| Objective:This study aims to learn the level,trend and structure of opioid analgesics use in different regions of China,to analyze influencing factors of opioid consumption geographic variations,as well as the patient affordability of opioid analgesics for cancer pain treatment.Methods:The study used a retrospective method to analyze the utilization of opioid analgesics in Morphine Use Density(MUD,daily defined doses of morphine used per 100,000 population)and its growth rate from 2006 to 2016 in China and in its 7 regions.National and regional needs of opioid analgesics(in morphine equivalents)were measured based on cancer registration data and standard treatment course as defined by the international treatment guidelines for cancer pain.Adequacy of consumption measure(ACM)was used to gauge the adequacy of opioid analgesic treatment of cancer pain in China and compared with international data.Using Coefficient of Variation(CV)to measure the MUD longitudinal differences among Chinese provinces,Pearson correlation test and multivariate linear regression analysis are conducted to analyze the influencing factors among provinces.The study adopts WHO/HAI method to evaluate the patient affordability of opioid analgesics with the standardized prices(DDC,cost of daily defined doses).Results:The national MUD increased from 1.45 DDD/100,000/day in 2006 to 6.93 DDDs/100,000/day in 2016,with a higher growth rate in early years and lower growth rate in the last 6 years.The ACM value increased from 0.0024 in 2006 to 0.0097 in 2016,which has always been at the international comparative level of "very poor".Southern China had the largest MUD in 2016(9.67 DDD/100,000/day),Northwest China had the lowest MUD(3.28 DDD/100,000/day).The CV of MUD among provinces decreased from 1.65 in 2006 to 0.74 in 2016,still much higher than 0.15.Pearson correlation test showed that MUD was positively correlated with annual disposable income per capita(correlation coefficient=0.88),the proportion of high school and above population(0.83),the number of practicing physicians per 1,000 people(0.71)and the proportion of population aged 15-64(0.55)(P<0.05);negatively correlated with the proportion of population aged 0-14(-0.63)and illiteracy rate aged 15 and over(-0.44)(P<0.05).Multivariate linear regression,the proportion of high school and above population(?=0.25,P<0.05)and per capita annual disposable income(10,000)(?=3.58,P<0.01)were included in the model.The overall model was P<0.01,R2=0.81.The actual use of morphine equivalents accounted for only 21.5%of the needs of morphine for cancer pain treatment,which was 26%in the Eastern China,36%in the Southern China,11%in the Southwest and 12%in the Northwest.The DDC of all studied opioid analgesics ranged from CNY 10.80 to 848.88.Except morphine injection,the out-of-pocket payments for the standard treatment course of all other opioid analgesics were more than one daily disposable income of all regions of China.Conclusions:The opioid analgesics use for the treatment of cancer pain were insufficient in China,which varies largely in different regions with different economic development.Long-term use may lead heavy economic burden to the cancer pain patients.All these findings call for actions to strengthen the cancer pain treatment and care,and to relief the patient affordability. |
PDF Full Text Request