药物政策分析及药物经济学在我国药物政策中的应用研究
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摘要
国家药物政策是国家卫生政策的一个组成部分,国家卫生政策的目标是实现人人享有初级卫生保健。国家药物政策以这一基本目标为出发点,配合国家卫生政策制定相应的战略目标,满足大多数人对基本药物的需求,保证使用安全、有效、优质的基本药物,促进医师和用药者合理使用药物。本文分析了国家药物政策的主要目标、关键内容及其关系。
国家为进一步加强基本医疗用药管理,制定下发了《国家基本药物目录》和《国家基本医疗保险和工伤保险药品目录》,通过药品目录来规范药品的使用,在控制药品数量、保证基本用药、确保药品质量、加强用药监督以及合理控制药品费用增长等方面发挥了积极的作用。但是,近年来,由于大处方、回扣药等不合理现象普遍存在,药品在医疗费用中所占比例过高,使药品问题已成为社会关注的热点问题。
如何控制药品费用的上涨已成为当前迫切需要解决的问题。药物经济学研究为解决这一问题提供了一个新的工具。药物经济学是一门新兴学科,已日益受到中国政府的卫生、社会保障、物价和药品监督部门和医药工业部门的重视。广大医师、药师和科研人员已将药物经济学的评价方法应用到临床研究,重视药物的疗效、安全性和经济性三者之间的平衡。
本文综合运用理论研究和实证研究的方法,对比研究了国外药物经济学方法的应用,从制定药品价格、决定药品补偿和共付状况、制定医院用药目录或诊疗规范以及促进合理处方等方面探讨了药物经济学在我国药品政策中应用的可行性及前景。
慢性乙型肝炎感染是一种严重的健康问题,给社会带来沉重的负担,本研究选择慢性乙型肝炎这一最常见的传染性疾病的治疗为例,应用药物经济学评价方法,对我国当前比较普遍使用的胸腺肽结合拉米夫定与胸腺肽α1结合拉米夫定两种治疗慢性的方案进行药物经济学分析,以期为临床合理用药,调整乙肝药品政策,减轻乙肝社会经济负担提供参考。
National Drug Policy is an important part of national health policy. The target of national health policy is to make sure that everyone can enjoy the primary health care. From this point of view, nation drug policy has made its own strategic target, which is to meet the most people’s need of essential drug, to make sure the drug is safety, efficacy and good quality, push forwards the rational use of drug. The main targets, key contexts and the relationship between them were analyzed in the thesis.
In order to strengthen the management of basic medical drug, our country had made National Essential Drugs List and National Essential Medicare and Industrial Injury Insurance Formulary. Both of the two lists were effective in controlling the amount of drugs consumed, guaranteeing employees’access to essential drugs, ensuring drug quality, strengthening utilization review and containing rational escalation of drug expenditure.
However, in the past few years, because of the phenomena of big prescription, backhander of drugs became more and more popular, drugs expenditure covered major part of medication charge, so medication problem has been a social-focused problem.
Controlling the rising of drug costs has become a problem which needed to be solved. The study of pharmacoeconomics(PE) provides a new approach to solute the problem. Pharmacoeconomics is a newly developed discipline. It has been paid much attention by Chinese government and many sectors, such as health, labor and social security, drug administration, pricing departments and drug enterprises. PE evaluation method was applied to clinical trails. The efficacy, effectiveness, safety and value of drug usage were seriously concerned simultaneously.
Theoretical analysis combined with the positive study was used in this article. In the thesis, the practices of pharmacoeconomics home and abroad were compared; the feasibility and future of PE evaluation in drug pricing, reimbursement, co-payment, hospital drug list and rational prescript in Chinese national drug policy were discussed.
Chronic hepatitis B virus (HBV) infection is one of the most serious health problems in China. The disease burden due to HBV infection has been a great concern across the country. Statistics suggested that HBV infection accounted for major loss of health expenditures in China. Thymosin and lamivudine combination therapy on chronic hepatitis B(CHB) is very popular. The thymosin and lamivudine combination and thymosinα1 and lamivudine combination therapy on patients with chronic hepatitis B were compared. The economic effects of thymosin and lamivudine combination therapy on patients with CHB were accessed. This research can provide reference to clinical rational drugs use, adjust CHB drug policy, and release the social economics burden of CHB patients.
