OBJECTIVES

China implemented a pilot Volume-Based Procurement (VBP) program in 2019 [Tang M et al, Drug Discoveries Therapeutics, 2019], with the intention of lowering drug costs and increasing treatment access. We examined the impact of VBP on the utilization and switch pattern of branded and generic atorvastatin, pre- vs. post-VBP implementation using real-world data from Guangzhou.

METHODS

This retrospective observational study analyzed atorvastatin prescription claims from Guangzhou Health Insurance which covers approximate 17 million people. Patients (aged ≥18) with cardiovascular diseases who were prescribed atorvastatin between 1APR2018 and 30SEP2019 were included. Total numbers of branded or generic atorvastatin prescriptions, switches from branded to generic and switchbacks, were examined in two 6-month periods: pre- (1APR2018-30SEP2018) and post-VBP implementation (1APR2019-30SEP2019). Analyses were also carried out by disease, sex and age subgroups.

RESULTS

From the pre- to post-VBP periods, the total number of atorvastatin prescriptions increased 49% from 497,445 to 742,630. The increase was driven by a 60-fold increase in generic prescriptions, despite 53% decrease in branded prescriptions. Of the 233,545 patients prescribed branded atorvastatin, 78,249 (34%) switched to generic atorvastatin in post-VBP period, a 76-fold increase from the 0.44% switches in the pre-VBP period. Of the 78,249 switchers in the post-VBP period, 22% switched back to branded atorvastatin. The percentages of back-switchers varied by disease (coronary heart disease (24%), dyslipidemia (23%), stroke (21%), hypertension (20%), and diabetes (19%), by sex (male, 23%) and female (21%)), and by age group (<60yrs (21%) and 60+yrs (23%)).

CONCLUSIONS

The VBP program in Guangzhou increased patient access to atorvastatin by 49%, driven by 60-fold increase in generic prescriptions. Approximately 2/3 of patients who initiated treatment on branded atorvastatin did not switch to generics, and about 1/5 switchers switched-back from generic to branded atorvastatin, indicating there remained a great need for branded medication.