# Impact of the national health insurance coverage policy on mecapegfilgrastim utilization for chemoradiotherapy-induced neutropenia in cancer patients in China: a retrospective real-world analysis

## TL;DR

A new health insurance policy in China significantly increased the use of mecapegfilgrastim to prevent neutropenia in cancer patients, but disparities remain.

## Contribution

This study demonstrates the impact of China's NHIC policy on mecapegfilgrastim utilization and highlights persistent inequities.

## Key findings

- Mecapegfilgrastim use increased from 8.17% to 36.05% after the NHIC policy implementation.
- Utilization rose abruptly and continued to increase significantly post-policy.
- Inequities in usage were observed based on location, cancer type, and tumor stage.

## Abstract

This study aimed to evaluate mecapegfilgrastim utilization for the prophylaxis of chemotherapy-induced neutropenia in cancer patients and to assess changes caused by the National Health Insurance Coverage (NHIC) policy.

Individual patient data, including demographics, medical insurance status, cancer type, and tumor stage, were extracted from electronic medical records in an oncology specialty tertiary hospital in Jiangsu Province, China. An interrupted time series (ITS) analysis with a segmented regression model was applied to evaluate the NHIC policy’s effects, and multivariate binary logistic regression analysis was used to identify key factors influencing mecapegfilgrastim utilization.

The proportion of cancer patients receiving mecapegfilgrastim increased from 8.17% before the NHIC policy implementation to 36.05% after its implementation (P < 0.001). Utilization rose abruptly following the policy intervention (β = 0.143, P < 0.001) and continued to increase significantly afterward (β = 0.011, P = 0.004). However, inequities were observed in mecapegfilgrastim usage among patient subgroups, with utilization closely associated with patients’ location, cancer type, and tumor stage after the policy implementation.

The NHIC policy significantly increased mecapegfilgrastim utilization, enabling more cancer patients to access this medication and effectively benefiting them. To address persistent inequities, the government should consider introducing additional measures, such as increasing the insurance reimbursement cap and separating the cost of expensive innovative anticancer medicines from hospital medical insurance budgets.