国家为进一步加强基本医疗用药管理,制定下发了《国家基本药物目录》和《国家基本医疗保险和工伤保险药品目录》,通过药品目录来规范药品的使用,在控制药品数量、保证基本用药、确保药品质量、加强用药监督以及合理控制药品费用增长等方面发挥了积极的作用。但是,近年来,由于大处方、回扣药等不合理现象普遍存在,药品在医疗费用中所占比例过高,使药品问题已成为社会关注的热点问题。
如何控制药品费用的上涨已成为当前迫切需要解决的问题。药物经济学研究为解决这一问题提供了一个新的工具。药物经济学是一门新兴学科,已日益受到中国政府的卫生、社会保障、物价和药品监督部门和医药工业部门的重视。广大医师、药师和科研人员已将药物经济学的评价方法应用到临床研究,重视药物的疗效、安全性和经济性三者之间的平衡。
本文综合运用理论研究和实证研究的方法,对比研究了国外药物经济学方法的应用,从制定药品价格、决定药品补偿和共付状况、制定医院用药目录或诊疗规范以及促进合理处方等方面探讨了药物经济学在我国药品政策中应用的可行性及前景。
慢性乙型肝炎感染是一种严重的健康问题,给社会带来沉重的负担,本研究选择慢性乙型肝炎这一最常见的传染性疾病的治疗为例,应用药物经济学评价方法,对我国当前比较普遍使用的胸腺肽结合拉米夫定与胸腺肽α1结合拉米夫定两种治疗慢性的方案进行药物经济学分析,以期为临床合理用药,调整乙肝药品政策,减轻乙肝社会经济负担提供参考。
National Drug Policy is an important part of national health policy. The target of national health policy is to make sure that everyone can enjoy the primary health care. From this point of view, nation drug policy has made its own strategic target, which is to meet the most people’s need of essential drug, to make sure the drug is safety, efficacy and good quality, push forwards the rational use of drug. The main targets, key contexts and the relationship between them were analyzed in the thesis.
In order to strengthen the management of basic medical drug, our country had made National Essential Drugs List and National Essential Medicare and Industrial Injury Insurance Formulary. Both of the two lists were effective in controlling the amount of drugs consumed, guaranteeing employees’access to essential drugs, ensuring drug quality, strengthening utilization review and containing rational escalation of drug expenditure.
However, in the past few years, because of the phenomena of big prescription, backhander of drugs became more and more popular, drugs expenditure covered major part of medication charge, so medication problem has been a social-focused problem.
Controlling the rising of drug costs has become a problem which needed to be solved. The study of pharmacoeconomics(PE) provides a new approach to solute the problem. Pharmacoeconomics is a newly developed discipline. It has been paid much attention by Chinese government and many sectors, such as health, labor and social security, drug administration, pricing departments and drug enterprises. PE evaluation method was applied to clinical trails. The efficacy, effectiveness, safety and value of drug usage were seriously concerned simultaneously.
Theoretical analysis combined with the positive study was used in this article. In the thesis, the practices of pharmacoeconomics home and abroad were compared; the feasibility and future of PE evaluation in drug pricing, reimbursement, co-payment, hospital drug list and rational prescript in Chinese national drug policy were discussed.
Chronic hepatitis B virus (HBV) infection is one of the most serious health problems in China. The disease burden due to HBV infection has been a great concern across the country. Statistics suggested that HBV infection accounted for major loss of health expenditures in China. Thymosin and lamivudine combination therapy on chronic hepatitis B(CHB) is very popular. The thymosin and lamivudine combination and thymosinα1 and lamivudine combination therapy on patients with chronic hepatitis B were compared. The economic effects of thymosin and lamivudine combination therapy on patients with CHB were accessed. This research can provide reference to clinical rational drugs use, adjust CHB drug policy, and release the social economics burden of CHB patients.
