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首页> 外文期刊>International Journal of Environmental Research and Public Health >Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China
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Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

机译：抗癌药物的可获得性，价格和可承受性：来自中国江苏省的两次横断面调查的证据

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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.
机译：目的：随着癌症发病率的增加，难以获得负担得起的抗癌药物一直是中国严重的公共卫生问题。为了帮助解决这个问题，我们评估了中国江苏省公立医院药物治疗癌症的可用性，价格和负担能力。方法：在2012年和2016年，收集了首都和其他五个城市的抗癌药物供应和价格信息。使用世界卫生组织/国际卫生行动的方法，对总共6家癌症护理医院，26家三级综合医院和28家二级综合医院进行了采样。在调查时已收集了库存中的抗癌药物数据。价格以通货膨胀调整后的中位数单价（MUPs）表示。如果所有处方的抗癌药物的总费用少于家庭支付能力的20％，则该药物是可以负担的。我们使用广义估计方程来估计2012年至2016年可用性差异的重要性，并使用Wilcoxon等级检验来估计MUP差异的重要性。计算多元逻辑回归以衡量可负担性的预测指标。结果：从2012年到2016年，原始品牌（OB）的平均供应量（从7.79％降至5.71％，p = 0.012）和最低价格的仿制药（LPG）（36.29％降至32.67％，p = 0.009）。二级综合医院和三级综合医院中抗癌药物的平均利用率显着低于癌症护理。从2012年到2016年，OB的MUP（差异：？21.29％，p <0.01）和它们的LPG（？22.63％，p <0.01）显着降低。所有抗癌药物的OBs（16.67％）均更低。比液化石油气负担得起（城市居民为34.62％，农村居民为30.77％）;他们的承受能力在不同的收入地区之间有所不同。从2012年到2016年，低可用性和低负担性的LPG的比例在城市地区分别从30.77％降至19.23％，在农村地区从34.62％降至26.92％。通用替代药和基本医疗保险所涵盖的药物是促进负担能力的因素。结论：令人担忧的是，2016年抗癌药物的供应量已从2012年的低水平下降。抗癌药物在高收入地区的患者比低收入地区的患者更负担得起。各国政府应考虑利用其议价能力来降低采购价格并废除抗癌药物的税收。政策应集中于针对低收入癌症患者的特殊健康保险计划。药物政策的目标应确保癌症患者可以使用一线仿制药并优先开处方。

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