中国浙江省级医保报销对于靶向抗肿瘤药使用的影响:一项带对照的间断时间序列分析

The impact of the provincial reimbursement scheme on the use of targeted anticancer medications in Zhejiang,China:a controlled interrupted time-series analysis

为了减轻昂贵的靶向抗肿瘤药物给患者带来的沉重经济负担,浙江省在2015年2月将6个靶向抗肿瘤药纳入本省医保报销范围。本研究基于间断时间序列的方法,利用浙江省22家三级医院2014年1月至2017年2月的药品采购数据,分析省级医保政策对6个纳入医保的靶向药(研究组)与4个没纳入医保的靶向药(对照组)的影响。结果显示,政策实施后6个研究组靶向药平均日费用有所降低,每月各医院平均采购量增加34.6 DDDs(P<0.001),每月各医院平均采购金额增加6614.9美元(P<0.001);4个对照组靶向药每月各医院平均采购量和采购金额均无显著变化。本研究表明,浙江省级医保政策可以减轻患者的经济负担,促进靶向药的可及。

To alleviate problems with access and affordability,six targeted anticancer medications(TAMs)were listed in the Provincial Reimbursement Drug List(PRDL)for the first time in Zhejiang,China in February 2015.In the present study,we aimed to evaluate the implementation of the PRDL policy on TAMs use.Using the pharmaceutical procurement data of these six listed TAMs(study group)and four unlisted TAMs(control group)from 22 tertiary hospitals in Zhejiang,China dated between January 2014 and February 2017,interrupted time-series analysis was adopted to examine differences in the average hospital purchasing volume(HPV)and the average hospital purchasing spending(HPS)between the two groups.The average daily cost of listed TAMs in the study group was decreased after April 2015.After enlistment,the average HPV per month was significantly increased by 34.6 defined daily doses(DDDs)(P<0.001),and the average HPS per month was significantly increased by USD 6614.9(P<0.001)for the listed TAMs in the study group(n=6).Neither the average HPV nor the average HPS changed significantly for the unlisted TAMs in the control group(n=4).The PRDL policy showed positive effects on improving patients’affordability and promoting access to TAMs in Zhejiang.The government should conduct further price negotiations and include more TAMs with clinical benefits into reimbursement schemes to relieve patients’financial burden and promote access.