2010-2019年中国艾滋病成人免费抗病毒治疗药品采购费用分析

Cost analysis for the national free AIDS ART program of China during 2010-2019

目的回顾性分析我国2010-2019年艾滋病ART免费药物费用,为ART药品采购模式优化、节省财政经费及持续保证药品可及性提供数据支持。方法在中国政府采购网检索2010-2019年中央公共卫生经费集中招标采购成人ART药品信息,按年度分析比较每种药品费用占比、日平均费用(DDC)变化,以及国产药、多供应商供应药品投入占比及其对DDC的影响。结果2010-2019年,我国共采购8种9个剂型免费药品用于成人ART,TDF(6.07%~40.58%)、EFV(18.34%~35.91%)和LPV/r(16.29%~38.61%)投入费用占比最高。国产药物、多供应商供应药物费用占比分别从2010年的25.31%、25.31%发展到2019年的61.39%、54.85%,均在2016年占比最高(76.78%,62.37%)。各药物DDC呈持续下降,EFV和TDF实现国产化、多供应商供应化之后,其DDC较之前显著降低。结论免费ART药品财政投入逐年上升,为治疗可及提供保障。药物国产化及多供应商供应的市场局面在节约经费、降低财政负担中起到关键作用。应进一步增加药物科研投入以加快国产化进程、进一步改进招标采购方式以提高国内企业参与积极性,同时考虑构建多种渠道的药品供应模式。

Objective This retrospective study on costs of the free drugs provided in China for AIDS antiretroviral therapy(ART)during 2010-2019 aims to provide policy development support for optimization of the national ART drug procurement,effective use of the designated financial resources,and sustainability of the national free ART program.Methods Information on the type,dosage,quantity,cost,and procurement of the ART drugs provided from 2010 through 2019 was collected on the China Central Government Procurement Network.Comparison and analysis were made on the yearly and daily cost of each drug(DDC)and the proportions of domestic drugs and multi-supplier drugs.Results During 2010-2019,9 ART drugs were purchased for the national free AIDS ART program in China.Among all the drugs,the yearly proportion of TDF(6.07%-40.58%),EFV(18.34%-35.91%)and LPV/r(16.29%-38.61%)was the highest.And the annual proportion of domestic drugs and that of multi-supplier drugs increased,with the rises from 25.31%to 61.39%for domestic drugs and multi-supplier drugs from 25.31%to 54.85%.The daily cost of all drugs continued to decline.During the period mentioned earlier,EFV and TDF converted from overboard production to domestic production.DDCs for both drugs were significantly lower after the production conversion.During this period,EFV and TDF also converted from single commercial suppliers to multiple suppliers.DDCs for both drugs were significantly lower after the supplier conversion.Conclusion Financial investment for the national free AIDS ART program has increased by the year.The national procurement system plays a pivotal role in its sustainability and cost-effectiveness.Domestic production and multiple supplier provision are two keys for the optimization of the national procurement system.Necessary policies should be updated to strengthen these two trends.