OBJECTIVES : China introduced “Volume-based Procurement (VoBP)” for medical products to contain healthcare costs recently. This study aims to understand the clinical and economic impacts associated with the utilization of different PIVCs resulting from the implementation of VoBP.

METHODS : Semi-structured interviews were conducted with qualifying nurses in Nanjing and Linyi, the pilot cities implementing VoBP for PIVCs. Nurses who used a leading multinational company’s (MNC’s) PIVCs before VoBP and changed to China local brands after VoBP were included. A conceptual framework was developed to systematically organize defined concepts (PIVC placement, complications, product issues, and training). A saturation grid was created to ensure sufficient sample size. Additionally, a cost model from healthcare system perspective was developed to evaluate the corresponding total costs considering the amount of PIVC use, product defects, complication managements, and nursing labor costs.

RESULTS : A total of 27 nurses from 16 clinical settings in Nanjing and Linyi were included. All domains listed in conceptual framework were mentioned in the first 15 interviews, indicating that saturation was achieved. After the change from MNC’s PIVCs to local brands, PIVCs used per patient increased from 2.0 to 3.5 and the average indwelling time decreased from 3.7 days to 2.1 days. Compared with MNC’s PIVCs, those from local brands were associated with a 0.9-minute increase in PIVC insertion time and a 9% relative decrease in first stick success rate. Increased complication, poor PIVC quality and reduced product training after PIVC change were also mentioned. Taking 100 inpatients as an example, the total costs increased by CNY1,573.3 (from CNY7,765.4 to CNY9,338.7) after PIVC product change.

CONCLUSIONS : PIVC product change following the implementation of VoBP may result in unexpected clinical performance issues and increased total costs. Therefore, establishing quality evaluation criteria, incorporating comprehensive economic assessment, and strengthening product monitoring mechanism are recommended for VoBP policy optimization on medical consumables.