Increasing Anti-Infective Drug Expenditure in Tianjin, China: A Decomposition Analysis

This study aimed to explore the driving factors of the increasing anti-infective drug expenditures in Tianjin, China, and to provide evidence-based suggestions for policymakers.

Data were extracted from inpatient records in Urban Employee Basic Medical Insurance data of Tianjin, China, from 2003 January to December 2007. Expenditure increase for a basket of 63 constantly used anti-infective drugs was decomposed into three broad categories: price effects, quantity effects, and therapeutic choices. Furthermore, the injection anti-infective drug expenditures from 2006 to 2007 were decomposed into six determinants.

From 2003 January to December 2007, the expenditure for a fixed basket of drugs increased by 9%. The driving factors were therapeutic choices and quantity effects; each increased 48% and 10%, respectively. The relative price decreased by 33% during the study period. After adding new drugs to the formulary in 2005, the rate of increase in drug expenditure was 28% from 2006 to 2007; the driving factors were still therapeutic choice (16.8%) and quantity effects (14.9%).

Therapeutic choice transferring from cheap drugs to expensive ones, rather than the price, was the main driving factor for increasing expenditures. Policymakers need to pay more attention to rationalize physicians' prescribing behavior to control the expenditure.