北京协和医院17种国家医保谈判抗癌药临床应用情况调查

Investigation on the Clinical Use of 17 Antineoplastic Drugs Passing National Medical Insurance Negotiation in Peking Union Medical College Hospital

  • 摘要:
      目的  了解国家卫生行政部门发布17种国家医保谈判抗癌药相关政策前后,北京协和医院相关药品的临床应用情况及变化趋势,以期为医院药品目录优化与调整提供参考。
      方法  收集并分析2017年12月1日至2019年11月30日(2017年12月1日至2018年11月30日为2018年度,2018年12月1日至2019年11月30日为2019年度)北京协和医院17种抗癌药的全部门诊及住院处方数据。对患者基本信息、用药数量、用药金额、用药频度、限定日费用等进行统计分析。
      结果  2019年度共6881例患者使用此17种抗癌药。其中,门诊患者4713例(68.5%),住院患者2168例(31.5%)。17种抗癌药用药金额占本院全部抗癌药用药金额、全部药品用药金额的比率分别为16.3%和3.8%;用药金额排名前3位的病种分别为胸部肿瘤、血液肿瘤和泌尿系统肿瘤; 用药金额排名前3位的药物分别为奥希替尼、奥曲肽微球、克唑替尼,且用药金额与用药频度同步性好; 限定日费用排名前3位的药物分别为维莫非尼、西妥昔单抗和伊布替尼。政策实施前已入院的6种抗癌药中,2019年度用药金额和处方量分别同比增加78.2%、89.8%;用药金额占本院全部抗癌药用药金额、全部药品用药金额的比率分别同比增加54.4%、78.6%;与2018年度相比,2019年度奥希替尼用量与用药金额均大幅增加,西妥昔单抗、阿昔替尼、舒尼替尼及奥曲肽微球用量增加而用药金额下降,培门冬酶用量和用药金额均显著下降。
      结论  国家医保谈判政策促进了17种抗癌药在临床的使用,提高了用药可及性,亦导致药品费用有较大幅度增加。应加强对相关药品的临床应用监测和动态评估,在保障患者用药需求的同时促进合理用药。

     

    Abstract:
      Objective  The aim of this study is to investigate the clinical use of 17 antineoplastic drugs passing national medical insurance negotiation in Peking Union Medical College Hospital before and after the implementation of national policies about promoting the inclusion of antineoplastic drugs in health insurance, and to provide reference for the optimization and adjustment of hospital formulary.
      Methods  The prescription data of 17 antineoplastic drugs of outpatients and inpatients in our hospital from December 1, 2017 to November 30, 2019(December 1, 2017 to November 30, 2018 for the year 2018, December 1, 2018 to November 30, 2019 for the year 2019) were collected. The basic information of patients, the usage amount and cost, defined daily doses (DDDs), and defined daily cost (DDC) were analyzed.
      Results  A total of 6881 patients used the 17 antineoplastic drugs in 2019. Among them, there were 4713(68.5%) outpatients and 2168(31.5%) inpatients. The proportions of the cost of 17 antineoplastic drugs to that of all antineoplastic drugs and all formulary drugs in our hospital were 16.3% and 3.8%, respectively. The 17 antineoplastic drugs were mainly used for thorax, hematologic, and urologic malignancies. The top three antineoplastic drugs in terms of cost were osimertinib, octreotide acetate microspheres and crizotinib, with good synchronization between drug cost and DDDs. The top three drugs in terms of DDC were vemurafenib, cetuximab and ibrutinib. The total cost and prescription of the six drugs that had already been included in the formulary of our hospital before the implementation of the policy increased by 78.2% and 89.8%, respectively in 2019 compared with those in 2018, and the proportions of the cost of six antineoplastic drugs to that of all antineoplastic drugs and all formulary drugs in the hospital increased by 54.4% and 78.6%, respectively. After the implementation of national policies, the quantity and cost of osimertinib increased significantly, and the drugs increased in quantity but decreased in cost were cetuximab, axitinib, and sunitinib in sequence. Both the quantity and the cost of pegaspargase decreased significantly.
      Conclusions  The national health insurance negotiation policy promoted the use of 17 antineoplastic drugs in the hospital and improved the accessibility of these drugs to patients significantly. At the same time, the total cost of the involved drugs had a sharp rise. It is necessary to strengthen the monitoring and dynamic evaluation of the clinical application of related drugs, so as to promote rational drug use while meeting patients' needs.

     

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