How does mass purchasing change the prescription behavior of doctors and the distribution of prescription departments?

Medical Network News, March 3, in November 2020, Shanghai Sunshine Pharmaceutical Purchasing Network announced the results of the third batch of large-scale procurement, and then, in February 2021, announced the fourth batch of selected results
.
In less than 3 months, Shanghai Sunshine Pharmaceutical Purchasing Network announced the results of two batches of selections.
The frequency of publication was higher, indicating that the trend of normalization of centralized procurement has become more obvious.
Facing the soul torture of "whether to enter the collection"
.
In the face of this torture, business decision makers must have a lot of questions: What kind of changes will happen to the purchase amount of the products that have entered or have not entered the centralized procurement? Will the market share of the winning bidders of centralized procurement really increase? Will the distribution of prescription departments change before and after the variety is awarded the bid? This article takes the lipid-lowering drugs purchased by hospitals in Shanghai as an example, combined with the data of two data products, HMAS (Hospital Market Analysis System) and RAS (Hospital Prescription Analysis System), to answer these questions for everyone.
What is the impact on the procurement pattern of lipid-lowering drugs in regional hospitals
? The "first two batches of centralized procurement" mentioned in this article respectively represent the first batch of 4+7 centralized procurement announcements announced in December 2018 and the second batch of centralized procurement announcements announced in January 2020
.
Please refer to Table 1 for the first two batches of lipid-lowering varieties that entered the centralized procurement, and see Table 2 for the non-first two batches of lipid-lowering varieties that entered the centralized procurement.
These varieties are all purchased products in Shanghai
.
Table 1 List of the first two batches of lipid-lowering varieties entered into centralized procurement (supplied in Shanghai) Table 2 List of non-first two batches of lipid-lowering varieties entered into centralized procurement (procured in Shanghai)
What will happen to the purchase amount before and after the implementation of thewinning/ non-successful varieties of centralized procurement Variety?
Figure 1 shows the changes in the purchase amount of the two lipid-lowering varieties (Jingnuo 10mg + Ale 20mg) that entered the first batch of Shanghai centralized procurement
.
It can be seen from the figure that the purchase amount in 2018 has been on a steady upward trend, but in 2019 Q1 and Q2 there has been a sharp decline, with a month-on-month decline of 38.
63% and 54.
04%, which happened to be the time when the first batch of centralized procurement began.
Shanghai execution time
.
In the next three quarters (2019Q3-2020Q1), the purchase amount has stabilized, but the purchase amount in each quarter still has not reached 1/2 of the 2018 Q4
.
Then, in Q2 of 2020, when the second batch of centralized procurement began, the purchase amount once again fell sharply, with a month-on-month drop of as much as 92.
06%
.
The purchase amount in Q3 and Q4 has been the same as Q2, and has never reached 1/10 of Q1 in 2020
.
Figure 1 The first batch of centralized collection of lipid-lowering varieties (Jinnuo 10mg + Ale 20mg) Shanghai regional hospitals purchase amount and growth rate After analyzing the first batch of centralized collection of two lipid-lowering varieties, let’s take a look at the second batch of entering the collection.
How did the collected simvastatin tablets (Sandoz, 20mg) perform
? It can be seen from Figure 2 that in Q2 of 2020, the second batch of centralized procurement began, the purchase amount has increased significantly, but the reason for this increase seems to be the abnormal purchase amount in Q1
.
In the next two quarters (2020Q3-Q4), its purchase amount has dropped slightly, which is slightly inferior compared to the performance before the start of the second batch of centralized procurement
.
Figure 2 The second batch of centralized collection of lipid-lowering varieties (20mg simvastatin tablets, Sandoz) Shanghai area hospital procurement amount and growth rate How about the performance of the non-centralized collection of lipid-lowering varieties? Figure 3 shows the changes in hospital procurement amounts of non-the first two batches of lipid-lowering varieties (see Table 2 for specific varieties) that were not collected by Shanghai Central
.
It can be seen from the figure that in Q2 of 2019, the first batch of centralized procurement began, the change trend of the purchase amount was similar to that of centralized procurement (Jingnuo 10mg + Ale 20mg), and there was a sharp decline
.
In the future, its purchase amount has remained stable.
The implementation of the second batch of centralized procurement does not seem to have a great impact on its procurement, but compared to the amount before the first batch of centralized procurement, there is also a certain amount of money.
Degree of decline
.
Figure 3 Non-first two batches of centralized procurement of lipid-lowering varieties in Shanghai area hospital procurement amount and growth rate From the analysis of the above three graphs, we can summarize the trend of changes in the procurement amount of the lipid-lowering varieties that entered or did not enter Shanghai centralized procurement: 1) After the implementation of centralized procurement, the purchase amount of hospitals in Shanghai will show a downward trend, but the impact on varieties that enter the centralized procurement later may be less; 2) Those that have not entered the centralized procurement After the implementation of centralized procurement of varieties, the procurement amount of hospitals in Shanghai will also show a downward trend, but as the number of centralized procurement increases, this downward trend will become more and more stable
.

