# Impact of national volume-based procurement on physicians’ antimicrobial prescribing behaviours: an interrupted time series analysis of 1200 prescriptions in a tertiary hospital

## TL;DR

A study in China found that a national drug procurement policy reduced antimicrobial costs but increased use of high-risk antibiotics, raising concerns about resistance.

## Contribution

This study is the first to use interrupted time series analysis to evaluate the impact of China's National Volume-Based Procurement policy on antimicrobial prescribing behaviors.

## Key findings

- The NVBP policy significantly reduced antimicrobial expenditures and patient out-of-pocket costs.
- Use of special-grade antimicrobials increased, raising concerns about antimicrobial resistance.
- Prescription patterns shifted with decreased β-lactam use and increased NVBP drug utilization over time.

## Abstract

This study aimed to investigate the impact of the National Volume-Based Procurement (NVBP) policy on antimicrobial use intensity, prescribing structure, and medical costs among inpatients in a tertiary hospital in China.

This study retrospectively extracted 1200 inpatient prescriptions from a tertiary hospital between April 2019 and March 2024. Using interrupted time series (ITS) analysis, the study assessed the immediate-level changes and long-term trend effects of the NVBP policy on medication indicators such as defined daily doses (DDDs) and costs.

Following NVBP implementation, antimicrobial prescribing structure changed significantly, with β-lactam utilization decreasing by 13.85%. The combination rate of β-lactams + fluoroquinolones fell significantly by 75.93%, while overall combination therapy remained unchanged. Use of special-grade antimicrobials showed a numerical increase (+31.98%), although not statistically significant. Cost indicators decreased significantly following policy implementation. ITS analysis further revealed a significant immediate decrease in the proportion of DDDs for NVBP antimicrobial agents (β2 = −15.464 units, p = 0.009), followed by a sustained upward trend (β3 = 1.400/month, p < 0.001). Similarly, DDDs of NVBP antimicrobial agents showed a significant upward trend (β3 = 0.135 units/month, p = 0.017) after the policy.

This study demonstrates that while the NVBP policy significantly reduced patient drug expenditures and promoted the use of NVBP varieties and nonrestricted antimicrobial agents, it also increased the proportion of special-grade antimicrobials agents, suggesting the need for caution against potential antimicrobial resistance and strengthened supervision of prescription.

The National Volume-Based Procurement policy significantly reduced antimicrobial drug expenditures and patient out-of-pocket costs in a Chinese tertiary hospital.The policy was associated with increased use of special-grade antimicrobials, highlighting potential risks for antimicrobial resistance.Future drug procurement policies should integrate with antimicrobial stewardship programs to balance cost control and rational antibiotic use.

The National Volume-Based Procurement policy significantly reduced antimicrobial drug expenditures and patient out-of-pocket costs in a Chinese tertiary hospital.

The policy was associated with increased use of special-grade antimicrobials, highlighting potential risks for antimicrobial resistance.

Future drug procurement policies should integrate with antimicrobial stewardship programs to balance cost control and rational antibiotic use.