首批药品集采品种采购量变化的影响因素分析

Analysis of influential factors for purchasing quantity changes in the procurement varieties of the first batch of drug centralized procurement

目的探讨首批药品集中带量采购(简称“集采”)品种采购量变化的影响因素。方法选取“4+7”政策的25个集采品种为研究对象,对“4+7”试点、续约、扩围政策实施前后上述集采品种的采购量变化进行分析,并从药品、医疗机构、地区3个层面确定影响因素,采用多元线性回归模型分析集采品种采购量变化的影响因素。结果“4+7”试点、续约、扩围政策干预期的采购量较基期平均分别增长52.1万DDDs、-0.2万DDDs、85.8万DDDs。在试点、续约、扩围期,集采品种的DDDc降幅都与集采品种的采购量增量呈显著正相关(P<0.01)。在试点和续约期,完全可替代药品品种数与集采品种的采购量增量呈显著正相关(P<0.1);在试点和扩围期,一定程度可替代药品品种数与集采品种的采购量增量呈显著负相关(P<0.05)。在续约期,三级医院集采品种的采购量增量显著小于基层医疗机构(P<0.05)。结论集采品种采购量的变化幅度与DDDc降幅相关,集采后药品价格降幅越大,其采购量的增幅就越大;集采品种的可替代药品品种数对其采购量变化有影响,但不稳定;随着政策实施,基层医疗机构的“放量”效果逐渐超过三级医院,提示集采品种的用量在向基层医疗机构转移,集采政策推动了分级诊疗制度的实施。

OBJECTIVE To investigate the factors influencing the changes in purchasing quantity in the procurement varieties of the first batch of volume-based drug centralized procurement(hereinafter referred to as centralized procurement).METHODS Using 25 procurement varieties of the“4+7”policy as research objects,the changes in purchasing quantity of procurement varieties were analyzed before and after the implementation of the“4+7”pilot,renewal and expansion policies.The influential factors were determined from the three levels of drugs,medical institutions and regions;and the multiple linear regression model was used to analyze the influential factors for the changes in the purchasing quantity of procurement varieties.RESULTS Before and after the implementation of the“4+7”pilot,renewal and expansion policies,the purchasing quantity increased by 52.1,-0.2,85.8 ten thousand DDDs on average,compared with base period.During pilot,renewal and expansion period,DDDc decrease in procurement varieties was positively correlated with the increase in purchasing quantity(P<0.01).During the pilot and renewal period,the number of absolutely alternative varieties was positively correlated with the increase in purchasing quantity(P<0.1).During the pilot and expansion period,the number of alternative varieties to a certain extent was negatively correlated with the increase in purchasing quantity(P<0.05).During the renewal period,the increment of purchasing quantity in tertiary hospitals was smaller than that of primary medical institutions(P<0.05).CONCLUSIONS There is a relationship between the decline of DDDc and the changes in the purchasing quantity,that is,the more the drug price dropped,the more the purchasing quantity increased.The number of alternative varieties for centralized procurement will affect the changes in their purchasing quantity,but it is not always stable.With the implementation of the policy,the volume of primary medical institutions gradually exceeds that of tertiary institutions,indicating that the consumption of centralized purchased varieties is transferred to the primary medical institutions,and centralized procurement has promoted the implementation of the hierarchical diagnosis and treatment system.