Analysis of drug use and expenditure of conventional and biological disease-modifying anti-rheumatic drugs: a study from Northwest China

This study evaluates the impact of China’s National Centralized Drug Procurement policy on DMARD accessibility, cost-effectiveness, and utilization patterns in a regional rheumatology institute in Northwest China, while examining the interplay between pricing policy and COVID-19 disruptions.

Data were sourced from our hospital information management system (HIS) from 2018 to 2022, encompassing prescribing records for approximately 70,000 annual outpatient rheumatology visits. DMARDs were classified into three groups: conventional synthetic DMARDs (csDMARDs), targeted synthetic DMARDs (tsDMARDs), and biological DMARDs (bDMARDs). Total revenue, defined daily doses (DDD), and defined daily dose costs (DDDc) were calculated, and compound annual growth rates (CAGR) were analyzed.

The CAGR of total revenue of DMARDs from 2018 to 2022 was 0.91%. Among csDMARDs, methotrexate for injection saw the largest revenue increase (CAGR of 92.26%). Recombinant human type II tumor necrosis factor receptor-antibody fusion proteins consistently led among tsDMARDs and bDMARDs. In contrast, infliximab experienced the largest decline (CAGR of − 23.49%). Leflunomide remained the most frequently used csDMARD, while several tsDMARDs and bDMARDs, except infliximab, showed upward trends, with baricitinib, tofacitinib, golimumab, and secukinumab exceeding 200% CAGR.

National centralized procurement policy achieved dramatic cost reductions (e.g., tofacitinib DDDc decreased by 93.3%), directly driving increased utilization of tsDMARDs and bDMARDs. This study provides empirical evidence that aggressive pharmaceutical pricing policies can rapidly improve access to advanced rheumatologic therapies in resource-limited settings, offering a replicable model for healthcare systems worldwide.