　　Has the market share of successful bidders increased?
Figure 4-Figure 6 respectively show the changes in the purchase amount/proportion of two batches of three types of centralized harvesting and lipid-lowering generic names, the original researched varieties and other non-successful varieties in Shanghai hospitals
.
Figure 4.
1 Procurement amount of rosuvastatin Shanghai hospital (million yuan) Figure 4.
2 Proportion of rosuvastatin procurement amount of Shanghai hospital (%) Figure 5.
1 Procurement amount of atorvastatin Shanghai hospital (million yuan) Figure 5.
2 Atorva Proportion of statin procurement in Shanghai hospital (%) Figure 6.
1 Procurement of simvastatin in Shanghai hospital (10,000 yuan) Figure 6.
2 Proportion of simvastatin procurement in Shanghai hospital (%) As can be seen from the figure, the three common names are at the beginning After the implementation of centralized procurement, the total purchase amount has dropped to a certain extent, with a decrease of more than 50% (the purchase amount of rosuvastatin and atorvastatin decreased by 65.
10% and 73.
13% in Q2 of 2019, respectively.
The purchase amount decreased by 77.
35% in Q2 of 2020)
.
The market share of the first batch of winning varieties (Jingnuo 10mg and Ale 20mg) did not show an upward trend after the implementation of centralized procurement.
Instead, the market share of original research products rose rapidly, and both exceeded 45% in Q4 of 2020.
The fixed market share is 47.
61%, and Lipitor’s market share is 72.
96%); the second batch of Sandoz simvastatin (20mg) won the bid after the implementation of the centralized procurement and the first batch of two varieties The performance is different.
Its market share has exceeded 95% after Q2 in 2020, while the original research Shu Jiangzhi's market share has remained within 5% after Q4 in 2018
.
Summarizing the above analysis, we can draw conclusions: 1) After the implementation of centralized procurement, the total purchase amount of hospitals in Shanghai has dropped by more than 50%; 2) The market share of the winning bidder may not necessarily be Upgrade, the specific situation depends on the variety
.

　　What are the changes in the distribution of prescription departments before and after the implementation of the centralized procurement of the winning bids?
Figures 7 and 8 respectively show the changes in the distribution of prescription amounts in the departments of Shanghai sample hospitals before and after the implementation of the first batch of Shanghai centralized procurement and lipid-lowering varieties (Jingnuo 10mg and Ale 20mg)
.
Before the implementation of centralized procurement, the amount of prescriptions from Q1 in 2018 to Q1 in 2019 was counted, and after the implementation of centralized procurement, the amount of prescriptions from Q2 in 2019 to Q2 in 2020 was counted
.
Figure 7 The proportion of prescription amounts in each department of Shanghai sample hospital before and after the implementation of Jingnuo 10mg centralized procurement Figure 8 The proportion of prescription amount in Shanghai sample hospitals before and after the implementation of Ale 20mg centralized procurement The rankings of the top 10 departments in the proportion of the prescription amount of these two varieties have not changed much, and the proportion of other departments outside the top 10 has increased to a certain extent; 2) The proportion of Jingnuo 10mg in the general medicine department is Certainly increased (the proportion increased by 45.
76%), while the proportion of prescriptions in general internal medicine clinics decreased (the proportion decreased by 47.
47%); 3) The proportion of Ale 20mg prescriptions in neurology clinics increased significantly (The proportion increased by 102.
09%), and the proportion of prescriptions in general medicine departments has decreased to a certain extent (the proportion decreased by 25.
90%)
.
These conclusions suggest that the main prescription departments of these two varieties have not changed much
.