Risk Management and Healthcare Policy (Sep 2023)
How National Health Insurance Coverage Policy Affected the Use of Trastuzumab and Rituximab in China: A Bicentric Retrospective Study
Abstract
Linlin Shang,1,* Yingtao Lin,2,* Wenqing Fang,3 Yanyan Liu,4 Yuwen Bao,4 Xin Li,1,2,4 Yuanyuan Zhang5 1Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, People’s Republic of China; 2Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China; 3Department of Medical Ethics Supervision, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 4Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, People’s Republic of China; 5Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanyuan Zhang, Department of Pharmacy, Jiangsu Cancer Hospital, No. 42 Baizi Ting Road, Xuanwu District, Nanjing, Jiangsu, 210009, People’s Republic of China, Email [email protected] Xin Li, Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, 211166, People’s Republic of China, Email [email protected]: Cancer is a significant health concern and is China’s leading cause of mortality. Targeted therapies, such as trastuzumab and rituximab, have enhanced clinical treatment efficacy. However, their high costs burden patients and healthcare systems considerably. Patient demographic factors further influence the utilization of these expensive drugs. On September 1, 2017, China implemented the National Health Insurance Coverage (NHIC) policy, necessitating additional real-world evidence to assess its impact on patients.Methods: Data on human epidermal growth factor receptor 2-positive breast cancer and CD20-positive non-Hodgkin B-cell lymphoma patients were gathered in Jiangsu Cancer Hospital and Fujian Cancer Hospital from September 2015 to August 2019, including demographic and clinical information. All eligible patients were divided into two groups. Univariate analysis and multivariable logistic regression were used to investigate the differences between subgroups. An interrupted time-series regression was used to examine the change in trastuzumab and rituximab utilization percentages.Results: Before and after the NHIC policy, utilization of trastuzumab increased from 61.13% to 75.10%, and the increase was statistically significant. Rituximab therapy increased statistically significantly from 64.79% to 74.88%. The key factor influencing trastuzumab and rituximab use was the NHIC policy. With policy implementation, medical insurance status, occupations, and cancer disease stage affected trastuzumab and rituximab use.Conclusion: The NHIC policy is essential to the utilization of trastuzumab and rituximab, and the patient’s income level and repayment abilities continue to impact the use of innovative anti-cancer drugs. Appropriate steps, such as reducing the urban-rural gap and broadening medical insurance coverage, would enable more people to access novel anti-cancer drugs.Keywords: National Health Insurance Coverage, trastuzumab, rituximab, breast cancer, non-Hodgkin lymphoma, utilization
