Comparison of affordability and availability of antidepressants in China from 2019 to 2022: evidence from national procurement database

Background Depression is a widespread mental disorder imposing significant societal burdens. The COVID-19 pandemic exacerbated its prevalence, emphasizing the need for improved access to affordable and effective treatments. This study aims to examine the trends of antidepressant availability and affordability in China from 2019 to 2022 and the role of the National Volume-Based Procurement (NVBP) policy.Methods Using nationwide daily procurement data of 19 antidepressants encompassing all medical facilities in China from 2019 to 2022, this study adapted the World Health Organization/Health Action International (WHO/HAI) methodology. Availability was defined as the percentage of health facilities procuring specific antidepressant during the year. Affordability was expressed as the number of days at provincial minimum wage to pay for a one-month course of treatment. Temporal variations were described and explored using fractional logit regression, stratified by originator, NVBP involvement, clinical preference, hospital features, and regions.Results Affordability improved steadily between 2019 and 2022 across most antidepressant groups. The largest improvement occurred among first-line NVBP antidepressants, where the monthly expenditure declined by 0.022-day minimum wage annually. In contrast, affordability changed little for first-line non-NVBP medicines (0.015-day decrease per year) and second-line non-NVBP medicines (0.004-day decrease per year). Availability of originator brands declined annually by 0.8 percentage points, while lowest-priced generics increased by 1.1 percentage points. The largest decline occurred in tertiary private facilities, where availability fell by 3.7 percentage points annually. Improvements in availability were mainly observed in secondary and tertiary public facilities, particularly in the East and Northeast regions. Overall, NVBP first-line medicines had 15.5 percentage points higher availability and greater affordability of 0.167-day minimum wage than other antidepressants.Conclusion The study highlights the positive influence of the NVBP policy on antidepressant affordability and availability. Regional gaps and facility-specific disparities, though narrowed, still call for policy response.