基于WHO/HAI标准调查法的湖北省SGLT-2抑制剂类药物可及性研究

Accessibility of SGLT-2 Inhibitors in Hubei Province Based on WHO/HAI Standard Survey Method

目的了解湖北省钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂的可及性现状,为药品临床使用和政策制定提供参考依据。方法依据世界卫生组织/健康行动国际组织(WHO/HAI)的标准调查法,调查湖北省医疗机构SGLT-2抑制剂的可及性,采取关键人物访谈法分析影响SGLT-2抑制剂可获得性及可负担性的关键因素。结果2018—2023年期间湖北省医疗机构SGLT-2抑制剂的配备数量和可获得性呈递增趋势,三级医院普遍高于二级医院。其中达格列净可获得性最好,由2018年可获得性差(<25%)增加为2023年的可获得性好(>75%),其次为恩格列净,其他药物可获得性相对较差。影响可获得性因素主要为药品价格、药品是否纳入医保和药品是否集采等。从药品可负担性出发,此类药物总体较差(药物30 d治疗费用均大于最低日薪1倍),卡格列净、艾托格列净和恩格列净部分仿制药国内价格低于国际参考价,影响可负担性因素主要为医保覆盖情况及报销比例、药品价格和患者及家庭收入等。结论SGLT-2抑制剂在湖北省内的药品价格、可获得性及可负担性均有待进一步改善。随着这类药物治疗地位提升及临床需求增加,期望相关部门可从集采、医保、基本药物及药品研发生产等政策方面促进调整。

Objective To investigate the availability of sodium-dependent glucose transporters 2(SGLT-2)inhibitors in Hubei Province,and to provide reference for drug clinical use and policy formulation.Methods According to the standard survey method of World Health Organization/Health Action International(WHO/HAI),the accessibility of SGLT-2 inhibitors in medical institutions in Hubei Province was investigated and evaluated,and key person interviews were used to analyze the key factors affecting the availability and affordability of SGLT-2 inhibitors.Results From 2018 to 2023,the specification and availability of SGLT-2 inhibitors showed an overall increasing trend,and was generally higher in tertiary hospitals than in secondary hospitals.Dapagliflozin had the best availability,which increased from poor availability(<25%)to good availability(>75%)in hospitals from 2018 to 2023,followed by empagliflozin,and the availability of other drugs was relatively poor.The main factors affecting the availability were drug price,whether drugs were included in medical insurance and whether drugs were collected.From the perspective of affordability,SGLT-2 inhibitors were generally poor(the cost of 30 d treatment of drugs was more than 1 times the minimum daily wage),but the domestic prices of some generic drugs such as canagliflozin,ertugliflozin and empagliflozin were lower than the international reference prices.The main factors affecting affordability were medical insurance coverage and reimbursement ratio,drug prices and patient and family income.Conclusion The price,availability and affordability of SGLT-2 inhibitors in Hubei Province needs to be further improved.With the promotion of the therapeutic status of such drugs and the increase in clinical demand,it is expected that relevant departments can promote adjustment in terms of policies such as collection,medical insurance,essential drugs and drug research and development and production.