Research On Drug Cost Structure Before And After Provincial Specialized Procurement Policy For Anticancer Drugs

Objective:Analyze the a mount and structure changes of anti-cancer drugs purchased in the Eastern,Central and Western provinces before and after the implementation of China’s anti-cancer drug special centralized procurement policy,evaluate the effect of price reduction and fee control,and provide a reference for improving the provincial anti-cancer drug special centralized procurement policy.Methods:Using the typical sampling method,three provinces in the east（Zhejiang）,middle（Anhui）and west（Sichuan）were selected as the sample areas,and the anti-cancer drug purchases covered by the policies of the three provinces from November 2018 to February 2019 were obtained from the National Health and Health Commission Statistical Information Center data.Based on the"National Essential Medicines Catalog（2018Edition）"and"National Essential Medical Insurance,Industrial Injury Insurance and Maternity Insurance Medicines Catalog（2017 Edition）","The State’s 36 Drugs and 17National Negotiated Drugs in the Basic Medical Insurance Catalog",etc.The documents classify medicines.SPSS21.0 software is used to statistically describe the purchase amount,price,and quantity（millions of DDDs）using indicators such as sum,rate,and proportion.The base period（T₁）of November 2018 before the implementation of this policy was set as T₂,T₃ and T₄ from December 2018 to February 2019.The"A.M"index method was used to analyze the purchase amount,purchase price,purchase volume and substitution effect of drugs.The A.M index and the index of each dimension are greater than 1,indicating that the total amount,price,and quantity have risen,and drugs with high average daily prices have replaced drugs with low average daily prices.Results:1.After cleaning up and merging the data,86 kinds of anti-cancer drugs were included,and a total of 2389 pieces of drug data were included.2.Drug costs（1）Overall situation of medicines:During the survey period,the number of varieties purchased increased from 71 in T₀ to 83 in T₃,and the total amount of anti-cancer drugs purchased reached 1.629 billion yuan,from 425 million yuan in T₀ to 449 million in T₁ After the yuan,it dropped to 314 million yuan in T₃;the total purchase amount was 14.80 million DDDs,which increased from 3.79 million DDDs in T₀ to 4.18 million DDDs in T₁,and then fell to 2.65 million DDDs in T₃ during the Chinese New Year.（2）Various types of drugs:the total amount of medical insurance drugs purchased was 1.540 billion yuan（accounting for94.5%）,and the total amount of purchase was 13.16 million DDDs;the total amount of essential drugs was 671 million yuan（accounting for 41.2%）,procurement The total amount is 6.82 million DDDs;the total amount of imported medicines is 657 million yuan,and the total amount of domestic medicines is 972 million yuan.The changes in the purchase amount and quantity of different types of medicines are similar to the overall change trend of medicines.（3）Drugs purchased by provinces:Zhejiang’s total purchase amount is 709million yuan,month-on-month is 241,263,218,and 170 million yuan,and the purchase amount is 1.79,2.15,1.91,and 1.24 million DDDs;Anhui Procurement The total amount is280 million yuan,followed by 72,84,81,and 43 million yuan,and the purchase volume is0.66,0.78,0.68,and 0.29 million DDDs.The total purchase amount in Sichuan is 457million yuan,and 112 month by month,102,142,and 101 million yuan,and the purchase volume was 1.35,1.25,1.59,and 1.12 million DDDs.3.Results of A.M Index System Analysis Method analysis（1）Overall situation:Compared with T₀,the cost index of T₁-T₃ is 1.05,1.03,and 0.73,the price index is 0.98,0.93,and 0.99.The therapeutic substitution index drops to 0.98 of T₁ and then rises to 1.06.（2）Various types of medicines:the cost indexes of medical insurance drugs T₁-T₃ are 1.05,1.04 and 0.73 in order;the cost indexes of basic drugs T₁ to T₃ are 1.05,1.09 and 0.74 in order,and the therapeutic substitution index first drops to 0.96after T₁ Rose to 1.10.The price index of medical insurance and essential medicines is similar to the overall change of medicines.The cost index of imported drugs T₁-T₃ is 0.93,0.99 and0.74 in order,the price index stabilizes at 0.95 in T₂-T₃,the substitution index first drops to0.93 of T₁ and then rises to 1.00;the cost index of domestic drugs T₁ to T₃ is sequentially1.13,1.04 and 0.71,the price index first fell to 0.95 at T₂ and then rose to 0.99,and the substitution index first fell to 0.99 at T₂and then rose to 1.09.（3）The drug situation in each province:Analysis of the drugs that are continuously purchased in the three provinces during T₀-T₃:○1_{E A} Expense index:1.07,0.93 and 0.69 in Zhejiang,1.13,1.09 and 0.50 in Anhui,and 0.91 in Sichuan,1.20 and 0.82;_A○2_{E A} price index:Zhejiang is 0.96,0.91 and 0.93,Anhui is 0.94,0.94 and 1.05,Sichuan is 0.99,0.95 and 0.97.Conclusion:（1）The policy has shown a price reduction effect on the overall drugs and different types of drugs in the three provinces,and imported anti-cancer drugs have driven the price reduction of domestic anti-cancer drugs;（2）The policy dividend is released and the variety of drugs is increased.The policy implementation has a role in the substitution of drug treatment in the first month Positive impact,but the monitoring and management of the anti-cancer drug purchase and use process still need to be further strengthened;（3）The drug price reduction and control charges have changed significantly before and after the policies of Zhejiang Province.The next step of the policy still needs to consider the differences in the economic,political and medical levels of various regions.