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Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China

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Abstract

Background

The global prevalence of hepatitis B virus (HBV) has presented a persistent challenge for public health prevention and treatment. However, studies that assess the public's access to anti-HBV drugs are absent.

Aim

To examine the availability, pricing, and affordability of anti-HBV drugs in Jiangsu province, China and provide recommendations for improvement.

Method

An enhanced methodology developed by the World Health Organization (WHO) and Health Action International was applied in a cross-sectional study that included 1026 healthcare facilities distributed in 13 prefectural-level cities in Jiangsu province.

Results

Since almost all drugs had an availability of less than 30%, the accessibility of anti-HBV drugs was notably low. Primary healthcare facilities had the lowest availability, reporting 1.4% for Original Brands (OBs) and 1.7% for lowest-priced generics (LPGs). Furthermore, the northern Jiangsu region recorded the lowest availability at 0.7%. LPGs demonstrated higher availability than OBs, with median availability probabilities of 2.6% and 1.4%, respectively. The drugs listed on the WHO Essential Medicines List exhibited higher availability than those on other lists. The median price ratios for OBs, LPGs, and volume-based purchasing drugs were 0.83, 0.50, and 0.27, respectively, less than 1.5 times the international reference price. Despite favorable pricing, affordability rate was 23% for urban residents and 0% for rural residents, which was discouraging.

Conclusion

Low availability and affordability of anti-HBV drugs were observed. Policy recommendations should emphasize the improvement of LPG availability by incentivizing priority prescribing. Healthcare subsidies should be provided more effectively and equitably.

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References

  1. World Health Organization. Health topics, Hepatitia. 2023. https://www.who.int/zh/health-topics/hepatitis#tab=tab_1,2023. Accessed 1 Jun 2023.

  2. Schweitzer A, Horn J, Mikolajczyk RT, et al. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546–55.

    Article  PubMed  Google Scholar 

  3. Tang LSY, Covert E, Wilson E, et al. Chronic hepatitis B infection: a review. JAMA. 2018;319(17):1802–13.

    Article  CAS  PubMed  Google Scholar 

  4. Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45(4):529–38.

    Article  PubMed  Google Scholar 

  5. Roberts LR. Untreated chronic hepatitis B is associated with a higher risk of extrahepatic malignancies. J Clin Oncol. 2022;40(29):3357–60.

    Article  PubMed  Google Scholar 

  6. Forbes C, Lavoie L, Satram S, et al. Global importance of new treatment strategies to efforts to control hepatitis B virus. Expert Rev Anti Infect Ther. 2023;21(8):847–62. https://doi.org/10.1080/14787210.2023.2225771.

    Article  CAS  PubMed  Google Scholar 

  7. National Health Commission of the People's Republic of China. 2021 China Health Care Statistics Yearbook. 2022. http://www.nhc.gov.cn/mohwsbwstjxxzx/tjtjnj/202305/304a301bfdb444afbf94b1a6c7f83bca.shtml. Accessed 1 Jun 2023.

  8. Younossi ZM, Wong G, Anstee QM, et al. The global burden of liver disease. Clin Gastroenterol Hepatol. 2023;21(8):1978–91.

    Article  PubMed  Google Scholar 

  9. Wan YM, Wang FZ, Zhang GM, et al. Risk of hepatitis B infection and burden of disease in adults. China Vaccine Immunity. 2019;25(05):611–6. https://doi.org/10.19914/j.cjvi.2019.05.027.

    Article  Google Scholar 

  10. Yao LX, Lin S, Huang JF, et al. Analysis and prediction of the burden of disease of viral hepatitis B-related diseases in China from 1990 to 2030. Chin J Schistosomiasis Control. 2023;35(05):464–75+496. https://doi.org/10.16250/j.32.1374.2023068.

    Article  CAS  Google Scholar 

  11. Zhang S, Ma Q, Liang S, et al. Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China. J Viral Hepatitis. 2016;23(3):202–10.

    Article  CAS  Google Scholar 

  12. Yang N, Bertoletti A. Advances in therapeutics for chronic hepatitis B. Hepatol Int. 2016;10(2):277–85.

    Article  PubMed  Google Scholar 

  13. Kim JH, Jung SW, Byun SS, et al. Efficacy and safety of tenofovir in nucleos(t)ide-naïve patients with genotype C chronic hepatitis B in real-life practice. Int J Clin Pharm. 2015;37(6):1228–34. https://doi.org/10.1007/s11096-015-0193-1.

