| 引用本文：魏霞, 冯宇轩, 杨莉.药物经济学在医保药品谈判中的角色——以丙型肝炎直接抗病毒药物为例[J].中国卫生政策研究,2021,14(2):44-49 |
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| 药物经济学在医保药品谈判中的角色——以丙型肝炎直接抗病毒药物为例 |
| 投稿时间：2020-11-30 修订日期：2021-02-07 PDF全文浏览 HTML全文浏览 |
| 魏霞, 冯宇轩, 杨莉 |
| 北京大学公共卫生学院 北京 100191 |
| 摘要:目的：以参加2019年国家医保药品谈判的丙型肝炎治疗药物为例，探讨药物经济学在医保药品谈判中的作用，为医保药品目录调整和同类药品谈判提供参考。方法：通过成本效用分析和阈值分析，测算丙肝治疗药物的降价幅度并与实际降价幅度进行对比，结合具体谈判方式探讨相关影响因素。结果：2019年丙肝药品谈判采用了竞争性谈判和比价磋商谈判两种方式。竞争性谈判纳入的基因1b型药品艾尔巴韦格拉瑞韦和来迪派韦索磷布韦测算降价幅度（50.7%和32.8%）低于实际降价幅度（89.0%和89.9%），比价磋商谈判纳入的非基因1b型药品索磷布韦维帕他韦测算降价幅度（36.7%）也低于实际降价幅度（81.2%），竞争性谈判降价幅度高于比价磋商谈判。结论：药物经济学、预算影响、国际参考价格和疾病市场特征等可为谈判提供依据，优化参照选择和成本计算可提高药物经济学证据的决策利用度，但谈判起决定性作用的还是支付者意愿。竞争性谈判不宜针对创新药物，易打击企业研发积极性。 |
| 关键词:医保药品目录 竞争性谈判 比价磋商谈判 丙型肝炎 药物经济学 |
| 基金项目:国家自然科学基金（71673004；71911530221）；北京新阳光慈善基金会支持项目 |
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| The role of pharmacoeconomics in national reimbursement drug negotiation: Taking direct-acting antiviral drugs for hepatitis C virus infection as an example |
| WEI Xia, FENG Yu-xuan, YANG Li |
| School of Public Health, Peking University, Beijing 100191, China |
| Abstract:Objective: To explore the role of pharmacoeconomics in national negotiation taking direct-acting antivirals (DAAs) for hepatitis C virus infection as an example based on data from 2019, so as to provide references for adjustment of national reimbursement drug list and the negotiation of similar drugs. Methods: Through cost-utility analysis and threshold analysis, the DAAs price reduction was calculated and compared with the actual price reduction, and relevant factors of influence were analyzed in combination with specific negotiation methods. Results: Competitive negotiation and price comparison negotiation were adopted in the negotiation of DAAs for Hepatitis C in 2019. The estimated price reduction for genotype 1b DAAs elbasvir/grazoprevir and ledipasvir/sofosbuvir included by competitive negotiation, i.e. 50.7% and 32.8%, respectively, were lower than actual price reduction (89.0% and 89.9%). The estimated price reduction of non-genotype 1b DAAs sofosbuvir/velpatasvir included in the price comparison negotiation (36.7%) was also lower than the actual price reduction (81.2%). However, the price reduction of competitive negotiation was higher than the actual price reduction in the price comparison negotiation. Conclusions: Pharmacoeconomics, budget impact, international reference prices, and disease market characteristics can provide evidence for negotiation. Optimizing reference selection and cost calculation can improve the decision-making utilization of pharmacoeconomics evidence, but it is the payer’s willingness that plays a decisive role in the negotiation. Competitive negotiation is not suitable when innovative drugs are to be targeted in the negotiation, and this can easily discourage the enthusiasm of research and development (R&D) enterprises. |
| Key words:National reimbursement drug list Competitive negotiation Price comparison negotiation Hepatitis C virus Pharmacoeconomics |
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