Background: Since 2020, China has implemented DIP (Diagnosis-Intervention Packet) payment reform to control medical costs and reduce patient financial burden. The reform was piloted in a representative tertiary public hospital within a provincial DIP pilot city. Methods: The study used hospital settlement and medication records from January 2019 to June 2023. Interrupted time series analysis (ITSA) and structural change degree (SCD) were applied to evaluate the impact of DIP reform on weekly per capita costs and cost structures for surgical and non-surgical groups. Synergistic effects of health system reforms were also assessed. Results: From January 2019 to June 2023, total costs for surgical and non-surgical groups decreased by 3.42% and 1.25%, respectively. Drug and surgical costs declined significantly (p < 0.05) in both groups, while consumable costs increased significantly (p < 0.05). The growth rate of total costs slowed (surgical group: β ₃ = −14.10; non-surgical group: β ₃ = −10.76). Total costs in the non-surgical group showed a decreasing trend post-DIP intervention (β ₁ + β ₃ = −3.12). Drug costs (surgical group: β ₃ = −5.50; non-surgical group: β ₃ = −4.11) and inspection costs (surgical group: β ₃ = −3.57; non-surgical group: β ₃ = −1.73) decreased in both groups. Structural change analysis showed a degree of structural variation (DSV) of 10.34% for the surgical group and 5.60% for the non-surgical group. Contribution rates of structural variation (CSV) indicated significant contributions from consumable costs (CSV = 55.83%) and drug costs (CSV = 36.02%) in the surgical group, and inspection costs (CSV = 48.75%) in the non-surgical group. Conclusion: DIP payment reform led to positive outcomes in the cost structure of inpatient care. However, increases in inspection costs and differences in cost structures between groups need further attention. Future efforts should focus on more precise cost management.

Purpose: Under the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization. Method: A pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated. Results: After policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs. Conclusion: The NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.

Objective: This study aimed to evaluate the impact of the National Centralized Drug Procurement (NCDP) policy on chemical pharmaceutical enterprises’ R&D investment and provide references for improving NCDP policy design and encouraging innovation in the pharmaceutical industry.Methods: Using the panel data of 102 Shanghai and Shenzhen A-share listed enterprises from 2016 to 2022 under the chemical pharmaceutical classification of Shenwan in Wind database as the research sample, this study developed difference-in-differences (DID) models on bid-winning and bid-non-winning enterprises, respectively, to evaluate the impact of NCDP policy on their R&D investment. In addition, this study tested the heterogeneity of bid-winning enterprises based on the bid success rate, the decline of drug price, and enterprise size.Results: The NCDP policy could encourage chemical pharmaceutical companies to increase R&D investment, but the low bid success rate and excessive drug price reduction would reduce their R&D enthusiasm, especially for small- and medium-sized enterprises.Discussion: It is suggested that the NCDP policy should be further improved: first, revise the bidding rule of the NCDP policy and increase the bid success rate so that more enterprises can win bids, and second, to solve the problem of excessive drug price reduction, evaluate the rationality of bid-winning prices, and introduce a two-way selection mechanism between medical institutions and supply enterprises. Integrate pharmacoeconomic evaluation into the NCDP rules to form a benign competition among enterprises. Third, attention should be paid to supporting policies for small- and medium-sized enterprises. By increasing procurement volume, shortening payment time limits, and increasing the proportion of advance payments, enterprises’ cash flow shortages can be alleviated, thus achieving fairness and inclusiveness in the implementation of the NCDP policy.

Background and objectives: Both gumarontinib and savolitinib have demonstrated efficacy in treating non-small-cell lung cancer (NSCLC) with tumors harboring mesenchymal–epithelial transition factor gene exon 14 (METex14) skipping. However, the comparison of their efficacy and pharmacoeconomics profiles remains limited. This study aims to evaluate the cost-effectiveness of gumarontinib versus savolitinib for the treatment of METex14 skipping NSCLC in China.Methods: A 3-state partitioned survival model (PSM) was developed with lifetime horizon from the perspective of Chinese healthcare system. Survival inputs were based on an unanchored matching-adjusted indirect comparison using individual patient data from GLORY trial to adjust for patient characteristics in NCT02897479. Costs and outcomes were discounted at an annual rate of 5%. Sensitivity and scenario analyses were conducted to explore model uncertainty.Results: Gumarontinib gained an additional 0.10 QALYs at an incremental cost of $1,893 compared to savolitinib, resulting in the ICERs of $19,243/QALY, which is below the threshold of 3 times the GDP per capita in China ($35,007 per capita in 2022). Sensitivity and scenario analyses confirmed the robustness of the base-case results.Conclusion: Gumarontinib is a cost-effective option compared to savolitinib for METex14 skipping NSCLC in China.