慢病复方制剂的医保准入评估模式研究

Study on Evaluation Model of Medical Insurance Access of Chronic Disease Compound Preparation

在慢病治疗领域,相比于单药联合使用方案,复方制剂具有疗效稳定、副作用少和依从性高等比较优势。近年来,随着健康中国建设步伐加快,我国复方制剂纳入医保目录的需求也快速增长。但由于在准入评估中,无法充分体现复方制剂的比例优势和制剂优势等临床价值,导致准入价格偏低,2021年成功率仅30%。本文结合我国医保目录调整实践和域外HTA先进经验,从参照药物选择、依从性测量、药物经济学模型转归三方面提出优化评估模式,精准体现复方制剂的患者获益的方法学思考。

In the field of chronic disease treatment,compared with the single drug combination scheme,compound preparation has the comparative advantages of more stable efficacy,fewer side effects and higher compliance.In recent years,with the accelerated pace of building a healthy China,the demand for compound preparations to be included in the medical insurance catalog has also grown rapidly.However,due to the failure to fully reflect the clinical value such as the proportion advantage and preparation advantage of compound preparations in the access assessment,the access price is low,and the success rate in 2021 is only 30%.Based on the practice of medical insurance catalog adjustment in China and the advanced experience of HTA abroad,this paper proposes an optimized evaluation model from three aspects of reference drug selection,compliance measurement,and the outcome of pharmacoeconomic model,which accurately reflects the methodological thinking of the benefits of patients with compound preparations.