Initiatives to improve prescribing efficiency in China and their influence: cardio-cerebral vascular medicines as a case history to provide future direction

Brian Godman, Wenjie Zeng, Junjie Zhen, Mengying Feng, Alexander Finlayson, Stephen Campbell

Research output: Contribution to journalMeeting abstract

Abstract

Background: Pharmaceutical expenditure has grown by 16% per annum in China during the past decade. This has been enhanced by increased coverage as well as incentives to physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, with medicines currently accounting for 46% of total hospital expenditure. Hospitals currently rely on revenues from procurement of medicines for their sustainability. Principal measures to moderate growth in drug expenditure include initiatives to reduce procured drug prices. However, to date no formal pricing policies for generics in China similar to Europe and limited demand-side measures to enhance appropriate prescribing, e.g. no universal measures to monitor the quality of prescribing. Current incentives have led to irrationality in prescribing; e.g. high use of injectable drugs, antibiotics and traditional Chinese medicines (TCMs) despite the development of essential medicine lists. Objective: Assess current utilisation and expenditure of CV medicines including TCMs between 2006 and 2012 and compare the findings with Western European countries. Methods: Uncontrolled retrospective study of prescriptions to treat cardio-vascular disease in one of the largest hospitals in Southwest China. Results: Utilisation of CV drugs increased 3.3 fold during the study period, greatest for TCMs. Procured expenditure increased 4.85 fold. Variable utilisation of generics at 29% to 31% of the total for each molecule in recent years among high volume pharmacotherapeutic products. However, low prices for generics have been achieved through multiple supply-side measures, matching those achieved among some European countries. Continued irrationality in prescribing is seen with high use TCMs despite limited evidence and the utilisation of drugs dropping significantly once low prices procured. Conclusion: Prices still have appreciable impact on the subsequent utilization of different CV drugs in China. Consequently, there is appreciable potential to introduce measures similar to Western Europe to improve future rationality and reduce overall drug costs. This could include robust formularies, quality targets and financial incentives. We are beginning to see improved rationality in the use of medicines with a reduction in TCMs. This will be monitored along with other suggestions to further enhance accessibility to medicines in China without prohibitive increases in pharmaceutical and overall expenditure.
LanguageEnglish
Article number105
Number of pages1
JournalBasic and Clinical Pharmacology and Toxicology
Volume115
Issue numberSuppl 1
Early online date23 Jun 2014
DOIs
Publication statusPublished - Jul 2014

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Cardiology
Health Expenditures
Chinese Traditional Medicine
Medicine
China
Pharmaceutical Preparations
Drug Utilization
Motivation
Formularies
Drug Costs
Pharmacies
Vascular Diseases
Prescriptions
Direction compound
Retrospective Studies
Anti-Bacterial Agents
Physicians
Costs and Cost Analysis
Injections
Costs

Keywords

  • prescribed drugs
  • China
  • cardio-cerebral vascular medicines

Cite this

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title = "Initiatives to improve prescribing efficiency in China and their influence: cardio-cerebral vascular medicines as a case history to provide future direction",
abstract = "Background: Pharmaceutical expenditure has grown by 16{\%} per annum in China during the past decade. This has been enhanced by increased coverage as well as incentives to physicians and hospitals. Hospital pharmacies dispense 80{\%} of medicines in China, with medicines currently accounting for 46{\%} of total hospital expenditure. Hospitals currently rely on revenues from procurement of medicines for their sustainability. Principal measures to moderate growth in drug expenditure include initiatives to reduce procured drug prices. However, to date no formal pricing policies for generics in China similar to Europe and limited demand-side measures to enhance appropriate prescribing, e.g. no universal measures to monitor the quality of prescribing. Current incentives have led to irrationality in prescribing; e.g. high use of injectable drugs, antibiotics and traditional Chinese medicines (TCMs) despite the development of essential medicine lists. Objective: Assess current utilisation and expenditure of CV medicines including TCMs between 2006 and 2012 and compare the findings with Western European countries. Methods: Uncontrolled retrospective study of prescriptions to treat cardio-vascular disease in one of the largest hospitals in Southwest China. Results: Utilisation of CV drugs increased 3.3 fold during the study period, greatest for TCMs. Procured expenditure increased 4.85 fold. Variable utilisation of generics at 29{\%} to 31{\%} of the total for each molecule in recent years among high volume pharmacotherapeutic products. However, low prices for generics have been achieved through multiple supply-side measures, matching those achieved among some European countries. Continued irrationality in prescribing is seen with high use TCMs despite limited evidence and the utilisation of drugs dropping significantly once low prices procured. Conclusion: Prices still have appreciable impact on the subsequent utilization of different CV drugs in China. Consequently, there is appreciable potential to introduce measures similar to Western Europe to improve future rationality and reduce overall drug costs. This could include robust formularies, quality targets and financial incentives. We are beginning to see improved rationality in the use of medicines with a reduction in TCMs. This will be monitored along with other suggestions to further enhance accessibility to medicines in China without prohibitive increases in pharmaceutical and overall expenditure.",
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author = "Brian Godman and Wenjie Zeng and Junjie Zhen and Mengying Feng and Alexander Finlayson and Stephen Campbell",
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language = "English",
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Initiatives to improve prescribing efficiency in China and their influence : cardio-cerebral vascular medicines as a case history to provide future direction. / Godman, Brian; Zeng, Wenjie; Zhen, Junjie; Feng, Mengying; Finlayson, Alexander; Campbell, Stephen.

