Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China
Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China
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抗癌药物的可获得性、价格和可负担性：来自中国江苏省两次横断面调查的证据
DOI：
10.3390/ijerph16193728
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发表时间：
2019-10-01
影响因子：
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通讯作者：
Li, Xin
中科院分区：
文献类型：
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作者：
Zhu, Yulei;Wang, Ying;Li, Xin
随着癌症发病率的增加，难以获得负担得起的抗癌药物已成为中国一个严重的公共卫生问题。为了帮助解决这一问题，我们评估了中国江苏省公立医院癌症药物治疗的可得性、价格和可负担性。方法：收集2012年和2016年首都及其他5个城市抗癌药物可及性和价格信息。总共抽样了6家癌症护理医院、26家三级综合医院和28家二级综合医院，采用了改编自世界卫生组织/卫生行动国际的方法。收集了调查时库存抗癌药物的数据。价格以通货膨胀调整后的中位数单位价格（MUPs）表示。如果所有处方抗癌药物的总费用低于家庭支付能力的20%，则药物是负担得起的。我们使用广义估计方程来估计2012年至2016年可用性差异的显著性，并使用Wilcoxon秩检验来估计mup差异的显著性。计算多元逻辑回归来衡量负担能力的预测因素。结果：2012 - 2016年，原药品牌（OBs）和低价仿制药（lpg）的平均可得性分别从7.79%下降至5.71%和36.29%下降至32.67%,p = 0.009。二级综合医院和三级综合医院的抗癌药物平均可得性明显低于癌症护理。2012 - 2016年，OBs的MUPs（差异为- 21.29%,p < 0.01）和LPGs（差异为- 22.63%,p < 0.01）显著下降。所有抗癌药的OBs（16.67%）比lpg（34.62%, 30.77%）更难以负担；他们的负担能力因不同收入地区而异。2012 - 2016年，城市低可用性和低可负担性的lpg比例分别从30.77%下降到19.23%，农村从34.62%下降到26.92%。非专利替代和基本医疗保险覆盖的药品是促进负担能力的因素。结论：2016年抗癌药物的可获得性在2012年已经很低的基础上有所下降。高收入地区的患者比低收入地区的患者更负担得起抗癌药物。各国政府应考虑利用其议价能力降低采购价格并取消抗癌药物税。政策应侧重于低收入癌症患者的特殊健康保险计划。药物政策的目标应该是确保一线的非专利药物可用于癌症患者，并优先开处方。
Objectives: With the increasing incidence of cancer, poor access to affordable anticancer medicines has been a serious public health problem in China. To help address this issue, we assessed the availability, price and affordability of pharmacotherapy for cancer in public hospitals in the Jiangsu Province, China. Methods: In 2012 and 2016, anticancer medicine availability and price information in the capital and five other cities was collected. A total of six cancer care hospitals, 26 tertiary general hospitals and 28 secondary general hospitals were sampled, using an adaptation of the World Health Organization/Health Action International methodology. Data was collected for the anticancer medicines in stock at the time of the surveys. Prices were expressed as inflation-adjusted median unit prices (MUPs). Medicine was affordable if the overall cost of all the prescribed anticancer medicines was less than 20% of the household’s capacity to pay. We used generalized estimating equations to estimate the significance of differences in availability from 2012 to 2016 and the Wilcoxon rank test to estimate the significance of differences in MUPs. Multivariate logistic regression was computed to measure predictors of affordability. Results: From 2012 to 2016 there was a significant decrease in the mean availability of originator brands (OBs) (from 7.79% to 5.71%, p = 0.012) and lowest-priced generics (LPGs) (36.29% to 32.67%, p = 0.009). The mean availability of anticancer medicines in secondary general hospitals was significantly lower than the cancer care, as well as in tertiary general hospitals. The MUPs of OBs (difference: −21.29%, p < 0.01) and their LPGs (−22.63%, p < 0.01) decreased significantly from 2012 to 2016. The OBs (16.67%) of all the anticancer medicines were found to be less affordable than LPGs (34.62% for urban residents and 30.77% for rural residents); their affordability varied among the different income regions. From 2012 to 2016, the proportion of LPGs with low availability and low affordability dropped from 30.77% to 19.23% in urban areas and 34.62% to 26.92% in rural areas, respectively. Generic substitution and medicine covered by basic medical insurance are factors facilitating affordability. Conclusion: There were concerning decreases in the availability of anticancer medicines in 2016 from already low availability in 2012. Anticancer medicines were more affordable for the patients in high-income regions than the patients in low-income regions. Governments should consider using their bargaining power to reduce procurement prices and abolish taxes on anticancer medicines. Policy should focus on the special health insurance plan for low-income patients with cancer. The goal of drug policy should ensure that first-line generic drugs are available for cancer patients and preferentially prescribed.