帕博利珠单抗用于治疗经一线治疗失败的不可切除或转移性黑色素瘤的预算影响分析

The Budget Impact Analysis on Introducing Pembrolizumab into Medical Insurance in Patients with Unresectable or Metastatic Melanoma after First-Line Treatment

目的:基于国家基本医疗保险特征,综合评价将帕博利珠单抗纳入国家医保目录后,对医保基金带来的总体预算影响,为决策者提供证据。方法:从医保支付方角度,建立预算影响分析模型,研究时限为2020-2024年,模型针对经一线治疗失败的不可切除或转移性黑色素瘤患者,对比测算帕博利珠单抗不进入医保和进入医保两种情境下对于医保基金预算支出产生的影响。结果:若将帕博利珠单抗纳入国家医保,2020-2024年对基金的影响分别为增加1159万元、1360万元、1475万元、1586万元和1706万元,分别占当年国家医保总支出的比例分别为0.00055%、0.00053%、0.00048%、0.00043%和0.00038%。结论:帕博利珠单抗进入医保目录后,由于接受治疗的患者人数增加,医保基金支出也相应增加,但用于经一线治疗失败的不可切除或转移性黑色素瘤患者治疗费用支出占当年医保基金总支出的比例逐年递减。

Objective:For the purpose of providing evidence for decision makers,the budget impact analysis of the Pembrolizumab introduced into the national medical insurance was carried out,basing on the characteristics of the national basic medical insurance.Methods:From the payer perspective,the budget impact analysis model was established.The time horizon was 2020 to 2024 and the model was aimed at unresectable or metastatic melanoma patients who failed the first-line treatment.The budget impact analysis was carried out with two scenarios(introduced and not introduced into the medical insurance).Results:With Pembrolizumab introduced into the national medical insurance,the incremental expenditure from 2020 to 2024 would be 11.59 million yuan,13.60 million yuan,14.75 million yuan,15.86 million yuan and 17.06 million yuan,respectively.Accounting for the total expenditure of the national medical insurance,the ratios were 0.00055%、0.00053%、0.00048%、0.00043%and 0.00038%,respectively.Conclusion:After Pembrolizumab introduced into the medical insurance catalogue,the number of patients receiving treatment increased,and the expenditure on medical insurance fund increased accordingly.Accounting for the total expenditure of the national medical insurance,the expenditure for treatment of unresectable or metastatic melanoma patients who failed first-line treatment would be decreasing year by year.