Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history

Abstract

Introduction: Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. Objectives: Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. Methodology: Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. Results: Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (−54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. Conclusion: Considerable opportunities to improve prescribing efficiency in China.

Keywords:

• angiotensin receptor blockers
• China
• drug utilization
• health reforms
• generics
• pharmaceuticals

Acknowledgements

We thank the publishing company of the Journal of China Pharmacy for providing us with the datasets used in this study.

Financial & competing interests disclosure

Part of the analysis and writing of this paper was supported by a grant from Karolinska Institutet. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Pharmaceutical expenditure rose steadily at over 16% per annum during the past decade, with medicines accounting for 46% of total expenditure in 2010. 80% of medicines are currently dispensed in hospitals.

• Physicians and hospitals currently use prescribing and procurement of medicines to enhance their income, with the average mark-up on medicines in hospitals at 42% in 2005. This has resulted in considerable irrationality in prescribing despite initiatives such as Essential Medicine Lists.

• This irrationality was also seen when the utilization of ARBs and their expenditure was examined in the largest hospital in Chongqing district of China and one of the largest hospitals in southwest China.

• The utilization of ARBs increased substantially between 2006 and 2012. However, the utilization patterns for different originator ARBs were variable and did not reflect their procured prices. There was also typically low utilization of cheaper generics versus originators.

• The reductions in the procured prices for generics over time were similar to those seen among some Western European countries. However, there are still considerable opportunities to further lower prices of generics in China as well as enhance their utilization versus originators.

• Introducing supply- and demand-side measures in China similar to Western European countries would enhance the potential for China to achieve its desired goal of universal coverage by 2020. However, this will need substantial changes to the remuneration system for physicians and hospitals to achieve this.

Notes