引文
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[8] Suzanne H, Andrew M,David H.Problems with the interpretation of pharmacoeconomic analyses:a review of submissions to the Australian Pharmaceutical Benefits Scheme.JAMA,2000,283(16):2116-2121
[9] Mullins CD.Emerging Standardization in Pharmacoeconmics.Clin Ther,1998,20(6):1194-1202
[10] 蒋虹丽,陈文.澳大利亚和英国药物经济学研究的经验借鉴.中国处方药,2006,4:(16-18)
[11] Enduso LA,Kotsanos JG.Review of health economic guidelines in the form of regulations,principles,policies and positions.Drug Infro mation Journal,1996,(30):1003
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[2] Drummond MF.The role of economic evaluation in the pricing and reimbursement of medicines.Health Policy,1997,40:199
[3] 胡善联,杨莉,陈慧云.药物经济学评价指南研究.上海:复旦大学出版社,2004
[4] Torrance G.Current experience With guidelines for economic evaluation in Canada.Drug Information Journal,1996,30:507
[5] Anis AH,Gagnon Y.Using economic evaluations to make formulary coverage decisions:so much for guidelines. Pharmacoeconomics,2000,18(1):55
[6] Glennie JL,Torrance GW,Baladi JF.The revised Canadian guidelines for the economic evaluation of pharmaceuticals.Pharmacoeconomics,1999,15(5):459
[7] 龚向光,胡善联.澳大利亚药物经济学评价指南介绍.卫生经济研究, 2002,6:21
[8] Suzanne H, Andrew M,David H.Problems with the interpretation of pharmacoeconomic analyses:a review of submissions to the Australian Pharmaceutical Benefits Scheme.JAMA,2000,283(16):2116-2121
[9] Mullins CD.Emerging Standardization in Pharmacoeconmics.Clin Ther,1998,20(6):1194-1202
[10] 蒋虹丽,陈文.澳大利亚和英国药物经济学研究的经验借鉴.中国处方药,2006,4:(16-18)
[11] Enduso LA,Kotsanos JG.Review of health economic guidelines in the form of regulations,principles,policies and positions.Drug Infro mation Journal,1996,(30):1003
[12] US CDC.A Practical Guide to Prevention Effectiveness:Decision and Economic analysis.Atlanta, GA:US Department of Health and Human Services.US Public Health Services.Centre for Disease Control and Prevention(CDC),1992
[13] Siegel JE,Torrance GW,Russell LB.Guidelines for pharmacoeconomic studies:Recommendations from the panel on cost-effectiveness in health and medicine.Pharmacoeconomics,1997,11(2):159
[14] 方来英.药物经济学—— 医生、药师和管理者的责任.药物经济学,2004 2(1):36
[15] 张钧,郭震洲,王立强,任守英.药物经济学概述及在我国运用的几点设想.中国药房.1993,5(1):11
[16] 胡善联.药物成本的研究.卫生经济研究,1999,5:45-47
[17] 胡善联.药物效果的研究.卫生经济研究,1999,11:35-37
[18] 胡善联.药物效用研究.卫生经济研究,1999,9:40-43
[19] 胡善联.药物效益的研究.卫生经济研究,1999,7:40-42
[20] 胡善联.敏感度分析.卫生经济研究,2000,1:36-38
[21] 尹玉琴,马自刚,何云霞.三组抗菌药物治疗急性支气管炎的费用-效果分析.军队医药,2002,12(1):15-17
[22] 田惠光,宋桂德,董燕敏,解鸿翔,董文莉.1996 年天津市慢性病综合干预项目的成本——效用和成本——效益分析.中国慢性病预防与控制,2000,8(4):147-150
[23] 张治英,徐德忠,苏景宽,李远贵,方沈应.部队甲肝疫苗接种策略的成本——效用分析.解放军预防医学杂志,2002,20(4):249-253
[24] 陈文,高继明,康宁,杨莉.国内药物经济学评价研究文献的系统评估.中国药房,2004,15(1):28
[25] 胡明,张伶俐.药物经济学研究论文结构浅析.中国药房,2005,16(15):1148-1149
[26] 王龙兴.卫生经济学理论与实践.上海,上海交通大学出版社,1998
[27] 邵明立.我国药物政策的有关问题.江苏药学与临床研究,2005,13(1):1
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