(194) The Impact of National Volume-Based Procurement Program Implementation on Medical Expenditures in China: A Population-based Study of 1.17 Million Hypertensive Patients

Background: The affordability of medicines remains a major challenge to global health care systems. In March 2019, the Chinese government launched the National Volume-Based Procurement (NVBP) program to enhance healthcare affordability by reducing drug prices, but the program’s impact on medical expenditure for individual patients remains unclear.

Objectives: To assess whether the implementation of NVBP has reduced medical expenditure for inpatients and outpatients treated for different diseases, and to further evaluate the impact differ among different hospitals.

Methods:

Design: Using a quasi-experimental interrupted time-series design, we conducted linear mixed-effects (LME) models to assess the medical expenditure for treating hypertension, dyslipidemia, diabetes, and chronic ischemic heart disease (IHD).
Setting: A municipality city in China.
Participants: 1,172,280 patients with hypertension diagnosed between 2015 and 2021 were identified from Tianjin Health Care Big Data Platform in China.
Exposures: Implementation of NVBP program.
Main Outcomes and Measures: Primary outcomes included total expenditures per visit for outpatients and total expenditures per admission for inpatients.

Results: A total of 3,223,973 outpatient visits and 68,839 inpatient admissions were analyzed. For outpatient expenditures, the implementation of NVBP was associated with an overall decrease in total expenditure per visit, which was statistically significant for treating hypertension [-16.3% (95% CI, -22.9% to -8.8%)], dyslipidemia [-28.0% (95% CI, -35.5% to -19.9%)], and diabetes [-12.3% (95% CI, -22.9% to -8.8%)], and not statistically significant for treating chronic IHD [-10.2% (95% CI, -20.4% to 1.4%)]. However, the effects varied on hospital level, despite a consistent trend of reduction in outpatient expenditures. The reduction rate was insignificant in 37.9% (34/71) hospitals for treating hypertension, 12.1% (8/66) for dyslipidemia, 71.7% (43/60) for diabetes. For inpatient expenditures, the implementation of NVBP was associated with no significant changes in the total expenditures for treating diabetes [-1.29% (95% CI, -4.65% to 11.29%)] and for chronic IHD [2.92% (95% CI, -4.78% to 2.35%)], but with significant decrease in drug expenditures for treating diabetes [ β = -404.47 (95% CI, -726.48 to -82.46)].

Conclusions: This study provided the long-term effects of NVBP on medical expenditures and found that the NVBP implementation was associated with significant reductions in total outpatient expenditures per visit for treating hypertension, dyslipidemia, and diabetes in general, but its impact differs among hospitals. Health policy implementors need to consider this difference among hospitals to improve the policy implementation.