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Changes in Use of Antidiabetic Medications Following Price Regulations in China (1999-2009)

Changes in Use of Antidiabetic Medications Following Price Regulations in China (1999-2009). Christine Lu Harvard Medical School and Harvard Pilgrim Health Care Institute WHO Collaborating Center in Pharmaceutical Policy ICIUM 2011 ( Poster 878 ). WHO Collaborating Center

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Changes in Use of Antidiabetic Medications Following Price Regulations in China (1999-2009)

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  1. Changes in Use of Antidiabetic Medications Following Price Regulations in China (1999-2009) Christine Lu Harvard Medical School and Harvard Pilgrim Health Care InstituteWHO Collaborating Center in Pharmaceutical Policy ICIUM 2011 (Poster 878) WHO Collaborating Center in Pharmaceutical Policy

  2. Acknowledgements • Co-investigators: Dennis Ross-Degnan, Anita Wagner, Bao Liu, Peter Stephens • IMS Health for providing the data • Location of work: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute • Conflict of interest: None

  3. Background – China • High and rapidly growing drug expenditures • Medicines = 48% of total health expenditures • 24 rounds of price reductions (by 5 to 40%) between 1997 and 2007 • Most medicines sold in hospitals • Diabetes is a major burden

  4. Study aim To examine the effects of two targeted price regulations on purchasing of insulin and oral hypoglycemics in Chinese hospitals: • Dec 2001: Specific human insulin (non-mixed) and several oral hypoglycemic products • Dec 2006: Specific animal insulin (non-mixed) and a large number of oral hypoglycemic products

  5. Methods • Antidiabetic medications: • Animal and human insulin products • Oral hypoglycemics: alpha-glucosidase inhibitors, biguanides, glinides, sulfonylureas, and thiazolidinediones • Data source: • Quarterly data on purchase volume of antidiabetic products collected by IMS Health (1999-2009) • Price regulation policies obtained from the China Economic Information Network

  6. Methods • Outcome measures: • Sales volume: number of standard units sold per 1000 population per quarter for a specific product • Market share: percentage of total market volume represented by price-regulated products • Among all antidiabetic products • Within specific drug classes • Interrupted time-series design and segmented regression analysis (Wagner AK et al. J ClinPharmTher2002)

  7. Results: Insulin products, 2001 Increase in trend of sales volume (0.06 standard units sold/1000 people/quarter)

  8. Results: Insulin products, 2006 Increase in trend of sales volume (0.18 standard units sold/1000 people/quarter)

  9. Results: Oral hypoglycemics, 2001 No observable change in sales volume following price reduction

  10. Results: Oral hypoglycemics, 2006 Increase in trend of sales volume (10.3 standard units sold/1000 people/quarter)

  11. Summary • Dec 2001 price regulation: • Increase in market volume trend of insulin products • Use of oral hypoglycemic products stable • Dec 2006 price regulation: • Increases in market volume trend of both insulin products & oral hypoglycemic products • No change in market share of price-regulated insulin and oral hypoglycemic products • Challenges: • No information on hospital purchasing prices

  12. Conclusions & research recommendations • China’s targeted approach to drug price reductions may have: • Been associated with increases in utilization of antidiabetics • Improved access to essential medications OR increased prescribing quantities OR both • Open research questions: • Did price and volume changes result in cost savings for • Patients? • Hospitals? • The system? • Did price and volume changes result in better quality of care? • What are effects of China’s 2009 health care reform which mandates 0% markup on essential medicines in health centers?

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