Effect of the national reimbursement drug list negotiation policy on utilization of negotiated anticancer drugs in Chinese public hospital: a quasi-natural experiment

Background High prices have limited access to targeted anticancer drugs in China. In 2017, 18 such drugs were added to the National Reimbursement Drug List (NRDL) through national price negotiation. Method Monthly hospital procurement data (2015–2019) from 887 public hospitals across 30 provinces were analyzed. Drug utilization was measured by expenditures and defined daily doses (DDDs). A difference-in-differences (DID) model and interrupted time series (ITS) analysis were employed to estimate policy effects. Results Following policy implementation, total DDDs of negotiated drugs rose 4.03-fold and expenditures 3.07-fold, both exceeding cancer incidence growth. DID analysis confirmed significant increases for Western medicines (+479,100 DDDs; p < 0.001). ITS showed sustained upward trends, especially for Trastuzumab, Bevacizumab, and Abiraterone, while traditional Chinese medicines declined. Bevacizumab demonstrated improved affordability, with higher DDDs but lower expenditures. Conclusion The NRDL negotiation substantially improved access to targeted anticancer therapies in public hospitals while containing cost growth. These findings highlight the effectiveness of centralized price negotiation in expanding coverage and equity of high-cost cancer treatments in resource-constrained settings.