Background The exorbitant cost of chronic disease medications poses a shared challenge for healthcare systems worldwide. China introduced the national volume-based procurement (NVBP) policy in 2018, aiming to leverage market mechanisms to lower medication costs and rationalize prescription patterns. Using oral antidiabetic drugs as a case study, this study analyzes the comprehensive impact of NVBP policy on the chronic disease medication market in Chinese public hospitals. Methods Data were obtained from the NVBP platform, encompassing procurement records from public hospitals across China from January 2018 to December 2022. (by month and province). The study selected oral antidiabetic drugs from the previous five NVBP batches as the sample, applying the anatomical therapeutic chemical/defined daily dose (ATC/DDD) method to standardize medication consumption (defined daily doses, DDDs) and expenditure (defined daily cost, DDDc). Price changes were assessed by Price index, drug consumption and expenditure were analyzed by quantity and cost indices, the influence on market structure was assessed by drug spending and sales proportions and market concentration rate. Interrupted time series (ITS) analysis was applied to quantify the policy effects. Results The overall price of oral antidiabetic drugs decreased significantly by approximately 60% (P < 0.001) after the implementation of NVBP policy, with prices of bid-winning drugs dropping by 74.2% (P < 0.001) and non-winning drugs by 50.3% (P < 0.001). The total drug quantity index (<InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="12913_2025_13449_Article_IEq1.gif" Format="GIF" Height="19" Rendition="HTML" Resolution="72" Type="Linedraw" Width="20" /> </InlineMediaObject> <EquationSource Format="TEX">\(\:{I}_{Q}\)</EquationSource> </InlineEquation>) increased by 86.1%, while the total drug expenditure variation index (<InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="12913_2025_13449_Article_IEq2.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">\(\:{I}_{\text{E}}\)</EquationSource> </InlineEquation>) decreased by 50.2% (P < 0.001), particularly the consumption of bid-winning drugs surging by 1094.1% (P < 0.001). The expenditure substitution rate of generic drugs increased from 62 to 73%, with the market substitution rate increased from 71 to 88%. Market concentration rate significantly decreased, with Concentration Ratio 5 (CR5) declining by 23.6% and Herfindahl-Hirschman Index (HHI) declining from 0.11 to 0.07 (P < 0.001), suggesting that market competition became more dispersed. Conclusions The NVBP policy effectively reduced the expenditures of chronic disease drugs, enhances therapeutic availability, and promoted the replacement of brand-name drugs by generic drugs. Rather than leading to a market monopoly, the policy enhanced competition in the antidiabetic drug sector, serving as an empirical reference for other countries seeking to resolve drug cost challenges through centralized procurement.

The impacts of the national volume-based procurement policy on the chronic disease medication market in China’s public hospitals: a case study of medications for diabetes

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2025年10月1日

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Biao Wang,
Kai Xiao,
Hao Xia,
Qianqian Yu,
Gan Wang,
Rui Huang,
Junyu Niu,
Li Luo

摘要

Background

The exorbitant cost of chronic disease medications poses a shared challenge for healthcare systems worldwide. China introduced the national volume-based procurement (NVBP) policy in 2018, aiming to leverage market mechanisms to lower medication costs and rationalize prescription patterns. Using oral antidiabetic drugs as a case study, this study analyzes the comprehensive impact of NVBP policy on the chronic disease medication market in Chinese public hospitals.

Methods

Data were obtained from the NVBP platform, encompassing procurement records from public hospitals across China from January 2018 to December 2022. (by month and province). The study selected oral antidiabetic drugs from the previous five NVBP batches as the sample, applying the anatomical therapeutic chemical/defined daily dose (ATC/DDD) method to standardize medication consumption (defined daily doses, DDDs) and expenditure (defined daily cost, DDDc). Price changes were assessed by Price index, drug consumption and expenditure were analyzed by quantity and cost indices, the influence on market structure was assessed by drug spending and sales proportions and market concentration rate. Interrupted time series (ITS) analysis was applied to quantify the policy effects.

Results

The overall price of oral antidiabetic drugs decreased significantly by approximately 60% (P < 0.001) after the implementation of NVBP policy, with prices of bid-winning drugs dropping by 74.2% (P < 0.001) and non-winning drugs by 50.3% (P < 0.001). The total drug quantity index ( \(\:{I}_{Q}\) ) increased by 86.1%, while the total drug expenditure variation index ( \(\:{I}_{\text{E}}\) ) decreased by 50.2% (P < 0.001), particularly the consumption of bid-winning drugs surging by 1094.1% (P < 0.001). The expenditure substitution rate of generic drugs increased from 62 to 73%, with the market substitution rate increased from 71 to 88%. Market concentration rate significantly decreased, with Concentration Ratio 5 (CR5) declining by 23.6% and Herfindahl-Hirschman Index (HHI) declining from 0.11 to 0.07 (P < 0.001), suggesting that market competition became more dispersed.

Conclusions

The NVBP policy effectively reduced the expenditures of chronic disease drugs, enhances therapeutic availability, and promoted the replacement of brand-name drugs by generic drugs. Rather than leading to a market monopoly, the policy enhanced competition in the antidiabetic drug sector, serving as an empirical reference for other countries seeking to resolve drug cost challenges through centralized procurement.