The impacts of the "4+7" pilot policy on the volume, expenditures, and daily cost of Serotonin-Specific Reuptake Inhibitors (SSRIs) antidepressants: A quasi-experimental study

Xiaotong Wen; Zhaolun Wang; Luxinyi Xu; Jia Luo; Xin Geng; Xiaoze Chen; Ying Yang; Dan Cui; Zongfu Mao

doi:10.3389/fphar.2022.829660

The impacts of the "4+7" pilot policy on the volume, expenditures, and daily cost of Serotonin-Specific Reuptake Inhibitors (SSRIs) antidepressants: A quasi-experimental study

Front Pharmacol. 2022 Aug 17:13:829660. doi: 10.3389/fphar.2022.829660. eCollection 2022.

Authors

Xiaotong Wen^{1

2}, Zhaolun Wang^{1

2}, Luxinyi Xu^{1

2}, Jia Luo^{1

2}, Xin Geng^{1

2}, Xiaoze Chen³, Ying Yang^{1

2}, Dan Cui^{1

2}, Zongfu Mao^{1

2}

Affiliations

¹ School of Public Health, Wuhan University, Wuhan, China.
² Global Health Institute, Wuhan University, Wuhan, China.
³ Xi'an Jiao Tong Liverpool University, Suzhou, China.

Abstract

Objectives: The purpose of this study was to quantitatively evaluate the impacts of the"4 + 7" pilot policy on purchase volume, purchase expenditures, and daily cost and to find the changes in the use of SSRIs. Methods: Data was collected covering 31 months, before, during, and after the "4 + 7" pilot policy was implemented in Shenzhen. Interrupted time-series (ITS) analysis was used to examine whether there had been a significant effect with the onset of the "4 + 7" pilot policy in March 2019. Findings: The daily cost of policy-related drugs had a substantial drop of 2.93 yuan under the "4 + 7" pilot policy. The result has shown a 76.70% increase in volume and a 3.39% decrease in the expenditure on policy-related drugs. This study found that the "4 + 7" pilot policy increased the proportion of purchasing winning drugs, with an increment of 85.60 percent. After the implementation of the "4 + 7" pilot policy, policy-related drugs decreased by 443.55thousand Chinese yuan. The study indicated that volume of winning products significantly increased as shown in the regression with a level coefficient (β ₂ ) of -224.17 (p < 0.001) and trend coefficient (β ₃ ) of 15.74 (p < 0.001). The result revealed that both volume and expenditures on branded products showed a significant decrease in the regression in the post-intervention period (level coefficient of volume: β ₂ = -57.65, p < 0.01, trend coefficient of volume: β ₃ = -3.44, p < 0.01; level coefficient of expenditure: β ₂ = -712.98, p < 0.01, trend coefficient of expenditure: β ₃ = -40.10, p < 0.01). Conclusion: The volume-based procurement has successfully led to price reductions and improved the affordability of medicines, especially for those with chronic diseases. The volume-based procurement has demonstrated initial success in reshaping the composition of the Chinese pharmaceutical market in favor of generics with high quality and low prices.

Keywords: antidepressants; expenditures; interrupted time-series analysis (ITSA); price; quasi-experimental design and analysis; serotonin-specific reuptake inhibitors (SSRIs); the “4+7” pilot policy; volume-based procurement.