台州市降糖类基本药物全额保障政策经济性评价研究

Economic Evaluation on the Full Coverage Policy for Hypoglycemic Essential Medicines in Taizhou City

目的:评价台州市降糖类基本药物全额保障政策的经济性,为改善我国药品可及性、完善国家基本药物制度提供参考。方法:提取台州市2009-2016年各区县糖尿病患者电子健康档案和财政投入数据,采用队列研究设计,以各区县各自政策实施时间作为间断点,将逐年记录的数据取均值处理为年度数据,形成政策实施前1年(基线年)和实施后3年的队列数据。根据政策实施后是否选择使用免费药物分为政策组和对照组,使用倾向性得分匹配法控制两组基线差异,形成最终研究样本,借鉴双重差分法模型进行分析,计算政策的实施成本和收益。结果:经匹配后两组各纳入研究14744人,政策实施期间台州市年人均财政投入为263.8元,与基线年比较,因政策实施引起的年人均药品费用减少了649.2元、年人均住院医疗费用减少了624.7元,投入-产出比为1∶4.8。结论:台州市基本药物全额保障政策有利于降低患者费用负担,政策具有经济性,通过结合相关政策进行科学设计,具备可推广性和持续性。

OBJECTIVE:To evaluate the economics of the full coverage policy for hypoglycemic essential medicines in Taizhou city,and to provide reference for improving medicine accessibility and essential medicine system in China.METHODS:The electronic health records and financial input data of diabetic patients were extracted from different districts and counties of Taizhou city during 2009-2016.In cohort study design,taking the implementation time of each district and county’s policies as the breakpoint,the data recorded annually were processed as annual data,forming the cohort data for 1 year before(baseline year)and 3 years after the implementation of the policies.According to the choice of free medicines after the implementation of the policy,they were divided into policy group and control group.Propensity score matching was used to balance the differences between two groups to get the final sample,and then the economics of the policy was evaluated with the methods of difference-in-differences.The cost and benefit of implementation policy were calculated.RESULTS:Totally 14744 people of each group were got by propensity score matching.The mean annual financial expenses on free medicine per capita were 263.8 yuan.Compared with baseline year,mean annual medicine expenses per capita reduced by the policy were 649.2 yuan,and mean annual hospitalization expenses per capita were 624.7 yuan.Thus the input-output ratio of the policy was 1∶4.8.CONCLUSIONS:The implementation of the policy is beneficial to reduce the cost burden of patients and economical.It can be popularized and sustained through scientific design combined with relevant policies.