OBJECTIVES: To investigate the impact of targeted-drugs on therapeutic models, expenditure patterns and disease burden of cancer patients with the purpose of providing reference for price negotiation and payment policy-making of National Reimbursement Drug List (NRDL).

METHODS: A retrospective observational study was conducted based on China Health Insurance Research Association (CHIRA) database in 2016. The year-round treatment data (including in-patient-department and out-patient-department) of sample cancer patients (with C00-C97 codes defined by ICD 10) were extracted, and their medical resource utilization, expenditure patterns and drug use mode were analyzed and described.

RESULTS: Medical expense of cancer patients is much higher than average level: with 0.71% distribution of total visits, their medical constitutes 6.71%, figures of visits and hospitalization days of each cancer patient (OPD 16.44, IPD 2.90, 32.70d) are higher than average (6.04, 1.54, 16.11d), their annual medical cost is 27,331 RMB. The medical cost of top 5 cancer diseases constitutes 54.02% of total: the cost difference expenditure and treatment patterns among cancers is obvious, the proportion paid by fund remains similar. Among prescribed drugs, the share of directly treating drugs takes less than 25%. The medical cost of patients treated by targeted-drugs brings sharp stressing impact on Basic Medical Insurance: the number of patient treating by targeted-drugs is not large yet but with rapid growth rate.

CONCLUSIONS: Listing targeted-drugs into NRDL by price negotiation will impact patient behavior, fund safety and market development, increase drug accessibility and better satisfy clinical demands. With consideration of improving price negotiation and payment management, we suggest:

1. Keep balance of fund utilization between cancer patients and of other diseases.
2. Improve relevant policy measures to promote rational use on targeted-drugs.
3. Evaluate targeted-drugs clinical value based on evidence, and closely monitor.

4. Decrease disease burden of cancer patients with a variety of methods.