In: Basic and Clinical Pharmacology and Toxicology , Vol. 115, No. Suppl 1, 105, 07.2014.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - Initiatives to improve prescribing efficiency in China and their influence

T2 - Basic and Clinical Pharmacology and Toxicology

AU - Godman, Brian

AU - Zeng, Wenjie

AU - Zhen, Junjie

AU - Feng, Mengying

AU - Finlayson, Alexander

AU - Campbell, Stephen

PY - 2014/7

Y1 - 2014/7

N2 - Background: Pharmaceutical expenditure has grown by 16% per annum in China during the past decade. This has been enhanced by increased coverage as well as incentives to physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, with medicines currently accounting for 46% of total hospital expenditure. Hospitals currently rely on revenues from procurement of medicines for their sustainability. Principal measures to moderate growth in drug expenditure include initiatives to reduce procured drug prices. However, to date no formal pricing policies for generics in China similar to Europe and limited demand-side measures to enhance appropriate prescribing, e.g. no universal measures to monitor the quality of prescribing. Current incentives have led to irrationality in prescribing; e.g. high use of injectable drugs, antibiotics and traditional Chinese medicines (TCMs) despite the development of essential medicine lists. Objective: Assess current utilisation and expenditure of CV medicines including TCMs between 2006 and 2012 and compare the findings with Western European countries. Methods: Uncontrolled retrospective study of prescriptions to treat cardio-vascular disease in one of the largest hospitals in Southwest China. Results: Utilisation of CV drugs increased 3.3 fold during the study period, greatest for TCMs. Procured expenditure increased 4.85 fold. Variable utilisation of generics at 29% to 31% of the total for each molecule in recent years among high volume pharmacotherapeutic products. However, low prices for generics have been achieved through multiple supply-side measures, matching those achieved among some European countries. Continued irrationality in prescribing is seen with high use TCMs despite limited evidence and the utilisation of drugs dropping significantly once low prices procured. Conclusion: Prices still have appreciable impact on the subsequent utilization of different CV drugs in China. Consequently, there is appreciable potential to introduce measures similar to Western Europe to improve future rationality and reduce overall drug costs. This could include robust formularies, quality targets and financial incentives. We are beginning to see improved rationality in the use of medicines with a reduction in TCMs. This will be monitored along with other suggestions to further enhance accessibility to medicines in China without prohibitive increases in pharmaceutical and overall expenditure.

AB - Background: Pharmaceutical expenditure has grown by 16% per annum in China during the past decade. This has been enhanced by increased coverage as well as incentives to physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, with medicines currently accounting for 46% of total hospital expenditure. Hospitals currently rely on revenues from procurement of medicines for their sustainability. Principal measures to moderate growth in drug expenditure include initiatives to reduce procured drug prices. However, to date no formal pricing policies for generics in China similar to Europe and limited demand-side measures to enhance appropriate prescribing, e.g. no universal measures to monitor the quality of prescribing. Current incentives have led to irrationality in prescribing; e.g. high use of injectable drugs, antibiotics and traditional Chinese medicines (TCMs) despite the development of essential medicine lists. Objective: Assess current utilisation and expenditure of CV medicines including TCMs between 2006 and 2012 and compare the findings with Western European countries. Methods: Uncontrolled retrospective study of prescriptions to treat cardio-vascular disease in one of the largest hospitals in Southwest China. Results: Utilisation of CV drugs increased 3.3 fold during the study period, greatest for TCMs. Procured expenditure increased 4.85 fold. Variable utilisation of generics at 29% to 31% of the total for each molecule in recent years among high volume pharmacotherapeutic products. However, low prices for generics have been achieved through multiple supply-side measures, matching those achieved among some European countries. Continued irrationality in prescribing is seen with high use TCMs despite limited evidence and the utilisation of drugs dropping significantly once low prices procured. Conclusion: Prices still have appreciable impact on the subsequent utilization of different CV drugs in China. Consequently, there is appreciable potential to introduce measures similar to Western Europe to improve future rationality and reduce overall drug costs. This could include robust formularies, quality targets and financial incentives. We are beginning to see improved rationality in the use of medicines with a reduction in TCMs. This will be monitored along with other suggestions to further enhance accessibility to medicines in China without prohibitive increases in pharmaceutical and overall expenditure.

KW - prescribed drugs

KW - China

KW - cardio-cerebral vascular medicines

UR - http://onlinelibrary.wiley.com/doi/10.1111/bcpt.12259_1/abstract

U2 - 10.1111/bcpt.12259_1

DO - 10.1111/bcpt.12259_1

M3 - Meeting abstract

VL - 115

JO - Basic and Clinical Pharmacology and Toxicology

JF - Basic and Clinical Pharmacology and Toxicology

SN - 1742-7835

IS - Suppl 1

M1 - 105

ER -