中国儿童基本药品可及性多中心研究

A multicenter survey of the accessibility of essential medicines for children in China

目的调查我国儿童基本药品的可及性现状,为提高我国儿童基本药品可及性,促进儿童合理用药提供依据。方法采用现况调查方法,于2017年5月26日至6月2日选取我国东部、中南部、西部和北部地区17个省或直辖市的55家公立医院,以调查表的形式对42种儿童基本药品进行可及性调查。每个药品调查原研药和仿制药两个品种。研究内容包括可获得性、价格、可承受性。42种儿童基本药品在所有调查机构中可以得到的百分比,即为该药品的可获得性。价格研究采用中位价格比值(MPR),即某一种药品单位价格的中位数与国际参考价格的比值,并针对所有药物得出中位MPR。药品费用的可承受性研究,是将治疗某一标准疗程疾病所需的费用,折算成赚取全国日最低工资所花费的天数,计算治疗该常见疾病的可承受性。对可获得性、价格、可承受性指标进行描述性分析。结果在42种调查药品中,原研药和仿制药的平均可获得性分别为33%和32%。原研药和仿制药的中位MPR分别为5.43和1.55;既有原研药又有仿制药的19种药品价格比较,原研药和仿制药的中位MPR分别为7.73和2.04。针对4种常见儿童疾病(肺炎、消化性溃疡、先天性甲状腺功能减低症、难治性肾病)的5种基本药品进行可承受性研究,使用仿制药需要花费0.63(0.16~6.17)d全国日最低工资,使用原研药需要花费1.03(0.16~11.53)d全国日最低工资。结论在42种儿童基本药品中,原研药和仿制药的可获得性均较低。仿制药价格基本合理,可承受性较好;原研药价格明显高于国际参考价,可承受性较差。需进一步提高我国儿童基本药品可及性。

Objective To investigate the availability,prices and affordability of essential medicines in pediatric population across China,in the hope of improving rational use of medicines.Methods A multicenter cross-sectional survey of medicine prices,availability and affordability was conducted in 17 provinces,municipalities and autonomous region across east,south-central part,west and north of China.Data on 42 medicines used in pediatric population,both original and generic,were collected in 55 public hospitals from May 26 to June 2,2017.Availability was expressed as the percentage of hospitals with stock of the target medicine on the day of data collection,and median price ratio(MPR)was the ratio of price upon investigation to international reference.Based on national minimum daily wage,affordability represents the number of working days needed to earn the expense which covers a standard course using the target medicine.Statistical software SPSS 13.0 was applied for descriptive analysis of availability,MPR and affordability.Results Mean Availability of original and generic medicine was 33%and 32%,with median MPR being 5.43 and 1.55.Among the 19 medicines with price information for both original and generic product,the median MPR was 7.73 and 2.04 respectively.Regarding the five medicines used to treat four common pediatric diseases(pneumonia,peptic ulcer,congenital hypothyroidism,refractory nephrotic syndrome),the affordability was 0.63(0.16-6.17)d for generic medicine,and 1.03(0.16-11.53)d for its original counterpart.Conclusions The availability to both original and generic products of the 42 medicines used in pediatric population was low in China.The prices of generic medicines seem to be lower and affordability higher than those of original medicines.There is an urgent need to improve the availability and affordability of pediatric medicines.