赫赛汀治疗HER-2阳性乳腺癌的医保预算影响分析

Budget Impact Analysis on Using Herceptin for Breast Cancer with HER-2 Positive

目的:通过对赫赛汀进行预算影响分析,为药品报销目录的遴选决策、药品降价谈判及确立医保支付价格提供科学依据。方法:构建预算影响分析模型,比较国家医保目录内辅助化疗治疗方案,测算赫赛汀在中国上市并进入医保目录对医保支出的预期影响。结果:如果2016年赫赛汀进入医保目录,到2020年HER-2阳性乳腺癌患者医保预算总费用增幅分别为135.30%、141.93%、142.25%、142.27%和143.82%。结论:将赫赛汀纳入城镇医保将较大增加医保预算费用,增幅和各变量呈线性相关,建议进一步发挥国家有关部门集中谈判优势,在"带量降价"基础上,根据各地经济、医保状况,将赫赛汀纳入医保合理报销范围。

Objective： To conduct a budget impact analysis on Herceptin, so as to provide references for the selection policy, drug decreasing negotiation and build up the medical insurance payment prices for the drug reimbursement list. Methods： Budget impact analysis model was constructed to compare the adjuvant chemotherapy treatment scheme in national medical insurance list and mea- sure the expected changes in the expenditure of medical insurance system. Results： If Herceptin could be reimbursed since 2016, the increase rate of medical insurance budget on patients with breast cancer with HER-2 positive would be 135.30%, 141.93%, 142.25%, 142.27% and 143.82% from 2016 to 2020. Conclusion： Reimbursement of Herceptin would considerably increase the total budget of medical insurance. The increase had linear correlation with different variables. It suggested to further improve the national relevant drug price negotiation strengths and make the reimbursement policy according the local economic and Medical Insurance fund func- tioning situation based on ＂reducing the price with quantity ＂ .