Objective To systematically review quasi-experimental studies assessing the impact of different procurement mechanisms on medicine prices worldwide and to conduct a Meta-analysis to inform the adoption of effective procurement mechanisms to reduce medicine price and improve access to medicines.

Methods A systematic search was conducted in 9 databases, including CNKI and PubMed from the inception of each database to April 30, 2026. Four researchers in two independent pairs performed the literature search, study selection and data extraction. The risk of bias of the included studies was independently assessed by two researchers. Meta-analysis was conducted using R 4.5.0 software.

Results A total of 49 studies were included in the systematic review, and 21 were included in the Meta-analysis. The identified procurement mechanisms included single-country public procurement and procurement mechanisms led by international or regional organizations. Most included studies focused China's National Centralized Medicines Procurement (n=40). Most procurement mechanisms were able to reduce in the prices of selected medicines to some extent [-0.13, 95%CI(-0.24, -0.02), P=0.02]. These effects varied according to patent status, purchase quantity, and the intensity of market competition of different therapeutic groups. China's National Centralized Medicines Procurement significantly reduced the prices of selected products [WMD=-3.51, 95%CI(-6.34, -0.68), P=0.02], but some non-selected products [WMD=0.21, 95%CI(0.10, 0.31), P<0.001], particularly substitute products [WMD=0.12, 95%CI(0.02, 0.22), P=0.02] experienced price increases.

Conclusion Pooling demand to gain bargaining power is the key to reducing medicine prices. Price reduction would not be achieved when the procurement volume is insufficient, particularly when procurement behavior cannot guide healthy market competition. Government-driven top-down procurement mechanisms and the application of electronic platforms help reduce procurement costs and improve procurement efficiency.

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