    Article  CAS  PubMed  Google Scholar 

  14. Lu Q. Analysis of the use of nucleoside (acid) analogues anti-hepatitis B virus drugs in the Third Hospital Affiliated to Nantong University from 2017–2019. J Clin Ration Drug Use. 2020;13(33):17–20+24.

    Google Scholar 

  15. Rupasinghe D, Choi JY, Kumarasamy N, et al. Viral hepatitis and the cascade of care among people living with HIV in the Asia-Pacific. HIV Med. 2022;23(9):959–68. https://doi.org/10.1111/hiv.13280.

    Article  CAS  PubMed  Google Scholar 

  16. Stockdale AJ, Meiring JE, Shawa IT, et al. Hepatitis B vaccination impact and the unmet need for antiviral treatment in Blantyre, Malawi. J Infect Dis. 2022;226(5):871–80. https://doi.org/10.1093/infdis/jiab562.

    Article  PubMed  Google Scholar 

  17. Zhu Y, Xu X, Fang W, et al. Availability, cost and affordability of selected antibiotics and antiviral medicines against infectious diseases from 2013 to 2019 in Nanjing, China. Trop Med Int Health. 2021;26(5):518–29.

    Article  PubMed  Google Scholar 

  18. Duong MH, Moles RJ, Chaar B, et al. Stakeholder perspectives on the challenges surrounding management and supply of essential medicines. Int J Clin Pharm. 2019;41(5):1210–9. https://doi.org/10.1007/s11096-019-00889-1.

    Article  PubMed  Google Scholar 

  19. Qi XY, Li ZR, Hao ZY. Analysis of the impact of the centralised procurement policy of state-organised drugs on the clinical application of selected ganciclovir and entecavir based on the interrupted time series method. China Pharm Ind. 2023;32(17):9–12.

    Google Scholar 

  20. Yuan J, Lu ZK, Xiong X, et al. Impact of national volume-based procurement on the procurement volumes and spending for antiviral medications of hepatitis B virus. Front Pharmacol. 2022;13:842944. https://doi.org/10.3389/fphar.2022.842944.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. World Health Organization. WHO model lists of essential medicines. 2023. http://www.who.int/medicines/publications/essentialmedicines/en/. Accessed 22 Aug 2023.

  22. Central Government of the People’s Republic of China, Departmental documents of the State Council. National Health Insurance Bureau Ministry of Human Resources and Social Security on the Issuance of the National Catalogue of Medicines for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2022). https://www.gov.cn/zhengce/zhengceku/2023-01/18/content_5737840.htm. Accessed 22 Aug 2023.

  23. Chinese Medical Association Hepatology Branch, Chinese Medical Association Infectious Diseases Branch. Guidelines for the prevention and treatment of chronic hepatitis B. Chin J Infect Dis. 2023;41(1):3–28.

    Google Scholar 

  24. Sun X, Wei J, Yao Y, et al. Availability, prices and affordability of essential medicines for children: a cross-sectional survey in Jiangsu Province, China. BMJ Open. 2018;8(10):e023646.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gong S, Cai H, Ding Y, et al. The availability, price and affordability of antidiabetic drugs in Hubei province, China. Health Policy Plan. 2018;33(8):937–47.

    Article  PubMed  Google Scholar 

  26. Leucht S, Samara M, Heres S, et al. Dose equivalents for antipsychotic drugs: the DDD method. Schizophrenia Bull. 2016;42(suppl_1):S90–4.

    Article  Google Scholar 

  27. World Health Organization. WHO Collaborating Centre for Drug Statistics Methodology, ATC/DDD Index 2023. 2023. https://www.whocc.no/atc_ddd_index/. Accessed 23 Aug 2023.

  28. Jiangsu Medical Protection Bureau Drugs and Medical Consumables Sunshine Purchasing Service Network, Volume-based drug list. http://ybj.jiangsu.gov.cn/col/col86465/index.html. Assessed 31 Oct 2023.

  29. Mu Y, Song K, Song Y. A cross-sectional study of price and affordability of drugs for rare diseases in Shandong Province, China. Int J Environ Res Public Health. 2022;19(20):13319.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jiangsu Provincial People’s Government. Jiangsu’s per capita disposable income of 49,862 yuan in 2022 higher than the national average. 2023. http://www.jiangsu.gov.cn/art/2023/2/9/art_84322_10745174.html. Assessed 13 June 2023.

