国家组织药品集中采购对耐药结核病患者药物可负担性的影响  

Effect of National Centralized Drug Procurement on Drug Affordability for Drug-Resis⁃tant Tuberculosis Patients

作　　者：郑梅琴[1] 刘硕[1] 许瑞[1] 李芃[1] 郭振勇[1] ZHENG Meiqin;LIU Shuo;XU Rui;LI Peng;GUO Zhenyong(Department of Pharmacy,Beijing Chest Hospital,Capital Medical University,Beijing,China 101149)

机构地区：[1]首都医科大学附属北京胸科医院药学部,北京101149

出　　处：《中国药业》2022年第1期8-11,共4页China Pharmaceuticals

基　　金：国家科技重大专项课题[2017ZX09304009]。

摘　　要：目的探讨国家组织药品集中采购(简称集采)政策对耐药结核病患者药物可负担性的影响。方法根据《耐药结核病化学治疗指南(2019年简版)》和药品说明书,按体质量50 kg成年人估算服药日剂量,参照北京市药品阳光采购平台和医院信息系统中的药品价格,测算集采政策实施前后耐药结核病患者的疗程费用,以灾难性医疗支出(指家庭的医疗支出占家庭可支付能力的比重≥40%)为指标评估耐药结核病患者的药物可负担性。结果对利福平敏感的耐药结核病患者的疗程费用为(0.40~0.88)万元,乙胺丁醇的价格在集采政策实施后下降了42.86%,但组合治疗方案的总疗程费用相差不大;耐多药结核病患者的疗程费用由集采政策实施前的(3.38~42.83)万元降为集采政策实施后的(2.85~21.04)万元,其中含有利奈唑胺的治疗方案的疗程费用降幅为31.68%~50.88%。48个耐多药结核病治疗组合方案中,造成灾难性医疗支出的组合方案由集采政策实施前的38个降至集采政策实施后的17个。城镇患者的药品支出占家庭可支配收入的比例由集采政策实施前的20.77%~102.43%降至集采政策实施后的19.74%~48.51%,造成灾难性医疗支出的治疗方案由集采政策实施前的9个降至集采政策实施后的5个;农村患者的药品支出占家庭可支配收入的比例由集采政策实施前的54.91%~270.83%降至集采政策实施后的52.19%~128.27%,但所有组合方案均会造成灾难性医疗支出。结论国家集采政策可在降低药品费用的同时降低个人自付费用,但二线抗结核药品价格仍较高,给耐多药结核病患者带来了较大的经济负担,且农村患者的情况更严峻。Objective To investigate the effect of the national centralized drug procurement(hereinafter referred to as centralized procurement)policy on drug affordability for drug-resistant tuberculosis patients.Methods According to the Guidelines for Chemical Treatment of Drug-Resistant Tuberculosis(2019 Simplified Edition)and the drug instructions,the daily dose was estimated according to the body-weight of 50 kg adults.According to the price of drugs in the Beijing Drug Sunshine Procurement Platform and the hospital information system(HIS)were referred,the treatment costs for drug-resistant tuberculosis before and after the implementation of the centralized procurement policy were calculated.The drug affordability of drug-resistant tuberculosis patients was assessed by catastrophic medical expenditure(referring to the proportion of the family's medical expenditure to the family's affordability≥40%).Results The costs of treatment for drug-resistant tuberculosis patients who were sensitive to rifampicin was 4000-8800 CNY.The price of ethambutol decreased by 42.86%after the implementation of the centralized procurement policy,but there was little difference in the total treatment cost of the combined treatment plans.The treatment costs for patients with multi-drug resistant tuberculosis had been reduced from 33800-428300 CNY before the implementation of the centralized procurement policy to 28500-210400 CNY after the implementation of the centralized procurement policy,among which the treatment cost of the combination plans containing linezolid decreased by 31.68%-50.88%.Among the 48 combination plans for the treatment of multi-drug resistant tuberculosis,the combination plans that caused catastrophic medical expenditures dropped from 38 plans before the implementation of the centralized procurement policy to 17 plans after the implementation of the centralized procurement policy.The proportion of urban patients'expenditure on medicines in household disposable income decreased from 20.77%-102.43%before the implementation

关 键 词：耐药结核病 国家组织药品集中采购 药品费用 灾难性医疗支出 药物可负担性 

分 类 号：R956[医药卫生—药学]