Ongoing initiatives to improve prescribing efficiency in China; statins as a case history

Introduction: Pharmaceutical expenditure rose by 16% per annum in China during the past decade, and now represents 46% of total healthcare expenditure. Initiatives to moderate growth include pricing regulations for pharmaceuticals and encouraging International Nonproprietary Name (INN) prescribing. However, there is limited monitoring of physician prescribing and current incentives encourage hospitals and physicians to profit from drug procurement. Objective: Assess changes in statin utilization and expenditure as additional generics are launched. Subsequently, compare results in China with findings among European countries to provide future guidance. Methods Observational retrospective study of statin utilization and procurement expenditure from 2004 to 2013 in two large teaching hospital groups. Results: Statin utilization rose 32-fold in one hospital group and 54-fold in the other. Expenditure also increased but to a lesser extent, i.e. from just over Renminbi 'yuan' (CNY) 0.65 million in 2004 to CNY 15.3 million in 2013 in one hospital group and from CNY 0.49 to CNY 19.3 million in the other. Atorvastatin (originator) was the most utilized statin. Utilization of each generic statin was typically low, e.g. 10% in 2013 in one hospital group. Procurement prices fell over time, greatest for generic simvastatin (-74% to -91%) mirroring data from European countries. However, no increase in their prescribing was observed. In fact, a significant decrease in generic prescribing was seen in one hospital group between 2004 and 2013. Conclusion: There are considerable opportunities to improve prescribing efficiency in China based on European experience. However, current incentives encouraging hospitals and physicians to profit from drug procurement need to be addressed.