3种抗肿瘤靶向药物的可负担性评价——以湖北省为例

Affordability Evaluation for 3 Kinds of Anti-tumor Targeted Drugs:Taking Hubei Province as an Example

目的:评价湖北省城乡居民对吉非替尼、曲妥珠单抗、舒尼替尼3种抗肿瘤靶向药物的可负担性,为我国恶性肿瘤靶向药物的医保准入提供参考。方法:参考湖北省肿瘤登记年报中3种恶性肿瘤的发病率和湖北省城乡居民收入数据,结合国家药价谈判中的"降低50%进口药价格"的政策,假设药物进入医保报销目录,分别采用世界卫生组织/国际健康行动组织(WHO/HAI)标准调查法、灾难性卫生支出评价法和致贫作用评价法计算3种药物的可负担性。结果:按WHO/HAI标准调查法,3种药物降价50%报销前后的可支付性增量为64.00%~74.00%;按灾难性卫生支出评价法,吉非替尼、曲妥珠单抗、舒尼替尼3种药物降价50%再经医保报销,分别会造成20.00%、59.28%、35.48%的城镇用药患者,以及50.63%、74.72%、75.93%的农村用药患者产生灾难性支出;按致贫作用评价法,3种药物降价50%且报销后在城镇与农村造成因病致贫的患者占比均不超过31.95%。结论:国家药价谈判降价50%后3种抗肿瘤靶向药物对农村居民造成的经济负担较城镇居民严重。在制定政策时应根据城乡、药价及病种来调整相应报销比例,平衡不同疾病患者的经济负担。

OBJECTIVE： To evaluate the affordability of 3 anti-tumor targeted drugs gefitinib, trastuzumab and sunitinib in urban and rural residents of Hubei province, and to provide reference for medical insurance price admission of anti-malignant tumor targeted drugs in China. METHODS： Referring to the incidence of malignant tumor stated in statistical yearbook of Hubei province and income data of urban and rural residents in Hubei province, based on the policy of reducing the price of imported drugs by 50% mentioned in the national drug price negotiations, and assume the drugs are included in the medical insurance reimbursement list, WHO/HAI standard survey method, catastrophic expenditure evaluation method and poverty effect evaluation method were adopted to calculate the affordability of 3 drugs. RESULTS ： According to WHO/HAI standard survey method, increment of payment for 3 drugs were 64.00%-74.00% before and after 50% discount and reimbursement. According to catastrophic expenditure evaluation method, 50% discount of gefitinib and reimbursement gefitinib, trastuzumab and stmitinib in urban area would result in catastrophic expenditures of 20.00%, 59.28% and 35.48% patients; in rural area, would result in catastrophic expenditures of 50.63%, 74.72% and 75.93% patients. According to poverty effect evaluation method, 50% discount of 3 drugs and reimbursement caused less than 31.95% urban and rural patients falling to poverty. CONCLUSIONS： Fifty percentage discount of 3 anti-tumor targeted drugs mentioned in the national drug price negotiations cause the economic burden more serious for rural residents than urban resi- dents. In the formulation of policies, the corresponding reimbursement ratio should be adjusted according to urban and rural areas, drug price and disease types for a balance of patients with different economic burden.