Trastuzumab Accessibility and Utilization for Breast Cancer Treatment in an eastern prefecture-level city in China: Does health insurance coverage matter?

Abstract

Background Trastuzumab, a monoclonal antibody for breast cancer, faces global accessibility challenges, especially in low- and middle-income countries, primarily due to high costs. This study examines the impact of medical insurance policy changes and price reductions on Trastuzumab utilization in China, using JX city as a case study, to provide insights into improving drug accessibility and affordability. Methods This retrospective study investigated Trastuzumab utilization among HER2-positive breast cancer patients at a tertiary hospital from May 2013 to December 2022 in JX, a prefecture-level city located in eastern China. Patients were stratified based on their CerbB2 indicator. Patients with a 2 + CerbB2 status require further FISH testing to confirm HER2 expression for Trastuzumab eligibility, while patients with a 3 + CerbB2 status directly qualifies for the treatment. We analyzed the utilization rates of FISH test and Trastuzumab using logistic regressions, identifying factors that influence their usage. Results 766 patients were included in this study. The utilization rate of Trastuzumab among patients with CerbB2 3 + rose from 40.40–77.94% in September 2017 following the expansion of insurance coverage, and further increased to 90.41% after a price reduction in 2020. The FISH test was not covered by health insurance, and it was not available in the local hospital until Trastuzumab became available in JX city. For patients with CerbB2 2+, the proportion undergoing the FISH test increased dramatically from 8.89–82.08% after the price reduction in 2020. The mere inclusion into basic medical insurance, regardless of insurance types, significantly increased the utilization of Trastuzumab and the FISH test. However, rural patients in JX city are still facing financial burdens with Trastuzumab's out-of-pocket cost accounting for 62.9% of their annual disposable income in 2020. Conclusions Our findings indicate that expanding insurance coverage and reducing the price significantly increased Trastuzumab utilization. Additionally, improving the accessibility of the FISH test plays a crucial role in enhancing the uptake of Trastuzumab among eligible patients. These insights are essential for informing policies in China and other low- and middle-income countries towards achieving universal health coverage.