国家医保谈判政策对布地格福、格隆溴铵福莫特罗吸入气雾剂用于中重度慢性阻塞性肺疾病维持治疗经济性的影响  

Impact of National Drug Price Negotiation Policy for Medical Insurance on the cost-effectiveness of budesonide,glycopyrronium bromide/formoterol for moderate to very severe chronic obstructive pulmonary disease

作　　者：王鹏鹏 梁乐[1] 李亚美 WANG Pengpeng;LIANG Le;LI Yamei(Department of Pharmacy,Xi'an No.1 Hospital,Xi'an 710002,China)

机构地区：[1]西安市第一医院药剂科,西安710002

出　　处：《临床药物治疗杂志》2025年第3期54-61,共8页Clinical Medication Journal

基　　金：陕西省重点研发计划项目(2024SF-YBXM-340)。

摘　　要：目的从卫生体系角度,对布地格福吸入气雾剂方案(布地格福方案)、格隆溴铵福莫特罗吸入气雾剂方案(格隆溴铵福莫特罗方案)进行药物经济学分析,评估国家医保谈判政策(国谈)对其经济性的影响,为慢性阻塞性肺疾病(COPD)个体化治疗提供参考。方法建立包含COPD分级、恶化事件及不良反应在内的Markov模型用于药物经济学分析。以布地奈德福莫特罗吸入气雾剂(Ⅱ)方案(布地奈德福莫特罗方案)为对照,对国谈前后布地格福方案、格隆溴铵福莫特罗方案进行成本-效用及单因素、概率敏感性分析。根据西安市医保门诊慢性病报销政策,评估国谈前后患者个人自付药品费用的变化。结果国谈后布地格福方案、格隆溴铵福莫特罗方案总成本分别下降35.15%、27.12%。以2023年度人均国内生产总值(GDP)为意愿支付阈值(WTP),国谈前布地格福方案增量成本-效用比(ICUR)为1.76倍GDP,格隆溴铵福莫特罗方案为绝对劣势方案;国谈后,布地格福方案ICUR为0.02倍GDP,格隆溴铵福莫特罗方案在WTP<3.8万元时具成本-效用优势。敏感性分析显示结果稳定性良好。在慢性病报销政策框架下,布地格福方案、格隆溴铵福莫特罗方案国谈后患者需自付药品费用均减少85%以上。结论国谈政策成效显著,提升目标药物经济性,降低治疗负担,为个体化治疗提供更多可选性。对推进药物更新迭代、提升患者治疗获益有所帮助。Objective To evaluate the impact and effectiveness of National Drug Price Negotiation(NDPN)Policy for Medical Insurance on the cost-effectiveness of budesonide,glycopyrronium bromide/formoterol fumarate(BGF)and glycopyrronium bromide/formoterol fumarate(GFF)for chronic obstructive pulmonary disease(COPD)with pharmacoeconomic analysis method from a perspective of healthcare system,thus to provide reference for economic and effective individualized treatment.Methods A Markov model including COPD grades,exacerbation events,and adverse reactions was established for the pharmacoeconomic analysis.BGF and GFF were divided into before-NDPN and after-NDPN groups.Cost-utility,one way sensitivity and probabilistic sensitivity analysis were conducted with budesonide/formoterol fumarate(BFF)as control.According to the outpatient chronic disease reimbursement policy of Xi'an,the change of patients'personal out-of-pocket payment before and after NDPN was evaluated.Results The total costs of BGF and GFF regimens decreased by 35.15% and 27.12%,respectively after NDPN.Using per capita GDP(2023)as the threshold of willingness to pay,the incremental cost-utility ratio(ICUR)of BGF was 1.76 times GDP and GFF was an undomatined regimen before NDPN;after NDPN,the ICUR of BGF was 0.02 times GDP and GFF became cost-utility when WTP<38 thousand CNY.The results of the sensitivity analysis showed that the study was robust.After NDPN,the patients'personalout-of-pocket payment of BGF and GFF decreased by more than 85% with the outpatient chronic disease reimbursement policy.Conclusion The NDPN policy has achieved remarkable results,which has improved the cost-utility of target drugs,reduced the burden of treatment,and provided more options for individualized treatment.It is helpful to promote drug renewal iteration and improve the treatment benefits for patients.

关 键 词：慢性阻塞性肺疾病 国家医保谈判 布地格福吸入气雾剂 格隆溴铵福莫特罗吸入气雾剂 成本-效用分析 

分 类 号：R974.3[医药卫生—药品] R956[医药卫生—药学]