  31. Charlton MR, Alam A, Shukla A, et al. An expert review on the use of tenofovir alafenamide for the treatment of chronic hepatitis B virus infection in Asia. J Gastroenterol. 2020;55(9):811–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Liu Z, Jin Q, Zhang Y, et al. Randomised clinical trial: 48 weeks of treatment with tenofovir amibufenamide versus tenofovir disoproxil fumarate for patients with chronic hepatitis B. Aliment Pharmacol Ther. 2021;54(9):1134–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cameron A, Ewen M, Ross-Degnan D, et al. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis [published correction appears in Lancet. 2009 Feb 21;373(9664):632]. Lancet. 2009;373(9659):240–9.

    Article  CAS  PubMed  Google Scholar 

  34. Hogerzeil HV, Liberman J, Wirtz VJ, et al. Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet. 2013;381(9867):680–9.

    Article  PubMed  Google Scholar 

  35. Yuan J, Lu ZK, Xiong X, Jiang B. Lowering drug prices and enhancing pharmaceutical afordability: an analysis of the national volume-based procurement (NVBP) effect in China. BMJ Glob Health. 2021;6(9):e005519.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zhu Y, Xu X, Fang W, et al. Availability, cost and affordability of selected antibiotics and antiviral medicines against infectious diseases from 2013 to 2019 in Nanjing, China. Trop Med Int Health. 2021;26(5):518–29. https://doi.org/10.1111/tmi.13559.

    Article  PubMed  Google Scholar 

  37. Wang X, He X, Zhang P, et al. The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis. Int J Equity Health. 2023;22(1):200. https://doi.org/10.1186/s12939-023-02006-1.

    Article  PubMed  PubMed Central  Google Scholar 

  38. The Latest! Summary of outpatient reimbursement policies for employees’ health insurance in 13 cities in Jiangsu province out. In Jiangsu Pharmaceutical Business Association, Wechat public account. 2023. https://mp.weixin.qq.com/s/czl5ibPhPAgLrzzS9XzC5g. Accessed 23 Aug 2023.

  39. Jiangsu Province to start the residents of medical insurance contributions: what standards, how to pay, outpatient can be reimbursed how much money? In Post-90s Coalition, Wechat public account. 2023. https://mp.weixin.qq.com/s/cqoZKq1Enuq0Ztuz9hwHsw. Accessed 1 Nov 2023.

  40. Trouiller P, Torreele E, Olliaro P, et al. Drugs for neglected diseases: a failure of the market and a public health failure? Trop Med Int Health. 2001;6(11):945–51.

    Article  CAS  PubMed  Google Scholar 

  41. Armstrong-Hough M, Sharma S, Kishore SP, et al. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: a descriptive time series analysis. PloS One. 2020;15(12):e0241555.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Quinn EK, Massey PD, Speare R. Communicable diseases in rural and remote Australia: the need for improved understanding and action. Rural Remote Health. 2015;15(3):3371.

    PubMed  Google Scholar 

  43. Si L, Chen M, Palmer AJ. Has equity in government subsidy on healthcare improved in China? Evidence from the China’s National Health Services Survey. Int J Equity Health. 2017;16(1):6. https://doi.org/10.1186/s12939-017-0516-z.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ozaras R, Corti G, Ruta S, et al. Differences in the availability of diagnostics and treatment modalities for chronic hepatitis B across Europe. Clin Microbiol Infect. 2015;21(11):1027–32.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We want to thank the Jiangsu Provincial Health Department for their help in distributing the questionnaires, and we appreciate the cooperation and participation of the hospital pharmacists and clinical workers.

Funding

This project was supported by the Soft Science Research of Jiangsu Innovation Support Programme: Study on the Impact of Volume-based Procurement Policy on the Innovation Capacity of Pharmaceutical Industry in Jiangsu Province (No. BR2023018-5).

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Authors and Affiliations

  1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 210009, People’s Republic of China

    Yue Li & Tao Lu

  2. Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People’s Republic of China

    Mengdie Zhang & Xin Li

  3. Department of Pharmacy, The First People’s Hospital of Lianyungang, Lianyungang, People’s Republic of China

    Yi Xu

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  1. Yue Li
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Correspondence to Tao Lu.

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Li, Y., Zhang, M., Xu, Y. et al. Availability, price, and affordability of anti-hepatitis B virus drugs: a cross-sectional study in China. Int J Clin Pharm (2024). https://doi.org/10.1007/s11096-024-01706-0

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