国际药品价格管制方式及效果研究的系统综述

The international regulation methods of pharmaceutical pricing and their impacts: A systematic review

目的:分析国际药品价格管制方式及效果。方法:采用系统综述的方法归纳不同国家药品价格管制方式、对象、过程及效果。结果:共纳入来自36个国家的130篇文献,其中包括定价管制政策文献97篇,评价定价管制影响文献33篇,且多为评价参考定价效果研究。大多国家主要对报销药品价格进行控制;国家价格比较和参考定价是两种最主要的政府定价方式;药品加成采用递减加成体系;现有证据表明参考定价对于降低药品价格、节省药品开支和对其他卫生服务的影响效果较好。建议:以药物经济学评价为基础,通过参考定价对药品报销价进行有效管制,通过协商谈判、递减加成和完善医保支付方式来控制药品费用不合理增长。

Objective： To analyze the measures and their impacts of different regulation methods in terms of pharmaceutical pricing.Methods： A systematic review is used to summarize different regulation methods of drug pricing,objects,implementation process and to evaluate the impacts of these regulations on pharmaceutical＇s utilization and production.Results： 130 studies covering 36 countries were included.Many studies（97 articles） aim to describe drug pricing strategies,while few studies（33 articles） are to evaluate the impacts of strategies,most of which aim to evaluate the effectiveness of reference price.Many countries only control the reimbursement price of the drug.International price comparison and internal price referencing are two main regulation methods.A regressive mark up system is often used.The existing evidences indicate that the reference price system could decrease the drug price,save the drug cost,and better the utilization of other healthcare.Recommendations： The effective regulation of drug price is to use the reference price to regulate the reimbursement price of the drugs,based on the pharmacoeconomics evaluation,to control the irrational drug cost by negotiating price,regressive mark-up and perfecting the third party payment method.