上海市抗肿瘤药物采购配备和临床使用情况分析  

Analysis on procurement and clinical use of antitumor drugs in Shanghai

作　　者：何江江[1,2] 杨燕[1] 吴文辉[3] 华雪蔚[4] 汤庆伟 熊玉琦[1] 戴秋霞 魏馨 章雄 

机构地区：[1]上海市医学科学技术情报研究所,上海200031 [2]上海市卫生发展研究中心,上海200040 [3]复旦大学公共卫生学院,上海200032 [4]上海市卫生和计划生育委员会,上海200125 [5]上海市医药集中招标采购事务管理所信息管理科,上海200081

出　　处：《中国卫生资源》2017年第3期189-193,共5页Chinese Health Resources

基　　金：美国中华医学基金会卫生体系研究与政策转化合作项目(CMB-CP 14-190);第四轮上海市公共卫生体系建设三年行动计划(2015-2017)项目(GWIV-33);上海市卫生计生委2016年度卫生政策研究定向委托课题(2016HP012)

摘　　要：目的:通过分析上海市抗肿瘤药物的采购配备与临床使用情况,为制定针对性的肿瘤药物规范管理策略提供参考。方法:基于上海市医疗机构药品招标采购数据库和医院临床用药信息分析系统,分析不同等级医疗机构、药品分类、通用名的抗肿瘤药品的采购金额分布情况,以及抗肿瘤药物处方的总数、总金额、单张处方金额、处方药品种类和数量。结果:从采购金额看,三级医院(占81.04%)、细胞毒类药品(占34.62%,尤其是影响核酸合成的药物)、生物反应调节药(占17.98%)、靶向治疗类药物(占11.91%,以单克隆抗体药和酪氨酸激酶抑制药为主)、辅助用药(占28.06%,其中造血生长因子占比最高)、采购金额最高的前十类药物(累计占比48.12%)都是合理用药和费用控制的关键点;从临床使用情况看,三级医院(处方数量占比70.32%,平均处方费用为1 110.46元)、40岁及以上中老年患者(处方数量占比90.20%,40~49岁区间人群的平均处方费用最高,为1 370.00元)、自费患者(平均处方费用为1 603.15元)都是处方使用的重点干预机构或人群,其中恶性淋巴瘤(3 818.31元/张处方)、肺恶性肿瘤(2 997.52元/张处方)、胰腺恶性肿瘤(2 737.62元/张处方)的处方费用较高。结论:基于上海市抗肿瘤药物采购端和使用端的数据分析结果,建议在限定医疗机构抗肿瘤药物和辅助用药品种品规数量、定期开展抗肿瘤药物重点品种使用的监测与评价、落实抗肿瘤药物和辅助用药的处方点评及公示制度等方面进行关键点控制。Objective： To analyze the procurement and clinical use of antitumor drugs in Shanghai, anu to prowue information for developing a standardized management policy specifically for antitumor drugs. Methods： Based on drug biding and procurement database of Shanghai Medical Institution, and Shanghai analysis system for clinical use of drug in hospitals, the study analyzed the procurement amount of antitumor drugs in different levels of medical institutions, and with different drug categories and generic names. The antitumor drugs prescriptions were analyzed in total number of prescriptions, total cost of prescriptions, cost per prescription, and categories and amount of prescription drugs. Results： The procurement information of antitumor drugs and adjuvant drugs showed that the key points for rational drug use and cost control were tertiary hospitals （ accounting for 81.04% of the total procurement amount on money ）, bioreaetor mediators （ 17.98% ）, eytotoxicity drugs （34.62%, especially drugs targeting nucleic acid synthesis ）, targeted therapeutic drugs （ 11.91%, mainly monoclonal antibody drugs and tyrosine kinase inhibitors ）, adjuvant drugs （ 28.06%, mainly hemopoietic growth factors ） and top 10 drugs of highest procurement amount（ with cumulative proportion of 48.12% ）.The clinical use of antitumor drugs and adjuvant drugs showed that the key institutions and/or population for intervention of prescription were tertiary hospitals （ the number of prescriptions accounted for 70.32%, 1 110.46 yuan per prescription ）, middle-aged and elderly patients who were 40 years old or above（ the number of prescriptions accounted for 90.20%, 1 370.00 yuan per prescription of the population of 40-49 years old was the highest ）, and patients without medical insurance （ 1603.15 yuan per prescription ）. The prescription cost of malignant lymphoma（ 3 818.31 yuan per prescription ）, malignant lung tumor（ 2997.52 yuan per prescription ）, and malignant pancreatic tumor （ 2 737.62 yu

关 键 词：抗肿瘤药物 辅助用药 合理用药 规范管理 计划 处方分析 

分 类 号：R979.1[医药卫生—药品] R95[医药卫生—药学]