1. Changes in Use of Antidiabetic Medications Following Price Regulations in China (1999-2009) Christine Lu Harvard Medical School and Harvard Pilgrim Health Care Institute WHO Collaborating Center in Pharmaceutical Policy ICIUM 2011 (Poster 878) WHO Collaborating Center in Pharmaceutical Policy

2. Acknowledgements  Co-investigators: Dennis Ross-Degnan, Anita Wagner, Bao Liu, Peter Stephens  IMS Health for providing the data  Location of work: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute  Conflict of interest: None

3. Background – China  High and rapidly growing drug expenditures Medicines = 48% of total health expenditures  24 rounds of price reductions (by 5 to 40%) between 1997 and 2007  Most medicines sold in hospitals  Diabetes is a major burden

4. Study aim To examine the effects of two targeted price regulations on purchasing of insulin and oral hypoglycemics in Chinese hospitals: 1. Dec 2001: Specific human insulin (non-mixed) and several oral hypoglycemic products 2. Dec 2006: Specific animal insulin (non-mixed) and a large number of oral hypoglycemic products

5. Methods  Antidiabetic medications: Animal and human insulin products Oral hypoglycemics: alpha-glucosidase inhibitors, biguanides, glinides, sulfonylureas, and thiazolidinediones  Data source: Quarterly data on purchase volume of antidiabetic products collected by IMS Health (1999-2009) Price regulation policies obtained from the China Economic Information Network

6. Methods  Outcome measures: Sales volume: number of standard units sold per 1000 population per quarter for a specific product Market share: percentage of total market volume represented by price-regulated products Among all antidiabetic products Within specific drug classes  Interrupted time-series design and segmented regression analysis (Wagner AK et al. J Clin Pharm Ther 2002)

7. Results: Insulin products, 2001 Increase in trend of sales volume (0.06 standard units sold/1000 people/quarter)

8. Increase in trend of sales volume (0.18 standard units sold/1000 people/quarter) Results: Insulin products, 2006

9. Results: Oral hypoglycemics, 2001 No observable change in sales volume following price reduction

10. Results: Oral hypoglycemics, 2006 Increase in trend of sales volume (10.3 standard units sold/1000 people/quarter)

11. Summary  Dec 2001 price regulation: Increase in market volume trend of insulin products Use of oral hypoglycemic products stable  Dec 2006 price regulation: Increases in market volume trend of both insulin products & oral hypoglycemic products No change in market share of price-regulated insulin and oral hypoglycemic products  Challenges: No information on hospital purchasing prices

12. Conclusions & research recommendations  China’s targeted approach to drug price reductions may have: Been associated with increases in utilization of antidiabetics Improved access to essential medications OR increased prescribing quantities OR both  Open research questions: Did price and volume changes result in cost savings for Patients? Hospitals? The system? Did price and volume changes result in better quality of care? What are effects of China’s 2009 health care reform which mandates 0% markup on essential medicines in health centers?