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. 2023 May 9:11:1159119.
doi: 10.3389/fpubh.2023.1159119. eCollection 2023.

The impact of China's zero markup drug policy on drug costs for managing Parkinson's disease and its complications: an interrupted time series analysis

Ruilin Wang #  1   2 , Xinya Li #  1   2   3   4 , Xinchun Gu  5 , Qian Cai  5 , Yayong Wang  1 , Zhan-Miao Yi  1   3   4 , Li-Chia Chen  5
Affiliations

The impact of China's zero markup drug policy on drug costs for managing Parkinson's disease and its complications: an interrupted time series analysis

Ruilin Wang et al. Front Public Health. .

Abstract

Background: In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures.

Objective: This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective.

Methods: The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β1) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β2). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML).

Results: Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (β1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (β2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β2 = -1.4, 95% CI: -2.6, -0.2) or not (β2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (β2 = 24.3, 95% CI 17.3, 31.4).

Conclusions: Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.

Keywords: Parkinson's disease; disease burden study; drug costs; interrupted time series; zero markup drug policy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The impact of the Zero Mark-up Drug Policy on drug costs per outpatient visit for managing Parkinson's disease and its complications. (A) Drug costs for managing Parkinson's disease. (B) Drug costs for managing complications of Parkinson's disease.
Figure 2
Figure 2
The impact of the Zero Mark-up Drug Policy on drug costs per outpatient visit of drugs, whether listed in EML for managing Parkinson's disease and its complications. (A) Drug listed in EML for managing Parkinson's disease. (B) Drug listed in EML for managing complications of Parkinson's disease. (C) Drugs not listed in EML for managing Parkinson's disease. (D) Drugs not listed in EML for managing complications of Parkinson's disease. EML, essential medicine list.
Figure 3
Figure 3
The impact of the Zero Mark-up Drug Policy on drug costs per outpatient visit of patients with or without health insurance for managing Parkinson's disease and its complications. (A) Drugs for managing Parkinson's disease in patients with health insurance. (B) Drugs for managing complications of Parkinson's disease in patients with health insurance. (C) Drugs for managing Parkinson's disease in patients without health insurance. (D) Drugs for managing complications of Parkinson's disease in patients without health insurance. HI, health insurance.
Figure 4
Figure 4
The impact of the Zero Mark-up Drug Policy on drug costs per outpatient visit for managing Parkinson's disease and its complications by age groups. (A) Drugs for managing Parkinson's disease in patients less than 65 years old. (B) Drugs for managing complications of Parkinson's disease in patients less than 65 years old. (C) Drugs for managing Parkinson's disease in patients greater than or equal to 65 years old and less than 75 years. (D) Drugs for managing complications of Parkinson's disease in patients greater than or equal to 65 years old and less than 75 years old. (E) Drugs for managing Parkinson's disease in patients greater than or equal to 75 years old. (F) Drugs for managing complications of Parkinson's disease in patients greater than or equal to 75 years old.
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