曲妥珠单抗纳入上海医保药品目录对乳腺癌患者靶向治疗的影响因素分析

Analysis of influence factors of trastuzumab inclued in drug directory of Shanghai medical insurance on targeted therapy for breast cancer patients

目的了解曲妥珠单抗纳入上海医保药品目录后,对HER-2阳性乳腺癌患者靶向治疗的影响。方法选取上海交通大学医学院附属瑞金医院HER-2阳性且按医保结算的患者282例作为研究对象,通过现场发放调查问卷、个别访谈等方式进行调查。问卷以选择选项为主,并设置开放性主观题。使用logistic软件分析年龄段、上年度家庭可支配收入、医保类型、确诊时间、个人医疗费用支出对患者使用曲妥珠单抗治疗的影响。结果 102例患者参与问卷调查,其中有96例(94.1%)使用曲妥珠单抗治疗。年龄分布以56~69岁为主,参保类型主要为城镇职工医保。96例患者中有60例(63%)使用曲妥珠单抗的费用支出大于等于可支配收入。个人医疗费用支出与患者是否使用曲妥珠单抗高度相关(P <0.05)。85.3%的患者认为医保设定的个人定额支付标准较高,其次是"三定"原则限制了医院的选择范围和药品的医保限定支付范围相对狭窄等。结论个人医疗费用支出是影响使用曲妥珠单抗的主要因素,建议上级医保部门进一步降低个人定额支付标准,加快推进全国门诊异地医保实时结算,并借力补充医疗保险为患者提供更多保障。

AIM To know the effects of trastuzumab on targeted therapy for breast cancer patients with HER-2 positive after inclusion in the drug directory of Shanghai medical insurance. METHODS A total of 282 patients with HER-2 positive and covered by medical insurance in Ruijin Hospital,School of Medicine Shanghai Jiao Tong University were selected as the research subjects, and investigated by on-site questionnaire and individual interview. The questionnaire mainly selected options and setted open subjective questions. Logistic software was used to analyze the influence of age group, household disposable income of the previous year, type of medical insurance, time of diagnosis, and personal medical expenses on patients treated with trastuzumab. RESULTS One hundred and two patients participated in the questionnaire survey, of which 96(94.1%) were treated with trastuzumab. The age distribution was mainly 56 to 69 years old, and the insured type was mainly urban employees’ medical insurance. Trastuzumab costs were more than or equal to disposable income in 60 of 96 patients(63%). Personal medical expenses were highly correlated with trastuzumab use(P < 0.05).There were 85.3% of patients thought that the payment standard of personal quota set by medical insurance was relatively high, followed by the “three fixed” principle which limited the scope of hospital choice and the relatively narrow scope of medical insurance payment. CONCLUSION Personal medical expenses are the main factor influencing trastuzumab use. It is suggested that higher level medical insurance department further reduce the payment standard of personal quota, accelerate the real-time settlement of outpatient out-of-place medical insurance nationwide, and provide more security for patients by taking advantage of supplementary medical insurance.