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Background High prices of targeted anticancer medicines (TAMs) result in financial toxicity for patients and the health insurance system. How national price negotiation and reimbursement policy affect the accessibility of TAMs for cancer patients remains unknown. Methods In this population-based cohort study, we used national health insurance claims data in 2017 and identified adult patients with cancer diagnoses for which price-negotiated TAMs were indicated. We estimated the half-month prevalence of price-negotiated TAMs use before and after the policy implementation in September 2017. We calculated direct medical costs, out-of-pocket (OOP) costs, and the proportion of OOP cost for each cancer patient to measure their financial burden attributable to TAMs use. We performed segmented linear and multivariable logistic regression to analyse the policy impact. Results We included 39 391 of a total 118 655 cancer beneficiaries. After September 2017, the prevalence of price-negotiated TAMs use increased from 1.4%-2.1% to 2.9%-3.1% (P=0.005); TAMs users' daily medical costs increased from US$261.3 to US$292.5 (P<0.001), while median daily OOP costs (US$68.2 vs US$65.7; P=0.134) and OOP costs as a proportion of daily medical costs persisted (28.5% vs 28.5%; P=0.995). Compared with resident beneficiaries, the relative probability of urban employee beneficiaries on TAMs uses decreased after the policy (adjusted odds ratio (aOR)=2.4 vs aOR=2.2). Conclusions The government price negotiation and reimbursement policy improved patient access to TAMs and narrowed disparities among insurance schemes. China's approach to promoting the affordability of expensive medicines provides valuable experience for health policy decision-makers. [ABSTRACT FROM AUTHOR]

Objective To identify pharmaceutical policy changes during the economic recession in eight European countries and to determine whether policy measures resulted in lower sales of, and less expenditure on, pharmaceuticals. Methods Information on pharmaceutical policy changes between 2008 and 2011 in eight European countries was obtained from publications and pharmaceutical policy databases. Data on the volume and value of the quarterly sales of products between 2006 and 2011 in the 10 highest-selling therapeutic classes in each country were obtained from a pharmaceutical market research database. We compared these indicators in economically stable countries; Austria, Estonia and Finland, to those in economically less stable countries, Greece, Ireland, Portugal, Slovakia and Spain. Findings Economically stable countries implemented two to seven policy changes each, whereas less stable countries implemented 10 to 22 each. Of the 88 policy changes identified, 33 occurred in 2010 and 40 in 2011. They involved changing out-of- pocket payments for patients in 16 cases, price mark-up schemes in 13 and price cuts in 11. Sales volumes increased moderately in all countries except Greece and Portugal, which experienced slight declines after 2009. Sales values decreased in both groups of countries, but fell more in less stable countries. Conclusion Less economically stable countries implemented more pharmaceutical policy changes during the recession than economically stable countries. Unexpectedly, pharmaceutical sales volumes increased in almost all countries, whereas sales values declined, especially in less stable countries. [TEXT NOT REPRODUCIBLE IN ASCII.] [TEXT NOT REPRODUCIBLE IN ASCII.] Objectif Identifier les changements de politique pharmaceutique au cours de la recession economique dans huit pays europeens et determiner si les mesures politiques ont entraine une baisse des ventes et des depenses en matiere de produits pharmaceutiques. Methodes Les informations relatives aux changements de la politique pharmaceutique entre 2008 et 2011 dans huit pays europeens ont ete obtenues a partir des publications et des bases de donnees sur la politique pharmaceutique. Les donnees sur le volume et la valeur des ventes trimestrielles des produits entre 2006 et 2011 pour les 10 classes therapeutiques les plus vendues dans chaque pays ont ete obtenues a partir d'une base de donnees d'etudes de marche sur les medicaments. Nous avons compare ces indicateurs dans des pays economiquement stables: Autriche, Estonie et Finlande, par rapport aux indicateurs mesures dans des pays moins stables: Grece, Irlande, Portugal, Slovaquie et Espagne. Resultats Les pays economiquement stables ont chacun mis en ceuvre 2 a 7 changements de politique, tandis que les pays moins stables en ont mis en oeuvre 10 a 22 chacun. Sur les 88 changements de politique identifies, 33 ont eu lieu en 2010 et 40 en 2011. Ils impliqualent des changements dans les paiements restants a charge pour les patients dans 16 cas, des plans d'augmentation des prix dans 13 cas et des baisses de prix dans 11 cas. Les volumes des ventes ont augmente moderement dans tous les pays a I'exception de la Grece et du Portugal qui ont connu de legeres baisses apres 2009. Les valeurs des ventes ont diminue dans les deux groupes de pays, mais elles ont davantage chute dans les pays moins stables. Conclusion Les pays moins stables economiquement ont mis en ceuvre plus de changements de politique pharmaceutique au cours de la recession que les pays economiquement stables. De maniere inattendue, les volumes des ventes de medicaments ont augmente dans presque tous les pays, alors que les valeurs des ventes ont baisse, en particular dans les pays moins stables. [TEXT NOT REPRODUCIBLE IN ASCII.] Objetivo Identificar los cambios en las politicas farmaceuticas en ocho paises europeos durante la recesion economica y determinar si las medidas de politica dieron lugar a una reduccion en las ventas y a un gasto menor en productos farmaceuticos. Metodos La informacion sobre los cambios en las politicas farmaceuticas entre 2008 y 2011 en ocho paises europeos se obtuvo a partir de publicaciones y bases de datos sobre politicas farmaceuticas. Los datos sobre el volumen y valor de las ventas trimestrales de productos entre 2006 y 2011 en las 10 clases terapeuticas mas vendidas en cada pais se obtuvieron de una base de datos de investigacion del mercado farmaceutico. Comparamos estos indicadores en los paises economicamente estables (Austria, Estonia y Finlandia) con los de los paises menos estables (Grecia, Irlanda, Portugal, Eslovaquia y Espana). Resultados Cada uno de los paises economicamente estables implemento entre dos y siete cambios de politicas, mientras que los paises menos estables implementaron entre 10 y 22 cada uno. De los 88 cambios de politicas identificados, 33 tuvieron lugar en el ano 2010 y 40, en el ano 2011. Implicaron cambios en los pagos directos por atencion sanitaria para pacientes en 16 casos, programas de aumento de precios en 13 casos y recortes de precios en 11. Los volumenes de ventas aumentaron moderadamente en todos los paises excepto en Grecia y Portugal, que experimentaron descensos ligeros a partir de 2009. El valor de las ventas disminuyo en ambos grupos de paises, si bien fue mayor en los paises menos estables. Conclusion Los paises economicamente menos estables implementaron mas cambios en las politicas farmaceuticas durante la recesion que los paises economicamente estables. Sorprendentemente, los volumenes de ventas de productos farmaceuticos aumentaron en casi todos los paises, mientras que el valor de las ventas disminuyo, especialmente en los paises menos estables., Introduction European public authorities struggle to maintain a high level of access to health care while restraining increases in expenditure associated with an ageing population and higher demand. (1-4) The [...]