Changes in the burden of lower respiratory infections in China before and after the implementation of the national centralized drug procurement policy

The implementation of the National Centralized Drug Procurement (NCDP) policy has had far-reaching effects. This study aims to assess the impact of the NCDP policy on the disease burden of lower respiratory infections (LRIs) in China.

The age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life-years rates (ASDR) from the Global Burden of Disease (GBD) 2021 database were used to describe the disease burden and compare it before (1990–2017) and after (2019–2021) the implementation of the NCDP policy. We applied interrupted time series (ITS) analysis to assess changes in the burden of LRIs before and after policy implementation, with 2018 designated as the intervention cutoff year.

The ITS analysis revealed a consistent declining trend in the ASIR, ASMR, and ASDR for LRIs in China from 1990 to 2021. Following the implementation of the NCDP policy in 2018, all three indicators showed a statistically significant acceleration in reduction. The ASIR decreased from 5,481.13 to 2,853.81 per 100,000 population. Following policy implementation (2019–2021), the slope of the ASIR was estimated to be −185.73, also indicating a statistically significant declining trend (β₃ = −109.45, p = 0.001). Similarly, the ASMR declined from 60.65 to 14.03 per 100,000, with the slope changing from −1.69 (p < 0.001) to −3.18 (p = 0.006). The ASDR also demonstrated a significant reduction from 3,128.39 to 347.67 per 100,000, with the trend slope accelerating from −101.66 (p < 0.001) to −196.36 (p = 0.007) after policy implementation. All models were adjusted for first-order autocorrelation using the Prais-Winsten method.

After the implementation of the NCDP policy, the disease burden of LRIs in China decreased, suggesting that the policy effectively reduced the disease burden on patients.