湖南省带量采购和分级管理政策对碳青霉烯类抗生素利用的影响  

Impact of antimicrobial volume-based procurement and classification management policy on the use of carbapenem antibiotics in Hunan Province

作　　者：吴泽华 陈君宇 许林勇[2] 明煜鑫 周宇松 黄勋[3] 付陈超[3] 王朝晖 刘世坤[1] 李佐军[1] WU Zehua;CHEN Junyu;XU Linyong;MING Yuxing;ZHOU Yusong;HUANG Xun;FU Chenchao;WANG Zhaohui;LIU Shikun;LI Zuojun(Department of Pharmacy,The Third Xiangya Hospital of Central South University,Changsha 410013,China;Xiangya School of Stomatology,Central South University,Changsha 410031,China;Center for Healthcare-associated Infection Control,Xiangya Hospital,Central South University,Changsha 410028,China;Hunan Public Resources Trading Center,Changsha 410116,China)

机构地区：[1]中南大学湘雅三医院药学部,湖南长沙410013 [2]中南大学湘雅口腔医学院,湖南长沙410031 [3]中南大学湘雅医院医院感染控制中心,湖南长沙410028 [4]湖南省公共资源交易中心,湖南长沙410116

出　　处：《中国感染控制杂志》2025年第1期105-112,共8页Chinese Journal of Infection Control

摘　　要：目的探索抗菌药物带量采购和分级管理政策对碳青霉烯类抗生素利用的影响。方法采用Mann-Kendall趋势检验分析各级医疗机构碳青霉烯类抗生素用药频度(DDDs)、采购金额(Cost)、药品日均费用(DDDc)、每天每1000居民用药频度(DID)的变化趋势,以2020年5月1日为带量采购政策的干预分界点,以2021年9月作为分级管理目录的干预分界点,采用间断时间序列分析法研究带量采购和分级管理政策对碳青霉烯类抗生素临床用药的影响。结果在带量采购政策执行后,碳青霉烯类抗生素DDDs、DID明显上升,但长期趋势变化不显著;与政策执行前相比,碳青霉烯类抗生素的Cost和DDDc瞬时下降,DDDc长期趋势变化显著,但Cost长期趋势变化不显著。分级管理目录更新后,碳青霉烯类抗生素DDDs、Cost瞬时下降,但长期下降趋势不显著,并且DDDc呈长期上升趋势。结论带量采购政策降低了碳青霉烯类抗生素DDDc,短期内降低了Cost;但对DDDs、Cost、DID的长期影响有限;分级管理对医疗机构碳青霉烯类抗生素的利用影响有限。Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn’t change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased immediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn’t change significantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

关 键 词：碳青霉烯类抗生素 抗菌药物带量采购 抗菌药物分级管理 药物利用评价 Mann-Kendall趋势检验 间断时间序列分析 

分 类 号：R197.323.4[医药卫生—卫生事业管理]