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Drug Utilization Research / Health policy and governance

Poster Session B

(B-082) Assessing the Impact of Volume-Based Procurement on Antidepressant Accessibility and Inequality: A Four-City Cohort Study Using Drug Sales Data

Monday, August 25, 2025
11:30 AM - 1:00 PM ET

    Presenting Author(s)

  • AX

    Aoming Xue

    School of International Business, China Pharmaceutical University, Jiangsu, China, China (People's Republic)

    • Co-Author(s)

  • QX

    Qingyuan Xue

    School of health management, Inner Mongolia Medical University ,Inner Mongolia, China, China (People's Republic)

  • KF

    Keye Fan

    School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu,China, China (People's Republic)

  • Bj

    Bin jiang

    School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China, China (People's Republic)

  • jz

    jifang zhou

    China Pharmaceutical University, China (People's Republic)

Background: Depression is prevalent in China, yet the spatial accessibility (SA) and inequality (SI) of antidepressants remain understudied.

Objectives: To evaluate how the VBP (Volume-Based Procurement) policy influenced SA and SI of antidepressants across four representative Chinese cities from 2018 to 2020.

Methods: Using procurement data, we calculated travel time to the nearest medical institution via the least-cost-path algorithm. Gini coefficient and Theil index measured accessibility and inequality. Ordinary Least Squares (OLS) and mediation analysis explored statistical relationships.

Results: The VBP policy led to increased procurement of two antidepressants, primarily driven by generic substitution (e.g., generic escitalopram: Beijing +159.8%, Shanghai +75.0%, Ningbo +146.4%, Harbin +146.3%). SI improved across all cities, with greater progress in economically underdeveloped areas (e.g., escitalopram’s Gini index in Harbin declined by 10.6%, paroxetine by 32.6%). Mediation analysis revealed that generic substitution partially explained SI improvements in Beijing (ACME = -0.00, p = 0.01) and fully mediated SI reduction for paroxetine in Harbin (ACME = -0.04, p = 0.01).

Conclusions: The VBP policy improved SA and SI of antidepressants, with generic substitution playing a key mediating role. These findings highlight the policy's effectiveness in reducing spatial disparities in drug access.