EFFECTS OF CHINA'S NATIONAL VOLUME-BASED PROCUREMENT ON DRUG AFFORDABILITY, UTILIZATION, AND SUBSTITUTION: A STRUCTURED EVIDENCE SYNTHESIS
Author(s)
Xinchang Liu, MSc1, Yan HE, MSc1, Qiwei Peng, MSc2, Wai-kit Ming, MBA, MPH, PhD, MD1.
1City University of Hong Kong, Hong Kong, China, 2The Chinese University of Hong Kong, Shenzhen, China.
1City University of Hong Kong, Hong Kong, China, 2The Chinese University of Hong Kong, Shenzhen, China.
OBJECTIVES: To synthesize quantitative evidence from a focused PubMed/MEDLINE evidence-mapping sprint on China's national volume-based procurement (NVBP) and centralized drug procurement policies, with emphasis on drug affordability, utilization, expenditure, and originator-to-generic substitution, and to assess whether outcomes appear sufficiently comparable for later meta-analysis.
METHODS: We searched PubMed/MEDLINE for NVBP, national centralized drug procurement, and 4+7 procurement studies. Eligible records reported quantitative policy-evaluation evidence on drug price, DDDc, utilization, expenditure, bid-winning or selected drug use, or generic/originator substitution. PMCID-linked full texts and authorized user-provided PDFs were retrieved when available. Studies were mapped by design, outcome family, full-text availability, and synthesis role. Interrupted time-series (ITS) and difference-in-differences (DID) evidence were kept analytically separate.
RESULTS: The search identified 163 records; 162 were screened. Thirty-seven core quantitative drug-policy studies were mapped: 26 ITS, 5 DID, 2 natural/quasi-experimental, 1 cross-sectional/survey, and 3 design-unclear records. Local Results sections were available for 36 core studies; 1 additional core study remained abstract-level only. Full-text signal mapping identified affordability or cost outcomes in 22 studies, utilization outcomes in 30, expenditure outcomes in 27, and substitution or selected/non-selected drug structure outcomes in 23. Twenty-seven studies reported model estimates, confidence intervals, p-values, or related uncertainty information. Sixteen ITS studies were triaged as possible narrow affordability meta-analysis candidates, pending effect-scale, overlap, and risk-of-bias checks.
CONCLUSIONS: The current evidence base supports structured synthesis of NVBP effects on drug affordability, utilization, expenditure, and substitution. Heterogeneous estimands, outcome definitions, policy timing, and potentially overlapping procurement datasets argue against reporting a single pooled NVBP effect.
METHODS: We searched PubMed/MEDLINE for NVBP, national centralized drug procurement, and 4+7 procurement studies. Eligible records reported quantitative policy-evaluation evidence on drug price, DDDc, utilization, expenditure, bid-winning or selected drug use, or generic/originator substitution. PMCID-linked full texts and authorized user-provided PDFs were retrieved when available. Studies were mapped by design, outcome family, full-text availability, and synthesis role. Interrupted time-series (ITS) and difference-in-differences (DID) evidence were kept analytically separate.
RESULTS: The search identified 163 records; 162 were screened. Thirty-seven core quantitative drug-policy studies were mapped: 26 ITS, 5 DID, 2 natural/quasi-experimental, 1 cross-sectional/survey, and 3 design-unclear records. Local Results sections were available for 36 core studies; 1 additional core study remained abstract-level only. Full-text signal mapping identified affordability or cost outcomes in 22 studies, utilization outcomes in 30, expenditure outcomes in 27, and substitution or selected/non-selected drug structure outcomes in 23. Twenty-seven studies reported model estimates, confidence intervals, p-values, or related uncertainty information. Sixteen ITS studies were triaged as possible narrow affordability meta-analysis candidates, pending effect-scale, overlap, and risk-of-bias checks.
CONCLUSIONS: The current evidence base supports structured synthesis of NVBP effects on drug affordability, utilization, expenditure, and substitution. Heterogeneous estimands, outcome definitions, policy timing, and potentially overlapping procurement datasets argue against reporting a single pooled NVBP effect.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR273
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas