Regional health inequalities of anticancer drug accessibility under the National Drug Price Negotiation in China: a decomposition analysis

Equitable access to anticancer drugs is a central concern in oncology care. China initiated National Drug Price Negotiation (NDPN) in 2016, which has been associated with improved accessibility and equity in anticancer drugs. This study aims to evaluate the current regional equity in the provision of negotiated anticancer drugs in China. The study collected data on the availability of anticancer drugs negotiated by public platforms across 31 provinces. We collected province-level data on the availability of negotiated anticancer drugs in hospitals and pharmacies across 31 provinces and calculated GDP-related concentration indices (CIs). A decomposition analysis of CIs was conducted to identify determinants of inequity, and CIs were further computed within the breast cancer subgroup. The CIs were 0.125 for hospitals and 0.139 for pharmacies, indicating pro-rich inequality in the regional provision of negotiated anticancer drugs, with higher-income eastern regions offering more hospitals and pharmacies with anticancer drugs. Medical insurance expenditures (56.209%) and inpatient costs (46.745%) exacerbated hospital supply inequality. The number of pharmacists in pharmacies (63.845%) was the primary positive contributor to pharmacy access inequality. Among breast cancer drugs, Abemaciclib and Nalatinib Maleate exhibited higher CIs of 0.244 and 0.223. The regional distribution of negotiated anticancer drugs reveals substantial disparities, with affluent regions more likely to access these medications through well-resourced hospitals and pharmacies. Health expenditure and financing mechanisms further amplify these inequalities. Even within similar indications, disparities persist in the availability of different drugs. Future initiatives should prioritize measures to ensure drug access in impoverished and remote areas.