Table 1 Rationale for the studying PPIs in China [ 13 , 14 , 20 , 21 , 36 , 47 , 50 , 51 ]

Key Factors

• The utilisation of antacids and medicines to prevent and treat ulcers has increased rapidly in recent years in China due to their effectiveness, similar to other countries

• There is no appreciable difference therapeutically between the various PPIs, and between originator and generic PPIs (provided bioequivalence has been demonstrated)

• Between 2004 and 2013, a range of generic PPIs were included in hospital lists in China with a considerable number available for potential procurement

• Injectable PPIs (originator and generic) are also available at considerably higher costs than oral equivalents, and limited medical justification for their routine use

Opportunities

• to evaluate generic penetration rates and savings versus originators for both oral tablets and injectables

• to compare and contrast PPI utilisation and expenditure patterns in China with those seen among Western European countries, which already provide universal and comprehensive healthcare and where multiple policies have been successfully introduced to enhance the prescribing of low cost oral generic tablets versus originators or patented (single-sourced) PPIs. In the Netherlands, combined measures resulted in expenditure for PPIs in 2010 58% below 2000 levels despite a 3-fold increase in utilisation, and in Scotland multiple measures resulted in expenditure on PPIs in 2010 56% below 2001 despite also a 3-fold increase in utilisation