(P-170) How Government Health Insurance Coverage of Novel Anti-cancer Medicines Benefited Cancer Patients in China: A Retrospective Analysis of the Insurance Claim Data

Background: China begun to include novel anti-cancer medicines into its public health insurance system at national level since 2016, aimed to reduce the financial burden of the individuals.

Objectives: There is a need to inform the policy-makers how did the inclusion policy benefit the patient, especially the most vulnerable one. This study took gefitinib, one of the first batch of insurance covered anti-lung-cancer novel therapies in December 2016 as a case to generate evidence to answer the question.

Methods: This is a retrospective interrupted time series study with segmented regression of the monthly number of lung cancer patients who initiated the treatment with the study medicines before and after the insurance inclusion based on the insurance claim data of Fujian province of China. The study also compared the distribution of the lung cancer patients who completed a standard course of treatment with the study medicines in different socioeconomic characteristics with Chi-square-test, and performed a multivariate linear regression to predict the factors that determined the patient affordability.

Results: The monthly number of the lunge cancer patients who initiated the treatment with the study medicines abruptly increased 19 in the month immediately after December 2016 (95%CI: 6-31, p=0·005), the afterwards trend increased significantly (p=0·005). The average proportion of such patients to the total number of lung cancer patients who initiated the treatment with the study medicines after December 2016 was only 3·8%. By controlling the other factors, the annual proportion of the patient OOP expenditure to the total lung cancer-related expenditures of the resident insurance beneficiaries was 44·3% higher than that of the government employee insurance beneficiaries (95%CI: 5·9-25·2%, p=0·002); the patients who did not complete a standard course of treatment with the study medicines had a 8.7% higher annual proportion of the patient OOP expenditure than those who completed (95%CI: 1·4-14·1%, p=0·02); the annual proportion of the patient OOP expenditure in 2017 and 2018 was 41·3% and 52·7% lower than that in 2016 (95%CI: 24·1-4·%/28·4-8·2%, p=0·004/ < 0·001).

Conclusions: The health insurance coverage significantly increased the availability of the novel anti-lung-cancer medicines and significantly decreased the individual financial burden of lung cancer patients generally in Fuzhou. However, there is still a need to further improve the benefit packages of the novel anti-cancer medications, especially for the resident insurance beneficiaries.