Systematic Review of Drug Listing and Reimbursement on China's National Reimbursement Drug List: Assessing Innovation Rewards and Future Trends

OBJECTIVES: The transformation of China's National Reimbursement Drug List (NRDL) involves prioritizing transparency and innovation amidst stringent drug price management. Real-world evidence (RWE) and Health Technology Assessment (HTA) are pivotal in NRDL drug listing and reimbursement decisions, though their integration and impact are not fully explored. This systematic review aims to comprehensively analyze RWE and HTA utilization in NRDL processes. It provides insights into evolving drug reimbursement policies in China, highlighting opportunities for innovation in the pharmaceutical sector and guiding future developments in the field.

METHODS: This systematic review examines the adoption and impact of RWE and HTA in drug listing and reimbursement decisions on the NRDL in China. Through a comprehensive literature search and analysis of policy documents and reports, the study assesses current developments and future trends. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted using Medline/PubMed and grey literature until May 2024, employing relevant search terms.

RESULTS: Out of 224 citations from PubMed, Google Scholar, grey literature, and 87 conference references, cross-referencing identified 16 articles meeting inclusion criteria. Results highlight China's NRDL policies emphasizing price control and innovation promotion, evidenced by significant price reductions for new drugs. However, challenges arise from underutilization of RWE and HTA, hindering optimal drug pricing and market access. Future prospects include enhancing pharmacoeconomic evaluations with real-world data (RWD) and integrating HTA to bolster evidence-based decision-making in drug reimbursement policies.

CONCLUSIONS: This review highlights the evolving role of RWE and HTA in shaping drug reimbursement policies on China's NRDL, emphasizing the need for greater integration and utilization of these methodologies. Addressing existing gaps and exploring future opportunities can enhance transparency, efficiency, and innovation within China's healthcare system, ultimately improving patient access to essential medications while ensuring sustainable healthcare spending.