Presentation (CTI)

OBJECTIVES: To analyze the utilization characteristics and generational substitution patterns of drugs from the National Drug Price Negotiation (NDPN) for non-small-cell lung cancer (NSCLC) in a first-tier city in China, and to provide references for optimizing clinical medication, improving medical insurance policies, and constructing the "Chinese scheme" for NDPN.
METHODS: A total of 48,236 health insurance claims records from a city between July 2018 and December 2024 were used, encompassing 26 NRDL drugs (including 8 EGFR-TKIs and 6 ALK-TKIs). Key indicators included the frequency of health insurance claims, drug costs, and defined daily doses (DDDs). Analyses were performed using Theil-Sen slope estimation, Mann-Kendall test, and sliding t-test.
RESULTS: From 2018 to 2024, the frequency of health insurance claims for NSCLC-related NRDL drugs increased from 1,484 to 12,519 (a cumulative growth of over 7 times). Both total DDDs and drug costs showed a significant upward trend (P<0.001), with the proportion of DDDs trend mutations (73.7%) higher than that of drug costs (47.4%). Generational substitution paths were differentiated: EGFR-TKIs exhibited "third-generation drugs substantially replacing first-generation drugs"—in the fourth quarter of 2024, third-generation drugs accounted for 95.0% of drug costs and 83.7% of DDDs; ALK-TKIs showed "second-generation drugs as the mainstay and third-generation drugs as supplements"—in the fourth quarter of 2024, second-generation drugs accounted for 61.7% of drug costs and 68.7% of DDDs, while third-generation drugs accounted for 27.7% of drug costs and 14.1% of DDDs.
CONCLUSIONS: The accessibility of innovative NSCLC drugs in the city has gradually improved. The iteration of clinical efficacy combined with medical insurance access has jointly driven the generational substitution of targeted drugs. Differences in substitution among drugs targeting different molecular subtypes provide key references for precise policy-making.