摘要
目的分析国家药品集中采购政策对公立医院药品经济可及与用药结构的影响。方法以降糖类、调脂类、抗肝炎病毒类(简称“抗病毒类”)药品和治疗精神病和抑郁症的精神类(简称“精神类”)药品为研究对象,采用间断时间序列模型,定量评估国家药品集采政策实施前后目标药品在全国样本医院中药品使用量、药品使用金额、日均费用等的变化情况,以及目标药品在某大型三级甲等医院中人均用药频度、门诊处方金额和医保结余留用金额的变化情况。结果集采实施后,全国样本医院的4类中选药品的使用量均增加(降糖类药品除外其余3类的P<0.01)、日均费用均显著下降(P<0.01),集采相关药品使用金额均显著下降(P<0.001);非中选药品的使用量(调脂类药品除外)均有明显的下降趋势(P<0.05),日均费用均明显降低(精神类药品除外其余3类的P<0.05);抗病毒类药品除外的其他可替代药品的使用量(P<0.01)、日均费用(仅精神类药品的P<0.01)均明显增加。不同的药品的用药结构受到集采政策影响不同,降糖类所受影响较为明显,集采后可替代药品的使用比例有所增加。单家医院门诊处方金额在集采后均显著降低,其中使用调脂类与抗病毒类集采相关药品患者支付费用降幅均大于0.60;目标中选药品可结余医保金额约125.25万元。结论集采政策有效缓解了患者药品支出负担,同时也带动了仿制药对于原研药的替换和可替代药品使用的增长等用药结构的变化。
OBJECTIVE To analyze the effects of the national centralized drug procurement(NCDP)policy on drug availability and the structure of drug use in public hospitals.METHODS Using hypoglycemic,lipid-lowering,antiviral drugs,and psychiatric drugs for the treatment of mental illness and depression as objects,the interrupted time series model was used to quantitatively evaluate the changes in consumption sum of drugs,consumption amount and daily cost of the target drugs in national sample hospitals as well as the changes in per capita medication frequency,outpatient prescription amount,and medical insurance surplus of target drugs in a third grade class A hospital before and after the implementation of NCDP policy.RESULTS After the implementation of the NCDP policy,the volume for the four bid-winning drugs increased significantly(P<0.01 for the remaining three categories except for hypoglycemic drugs),but DDDc(P<0.01)and the amount of related drugs(P<0.001)decreased significantly.The volume for the non-winning drugs(except for lipid-lowering drugs)decreased significantly(P<0.05),and DDDc also decreased significantly(P<0.05 for other 3 categories except for psychiatric drugs);the volume(P<0.01)and DDDc(P<0.01 only for psychiatric drugs)for alternative drugs all increased except for antiviral drugs.The structure of drug use for different drugs was affected differently by the NCDP policy,and that of hypoglycemic drugs was affected obviously;the proportion of alternative drugs increased after centralized procurement.The outpatient prescription amount of each hospital significantly decreased after centralized procurement,and the decrease in the cost paid by the patients using lipidlowering and antiviral drugs related to centralized procurement was greater than 0.60;the remaining medical insurance amount for bid-winning drugs was approximately 1.2525 million yuan.CONCLUSIONS NCDP policy effectively alleviates the burden of medical expenditure and also drives the structure changes of drug use such as the substitution of generic drugs for original drugs,the growth of the volume of alternative drugs.
作者
林丽敏
彭晓青
唐榕
刘国栋
刘洪
尹嘉瑜
LIN Limin;PENG Xiaoqing;TANG Rong;LIU Guodong;LIU Hong;YIN Jiayu(School of Medicine,South China University of Technology,Guangzhou 510006,China;Dept.of Pharmacy,the Second Affiliated Hospital of South China University of Technology,Guangzhou 510180,China;Dept.of Pharmacy,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China)
出处
《中国药房》
CAS
北大核心
2023年第24期2968-2974,共7页
China Pharmacy
基金
广东省基础与应用基础研究基金区域联合-青年基金项目(No.2020A1515110615)
2020年广东省医院药学研究基金(No.2020XC125)
广州市中医药和中西医结合科技项目(No.20222A01-0006)。
关键词
国家药品集中采购政策
用药结构
间断时间序列
药品可及性
national centralized drug procurement policy
the structure of drug use
interrupted time series model
drug availability
