国家谈判靶向抗乳腺癌药物纳入基本医疗保险政策患者惠及研究  

Analysis of How Public Health Insurance Coverage of Targeted Anti-Breast Cancer Medicines through National Medicines Price Negotiation Benefited Patient

作　　者：李明爽 刁一凡 叶建春 孙静[2] 江宇[1] Li Mingshuang;Diao Yifan;Ye Jianchun;Sun Jing;Jiang Yu(School of Population Medicine and Public Health,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;School of Health Policy and Management,Chinese Academy of Medical Sciences and Peking Union Medical College;Fujian Healthcare Security Monitoring and Electronic Settlement Center)

机构地区：[1]中国医学科学院北京协和医学院群医学及公共卫生学院,北京100730 [2]中国医学科学院北京协和医学院卫生健康政策管理学院 [3]福建省医疗保障监测和电子结算中心

出　　处：《药物流行病学杂志》2021年第6期398-403,428,共7页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:以2017年9月纳入福州市基本医疗保险(以下简称"医保")的国家谈判靶向抗乳腺癌药物为例,分析我国靶向抗乳腺癌药物纳入医保政策对不同患者群体的惠及情况,及乳腺癌相关诊疗费用患者经济负担的影响因素,为该政策更加公平地惠及广大患者提供证据。方法:对目标药物纳入医保前后,采用目标药物治疗的患者人口和社会学分布进行描述性统计分析;采用间断时间序列模型对首次采用目标药物治疗的月度患者人数进行纵向分析;利用多元线性回归模型,分析采用目标药物治疗一个标准疗程的人类表皮生长因子受体2(HER 2)阳性乳腺癌相关诊疗费用中患者实际自付比例的影响因素。结果:纳入医保后,各类患者采用目标药物治疗的人数都显著增加。纳入医保首月,首次采用目标药物治疗的患者人数显著增加了24例[95%CI(12,36),P<0.01];纳入医保后,首次采用目标药物治疗的患者人数持续显著增加(P=0.02)。在控制其他变量条件下,相比享受公务员补助的机关事业单位患者,城乡居民医保参保患者采用目标药物治疗一个标准疗程的HER 2阳性乳腺癌相关诊疗费用患者实际自付比例高106.2%[95%CI(88.6%,123.7%),P<0.001]。结论:国家谈判靶向抗乳腺癌药物纳入医保政策整体上显著提高了患者对创新抗癌药物的利用,该政策使广大患者普遍获益,减轻了其医药费用负担,但低收入患者的个人经济负担显著高于高收入患者,农村患者的药品费用负担整体仍然十分沉重。为贯彻中央深化我国医疗保障制度改革"促进公平、逐步缩小待遇差距"的原则,应进一步加强基本医保对城乡居民医保参保癌症患者的保障,并夯实对经济困难患者超过个人支付能力的恶性肿瘤相关医药费用的兜底性保障。Objective:To take targeted anti-breast-cancer medicines which were covered by the public health insurance through the national price negotiation and implemented in Fuzhou city in September 2017 as a case,to analyze how the insurance coverage benefited different breast cancer patients.And to predict factors associated with the patient affordability.To provide evidence for the optimization of the public health insurance coverage of targeted anti-cancer medicines,in order to benefit broader patients in an equity way.Methods:Fristly,the descriptive analyses of the distributions of patients who adopted the study medicines before and after the insurance coverage were conducted.Then,the interrupted time series regression of the monthly number of patient who initiated the treatment with the study medicines to measure the level and trend changes was performed.Finally,the multi-factor analysis to predict the factors associated with the proportionate patient out-of-pocket(OOP)expenditure for a standard course of treatment of human epidermal growth factor receptor 2(HER 2)positive breast cancer was performed.Results:The number of all sorts of patients to adopt the study medicines increased after the insurance coverage.The monthly number of the study patients increased 24(95%CI 12 to 36,P<0.01)in the first month that the study medicines were covered by the basic health insurance program of Fuzhou city,and kept at a statistically increased trend afterwards(P=0.02).By controlling the other factors,the proportionate OOP expenditures for a standard course of treatment of HER-2 positive breast cancer patients enrolled in the urban and rural residents health insurance program were 106.2%(95%CI 88.6%to 123.7%)higher than that of the patients who were public sector staff and entitled with government budget funded supplementary health insurance coverage(P<0.001).Conclusion:The public health insurance coverage of targeted anti-breast-cancer medicines through the national price negotiation significantly increased the utilization of the

关 键 词：靶向抗乳腺癌药物 基本医疗保险 患者惠及 药物利用 

分 类 号：F407.7[经济管理—产业经济]