铜绿假单胞菌注射液治疗恶性胸腔积液的预算影响

Budget Impact of Pseudomonas Aeruginosa Injection in the Treatment of Malignant Pleural Effusion

目的基于医保支付方角度,预测铜绿假单胞菌注射液纳入国家医保目录后1~3年内对医保基金的影响,为铜绿假单胞菌注射液的价格制定和医保报销提供决策支持。方法利用EXCEL软件构建预算影响分析模型,依据销售额、销售额中用于目标疾病的比例、疗程费用计算药物的使用总疗程数,基于2015—2019年的平均增长率预测2020—2023年目标疾病人群的总用药疗程数。根据厂家预估铜绿假单胞菌注射液实现医保准入后的销量情况,以及未准入情境下铜绿假单胞菌注射液的销量变化情况,和相关竞品被替代比例,分析其进入医保后对于医保基金的影响。结果基础分析结果显示,铜绿假单胞菌注射液进入国家医保目录后,相对于不进入国家医保目录,以乙类药品平均报销70%的报销率假设,2021—2023年医保基金支出分别增加3819.64万元、4953.58万元和6402.09万元,占医保总基金支出的比值为0.00148%、0.00173%、0.00204%。不确定性分析结果显示,不同参数假设下铜绿假单胞菌注射液国家医保补偿后会增加医保基金支出,但增加比例在0.003%以下,研究结果具有一定的稳定性。结论铜绿假单胞菌注射液医保补偿后,一定程度上增加了医保基金支出,但增加的医保基金支出占医保基金总支出的比例不大,对医保基金的影响有限。

Objective Based on the perspective of medical insurance payers,to predict the impact of pseudomonas aeruginosa injection on the medical insurance fund within 1-3 years after it was included in the national medical insurance directory,and to provide decision support for the price setting and medical insurance reimbursement of pseudomonas aeruginosa injection.Methods Excel software was used to build a budget impact analysis model.According to the sales volume,the proportion of sales volume devoted to target diseases and treatment cost,the total number of treatment courses of drugs was calculated.Based on the average growth rate from 2015 to 2019,the total number of treatment courses of patients with target diseases was predicted from 2020 to 2023.According to the estimated sales volume of pseudomonas aeruginosa injection after medical insurance access,the sales volume change of pseudomonas aeruginosa injection without medical insurance access,and the proportion of relevant competitive products being replaced,the influence of pseudomonas aeruginosa injection on medical insurance fund after its entry into medical insurance was analyzed.Results The results of basic analysis showed that,after pseudomonas aeruginosa injection was included in the national medical insurance directory,compared with not included in the national medical insurance directory,assuming that the reimbursement rate of average reimbursement of class B drugs was 70%,the medical insurance fund expenditure from 2021 to 2023 would increase by 38196400 yuan,49535800 yuan and 64020900 yuan respectively,accounting for 0.00148%,0.00173%and 0.00204%of the total medical insurance fund expenditure.The uncertainty analysis results showed that under different parameter assumptions,the national medical insurance compensation for pseudomonas aeruginosa injection would increase the medical insurance fund expenditure,but the increase proportion was less than 0.003%,and the research results were stable to a certain extent.Conclusion After medical insurance compensation,pseudomonas aeruginosa injection increases the total expenditure of medical insurance fund to some extent,but the increased expenditure of medical insurance fund does not account for the proportion of the total expenditure of medical insurance fund,and has limited influence on the medical insurance fund.