The impact of centralized drug purchasing policy on pediatric medicines and related health system performance outcomes: a systematic review and evidence gap map

Background Centralized drug purchasing policies have been applied in many countries, but the impact on pediatric medicine supply has been controversial. In this study, we evaluated the impact of centralized drug purchasing policies on pediatric medicines and related health system performance outcomes. Methods Eight databases, including Cochrane, Embase (Ovid), and PubMed and so on, were searched from inception to August 2026. Two researchers independently conducted literature screening, data extraction, and quality assessment. The main outcomes were categorized according to the WHO-HSPA framework. Thematic analysis was used to summarize the evidence of these outcomes and create an evidence gap map. Results Twelve studies were included in this study, all from China. These comprised two ITS, three uncontrolled before–after studies, two controlled before–after studies, and four surveys, with seven at high risk of bias, four at moderate risk, and one at low risk. The studies covered seven pharmaceutical system outcome domains and four health system performance outcome domains. Centralized drug purchasing policies could reduce the price, cost, and increase the affordability of selected medicines, indicating financial protection, without a significant impact on effectiveness, safety, and efficiency. However, they could also lead to issues such as clinicians’ distrust in the quality of selected medicines, the reduced accessibility of some pediatric medicines, increased costs and use of alternative medicines, and unsuitable dosage forms and specifications of selected medicines. Conclusion The included studies indicate decreased prices and cost, increased affordability after the policy, without a significant difference in effectiveness, safety, and efficiency. However, the selected drugs are not suitable for children. As all studies were from China, with small numbers and high risk of bias of most included studies, and off-label drugs were not identified in this study, the impact of centralized drug procurement policies on pediatric medicines remains to be further explored. PROSPERO Registration Number CRD42024495063.