain level.

Objective. To explore the drivers of the increase in adverse drug reactions (ADRs) associated with drugs in China's list of essential medicines and to analyse the ADR impact of the number of visits, based on the recorded annual increase in ADRs associated with essential medicines in China, to provide a reliable theoretical basis for further analysis and optimization of the safety of essential drugs. Methods. A time-series analysis was conducted based on the ADR data for essential medicines from 2011 to 2020 collected from the National ADR Monitoring Center. The relationship between the ADRs associated with essential medicines and the number of visits was explored by means of a vector autoregressive model, Granger causality test, impulse response analysis, variance analysis and other quantitative analysis methods. Results. There was a long-term cointegration relationship and one-way causality between the number of visits and ADRs caused by essential medicines. In the initial stage, the ADR response to the number of visits increased sharply, but with an increase in the number of lag periods, the impact remained basically stable, even showing a slight decreasing trend. Conclusion. The number of visits impacts ADRs caused by essential medicines, but this impact remains basically stable after reaching a certain level. In the long run, the impact may decrease.

Objective. To evaluate the difference of clinical efficacy of peramivir alone and peramivir combined with immunomodulators (either ribonucleic acid or thymopetidum) in the treatment of severe influenza A with primary viral pneumonia. Methods. A retrospective analysis was applied to 45 patients who were diagnosed with severe influenza A with primary viral pneumonia in our hospital from December 2017 to March 2018. The cases were divided into three groups: the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group. Results. The duration of viral nucleic acid positivity in the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group was 6.13 ± 2.06, 6.53 ± 2.72, and 6.10 ± 1.37 days, respectively. The remission time of the clinical symptoms of the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group was 8.06 ± 2.73, 7.94 ± 2.89, and 7.67 ± 1.58 days, respectively. Comparisons between the peramivir group and the peramivir combined with ribonucleic acid group or the peramivir combined with thymopetidum group revealed no significant differences in the duration of virus nucleic acid positivity, remission time of clinical symptoms, time to fever alleviation, and time to cough alleviation. Conclusions. There is no observed benefit in the addition of ribonucleic acid or thymopetidum when peramivir sodium chloride injection is used in the treatment of severe influenza A with primary viral pneumonia. This trial is registered with ChiCTR1800019417.