In Depth: Cost Concerns Loom Over China’s Growing Market for Liver-Protection Drugs

The hepatoprotective drugs industry in China has expanded rapidly, creating a billion-dollar market but also raising concerns about the financial and health impacts on patients. These drugs, marketed as protectors of liver function, are widely used despite ongoing debates over their efficacy and cost-effectiveness. [para. 1]

In 2023, China's market for four main categories of liver-protection drugs reached 9.5 billion yuan ($1.3 billion), with significant sales attributed to public hospitals. Prescription data from 119 hospitals across nine cities showed spending on these drugs in liver disease outpatient clinics rising from 85.4 million yuan in 2016 to over 100 million yuan in 2023. This growth underscores a significant and increasing demand. [para. 2][para. 3]

Hepatoprotective drugs in China are considered supplementary therapies, used to enhance primary treatments, mitigate side effects, or prevent complications. Common types include ursodeoxycholic acid and glutathione, which are believed to detoxify the liver, reduce liver enzyme levels, and support liver cell regeneration. Despite their widespread use, these medications do not directly address underlying liver diseases. [para. 4]

These drugs are most frequently prescribed for conditions such as cirrhosis, fatty liver disease, and hepatitis B. Notably, China has approximately 75 million hepatitis B patients, one of the largest populations globally. However, medical consensus on the benefits of hepatoprotective drugs remains elusive; no long-term evidence supports their effectiveness in maintaining liver health. They can temporarily reduce certain indicators of liver injury but do not treat the root causes of liver disease. [para. 5][para. 6][para. 7]

Experts, including World Health Organization representative Po-Lin Chan, assert there is insufficient evidence for the use of these drugs, leading the WHO to exclude them from hepatitis treatment guidelines. Doctors involved in liver disease generally prefer antiviral treatments like entecavir and tenofovir for hepatitis B patients, citing both effectiveness and lower cost. [para. 8][para. 9]

Antiviral drugs have become much more affordable, with entecavir now costing about 5 yuan per month under a national centralized procurement program, compared to hepatoprotective drugs, which can range from several hundred to 2,000 yuan per month. In some cases, patients are prescribed multiple liver-protection drugs simultaneously and kept on them for years, dramatically increasing their financial burden. [para. 10][para. 11]

There are also health risks. Experts warn that relying solely on hepatoprotective drugs without addressing underlying diseases like hepatitis B can worsen health outcomes. Such drugs should only be used for short periods (two to three months) if necessary, not long-term. Overuse, especially in combination, may even increase the risk of drug-induced liver injury. [para. 12][para. 13][para. 14][para. 15]

The widespread prescription of these drugs is driven by complex factors, including a lack of clear regulations, doctor discretion, and financial incentives within hospitals. Corruption cases have revealed that kickbacks are sometimes tied to drug prescriptions. Top liver specialists recommend targeted treatment rather than a default use of liver-protection drugs. [para. 16][para. 17][para. 18][para. 19][para. 20]

Calls have grown for more research on the effectiveness and safety of hepatoprotective drugs and for reforms to reduce financial incentives for overprescription, aiming to ensure appropriate, evidence-based patient care. [para. 21][para. 22]