OBJECTIVES: The negotiation and adjustment of the National Reimbursement Drug List (NRDL) in China plays a critical role in improving access to care. Yet, the long-term impact of these adjustments, especially on patients from varying socioeconomic backgrounds, were rarely studied. This research investigates the effects of the 2021 NRDL negotiations on health outcomes and financial burdens for patients with multiple sclerosis (MS), highlighting disparities across socioeconomic statuses.

METHODS: We utilized an extended cost-effectiveness analysis to assess the implications of the 2021 NRDL negotiations on disease-modifying therapies (DMTs) for MS. This analysis compared scenarios before and after the negotiations – initially, only one DMT was covered, whereas post-negotiation, two additional DMTs were included in the NRDL. We analyzed data from a patient survey conducted in 2022, including patient demographics, socioeconomic status, disease progression, treatment history, and associated costs. Using a Markov model, we projected the lifetime outcomes in terms of quality-adjusted life years (QALYs) and out-of-pocket expenses across various household income quintiles.

RESULTS: Incorporating new DMTs into the NRDL resulted in an average lifetime gain of 0.0087 QALYs per patient, alongside an increased financial burden of 5,352 RMB per patient. This impact was not uniformly distributed across income levels, indicating significant disparities in access to DMTs. Wealthier patients benefitted more in terms of both health outcomes and financial impacts, while those in lower socioeconomic brackets experienced lesser gains in QALYs and substantial increases in out-of-pocket expenses, particularly the second-lowest income group.

CONCLUSIONS: This analysis reveals a skewed benefit towards wealthier individuals following the NRDL updates related to DMTs for MS. It underscores the critical need for continued emphasis on health equity in the aftermath of NRDL negotiations. Effective monitoring and intervention strategies are necessary to ensure equitable access to therapies and to mitigate the financial impact on vulnerable groups.