Theoretical And Empirical Study On The Drug Price Level

OBJECTIVES: To explore the best selection strategies of drug price indices using in China, and to provide precise drug price level of different administrative regulation levels(the essential and non-essential drugs), and different therapeutic categories(the antimicrobial and antineoplastic drugs).METHODS: Data of 30% random sample of enrollees from 2008-2010 Tianjin Urban Employee Basic Medical Insurance databases was used. Laspeyres, Paasches, Fisher and chained Fisher index methods were employed to measure the price level. Price indices were calculated both at molecule level(defined by active ingredient) and product level(defined by molecule, strength, preparation and manufacturer). Units of quantity and price were defined as per DDD, per milligram of active ingredient, and per minimum unit separately to calculate the indices.RESULTS:(1) From 2008Q1 to 2010Q4, there were 12.4 kinds of the antimicrobial basic medical insurance drugs(BMIDs), 3.2 kinds of the antineoplastic BMIDs, 20.7 kinds of the antimicrobial essential drugs(EDs), 7.3 kinds of the antimicrobial insurance non-essential drugs(INEDs) in per molecule, these indicated that the competition of the antimicrobial BMIDs was larger than the antineoplastic BMIDs, and the competition of the antimicrobial EDs was larger than the antimicrobial INEDs;(2) At the molecule level, 85% of the antimicrobial BMIDs, 77% of the antineoplastic BMIDs, 98% of the antimicrobial EDs, 78% of the antimicrobial INEDs were constantly used;At the product level, only 26% of the antimicrobial BMIDs, 39% of the antineoplastic BMIDs, 20% of the antimicrobial EDs, 33% of the antimicrobial INEDs were constantly used, it suggested that with the narrower drug definition, the less of drugs were constantly used;(3) The price level of Antimicrobial EDs and INEDs decreased heavily, and the former decreased faster than the latter(43% vs. 16%, Chained Fisher-DDD, at the molecule level);(4) The price level of antimicrobial BMIDs had decreased heavily, while price of antineoplastic BMIDs increased slightly(decreased 26% vs. increased 2%);(5) For the antimicrobial BMIDs, the price indices at molecule level decreased faster than the counterparts at product level(decreased 26% vs. decreased 9%); while for the antineoplastic BMIDs, at the molecule level the price indices increased, but at the product level the price indices decreased(increased 2% vs. decreased 5%,), which suggested that the cheap products substituted for the costly ones in the antimicrobial BMIDs molecule, but in the antineoplastic BMIDs molecule there was a opposite substitution effect;(6) For antimicrobial BMIDs, Laspeyres consistently exceeded Paasches ones(0.79 vs. 0.68, 2010Q4), while there were opposite results for antineoplastic BMIDs(1.01 vs. 1.03, 2010Q4), which suggested that there was normal supply-demand relationship for the antimicrobial BMIDs, but for the antineoplastic BMIDs the supply-demand relationship was abnormal;(7) For all the study drugs, the results of Chained Fisher and unchained counterparts were similar, which suggested that the price of newer and older drugs changed at similar rate.CONCLUSIONS:(1) Chained Fisher index maybe the best choice to measure the drug price level in China at the molecule level and using DDD as the measurement unit;(2) The drug price level variations were very different among different administrative regulation levels, and among different therapeutic categories;(3) The relatively cheap antimicrobial BMIDs were more used, but, which was contrary to the antineoplastic BMIDs.