带量采购政策下口服质子泵抑制剂在宣武医院的应用分析

Analysis on the Application of Oral Proton Pump Inhibitors in Xuanwu HospitalUnder the Centralized Volume-based Procurement Policy

目的:分析带量采购奥美拉唑肠溶胶囊对其他4个口服质子泵抑制剂(Proton Pump Inhibitors,PPIs)使用的影响及其处方合理性,探讨带量采购政策执行过程中存在的问题,促进临床合理用药和优化带量采购政策。方法:采用药物经济学方法,根据实施集采1年PPIs使用情况分析门诊药物奥美拉唑带量采购实施前后口服PPIs的销售数量、销售金额、用药频度(DDDs)和日均费用(DDC)、仿制药替代率、PPIs构成比、日剂量、排序比等指标变化情况。结果:奥美拉唑肠溶胶囊带量采购后使原用药奥美拉唑肠溶片的DDDs降低,同时也对其他抑酸药的使用产生影响,不同品规使用结构有变化,集采后奥美拉唑DDDs排序第二,代替了集采前兰索拉唑的排序。雷贝拉唑DDDs仍居首位,艾司奥美拉唑DDDs保持第三。PPIs的DDC整体下降,奥美拉唑的排序比B/A>1,集采药品带来的经济效益与社会效益同步化。就双倍标准日剂量的占比而言,奥美拉唑和雷贝拉唑增加而兰索拉唑减少。肾科PPIs消耗量下降,主要与奥美拉唑的用量减少、法莫替丁使用量增加相关。此外,仍有13.87%的奥美拉唑处方被认为是超说明书用药,需加强监管。结论:实施集采后,口服PPIs实现量增价减的同时还存在一些亟待解决的问题,比如日剂量并非是最低有效剂量、肾科对集采药品接受度不高、超说明书用药等,这些问题影响了政策正面作用的发挥,应加强精细管理促进集采药品合理使用。

Objective:To analyze the effect of the volume-based procurement of omeprazole enteric-coated capsules on the use of other four oral PPIs and the prescriptions rationality,and to explore the problems existing in the implementation of volume-based procurement policy,and to promote clinical rational drug use and optimize volume-based procurement policy.Methods:The pharmacoeconomics method was used to analyze the changes in the sales quantity, the sales amount, defined daily doses (DDDs), defined daily cost (DDC), generic drugreplacement rate, the component ratio of PPIs, daily dose, ranking ratio and other indicators of oral PPIs beforeand after the implementation of omeprazole volume-based procurement in outpatient department according to theuse of PPIs in the fi rst year. Results: After the volume-based procurement of omeprazole enteric-coated capsules,the DDDs of the original drug omeprazole enteric-coated tablets were reduced, which also had an impact on theuse of other acid-inhibiting drugs. The structure of use of diff erent specifi cations changed, and omeprazole DDDswere ranked second after volume-based procurement policy, replacing the ranking of lansoprazole before volumebased procurement. Rabeprazole DDDs remained at the top, and esomeprazole DDDs remained third. The DDCof PPIs decreased overall, the ranking ratio of omeprazole was B/A>1, and the economic benefits brought bycentralized volume-based procurement drugs were synchronized with social benefi ts. In terms of the proportionof double standard daily doses, omeprazole and rabeprazole increased while lansoprazole decreased. The decreasein the consumption of PPIs in nephrology was mainly related to the decrease in the use of omeprazole and a risein the use of famotidine. In addition, 13.87% of omeprazole prescriptions were still considered off -label that needto be regulated. Conclusion: After the implementation of centralized volume-based procurement, there existsome urgent problems to be solved while quantity increases and price decreases of oral PPIs, for example, thedaily dose is not the minimum eff ective dose, the acceptance of centralized volume-based procurement drugs bynephrology is not high, and the off -label medication. These problems aff ect the positive role of the policy, and fi nemanagement should be strengthened to promote the rational use of centralized volume-based procurement drugs.