国家组织集中采购质子泵抑制剂在全国范围医疗机构中的可及性调查研究

Accessibility of national-organized centralized procurement of proton pump inhibitors at medical institutions nationwide

目的:调研国家组织集中采购(以下简称“国家集采”)质子泵抑制剂(PPIs)在全国范围内的可及性现状,为评价国家集采政策的实施效果提供参考依据。方法:以前5批国家集采药品中PPIs为调研对象,参照世界卫生组织/健康行动国际组织(WHO/HAI)标准调查法,分别从可获得率、限定日费用(DDDc)、用药频度(DDDs)和可负担性4个维度对我国31个省级行政区900余家二、三级公立综合医院进行调查。结果:国家集采政策实施后,PPIs的可获得性明显提高和呈现逐批次递增趋势,同时PPIs在三级医院的可获得性均显著高于二级医院,越发达的地区可获得性越高;PPIs的DDDs显著提高(增长6634.40%),其中泮托拉唑钠肠溶片和艾司奥美拉唑镁肠溶片的DDDs和增幅均排在前列;PPIs的DDDc大幅降低(平均降幅83.73%),大部分PPIs的DDDs随着DDDc的降低而升高;对于农村和城镇居民,PPIs的可负担性均明显提升,并且我国居民对绝大多数PPIs有较好的可负担性。结论:国家集采政策实施后PPIs的可获得性和DDDs均显著提高,DDDc显著下降,可负担性明显提升,国家集采政策提高了PPIs的可及性,公立综合医院执行国家集采政策效果显著。

OBJECTIVE To explore the accessibility of national-organized centralized procurement of proton pump inhibitors(PPIs)nationwide to provide references for evaluating the implementation outcome of national centralized procurement policy.METHODS The previous five batches of nationally procured PPIs were utilized as research objects.According to the standard survey scheme of World Health Organization/Health Action International(WHO/HAI),over 900 secondary/tertiary public general hospitals in 31 provincial-level administrative regions of China were surveyed from four dimensions of availability rate,defined daily dose cost(DDDc),defined daily doses(DDDs)and affordability.RESULTS After an implementation of national centralized procurement policy,availability of PPIs significantly improved with a rising trend of batch by batch.At the same time,availability of PPIs at tertiary hospitals was significantly higher than that at secondary hospitals and availability was higher in more developed areas;DDDs of PPIs jumped sharply by 6634.40%).And DDDs and spikes of pantoprazole sodium enteric-coated tablets and esomeprazole magnesium enteric-coated tablets ranked at the forefront;DDDc of PPIs dropped by an average decline of 83.73%while DDDs of most PPIs rose;for both rural and urban residents,affordability of PPIs has improved obviously and Chinese residents enjoyed better affordability for most PPIs.CONCLUSION After an implementation of national centralized procurement policy,both availability and DDDs of PPIs have significantly improved while DDDc has significantly lowered with a greater affordability.National centralized procurement policy has greatly improved the accessibility of PPIs.Public general hospitals have achieved remarkable outcomes in implementing the national centralized procurement policy.