替格瑞洛治疗急性冠状动脉综合征的预算影响分析

Budget Impact Analysis on Ticagrelor in the Treatment of Acute Coronary Syndromes in China

目的:针对急性冠脉综合征患者最多为期12个月用药的情况,从医保支付方角度对替格瑞洛进行预算影响分析,为药品报销目录的遴选、医保支付价格的决策及医疗机构用药方案的制定提供科学依据。方法:基于替格瑞洛PLATO临床研究中患者转归情况和医疗资源使用情况,结合我国的成本和市场份额数据,构建预算影响分析模型,测算替格瑞洛纳入医保报销对医保基金的预期影响。结果:在不计替格瑞洛和氯吡格雷的药品花费情况下,综合考虑所有相关住院事件发生率后,对于患者年人均住院费用中的基金支出,替格瑞洛为39907元/人·年,氯吡格雷为40486元/人·年,使用替格瑞洛将比氯吡格雷年人均节约579元的基金支出。如果替格瑞洛与氯吡格雷享受同等报销条件进入乙类医保目录,则第一年医保基金支出增加约6600万元,占医保总支出的0.0054%。如果替格瑞洛降价9%,报销替格瑞洛将会减少医保年度总支出。结论:使用替格瑞洛可以节省患者基金年均住院支出,纳入替格瑞洛对医保基金影响微小。若替格瑞洛能适当降低价格,则可以减少医保年度总费用的支出。

Objective:To conduct a budget impact analysis of ticagrelor for medical insurance policy-decision to provide scientific evidence fordecision making process related to reimbursement formulary,reimbursement price,along with therapeutic regimen.Methods:Budget impactanalysis model was constructed to measure the expected changes in the expenditure of health care system after the adoption of ticagrelor in China.Results:Excluding the cost of drugs,the annual hospitalization cost covered by health insurance per capita of ticagrelor group and clopidogrelgroup were39907CNY and40486CNY.The health insurance fund would be increased by66107143CNY,0.0054%of the total fund if ticagrelorwas reimbursable.If the price of ticagrelor was reduced by9%,the health insurance fund would be saved.Conclusion:This analysis suggests thatintroducing ticagrelor into the reimbursement list would only have minimal effect on the health care budget.If the price of ticagrelor could bereduced,the health insurance fund would be saved.