英国药品定价方法的调整趋势及对我国的启示

目的:为我国政府部门制定和调整药品价格提供参考。方法:明晰英国药品定价的目标,分析其定价方法对定价目标的支撑和吻合情况,介绍和分析其新的调整趋势——价值定价法。结果与结论:英国药品定价方法在不断调整和完善,价值定价法更加符合价格管理目标的客观要求。我国政府定价部门应及早予以深入研究和尝试此类方法,通过对药品的成本-效果进行评估、确定药品间功能差异指标、确定指标权重、评价药品的价值,进行合理的药品定价。     

Risk sharing in managed entry agreements—A review of the Swedish experience

BackgroundIn 2014 managed entry agreements (MEA) between Swedish health care payers (county councils), the reimbursement authority (the Dental and Pharmaceutical Benefits Agency (TLV)) and pharmaceutical companies were introduced to facilitate early and equal access to treatments. MEAs complement the value-based pricing system for out-patient drugs and enables stake-holders to negotiate risk-sharing agreements.AimThe aim of the study was to review existing agreements, describe the type of uncertainty dealt with, and to analyze incentives created using the literature on performance-based reimbursement schemes in Sweden.MethodA document review of all agreements made in the period January 2015 to August 2019 was conducted, classifying agreements by the type of uncertainty dealt with.ResultsAgreements were made for 56 products during the studied time period (45 ongoing), mainly in the fields of hepatitis C (n = 10) and oncology (n = 14). Uncertainties addressed in ongoing agreements included size of treated population (10), treatment duration (13), and effectiveness (9). The mechanism for risk-sharing was limited to refunds based on patient numbers, duration or just flat-rate refunds. The estimated refund in 2018 was 50 % of total sales.DiscussionThis review show that the main driver behind risk sharing in Sweden so far have seem to be affordability rather than managing uncertainty.     

New care measures and their impact on pain medicine: One pain specialist’s perspective

Value-based purchasing (VBP) goes into effect this year and it links the quality of care to payments for care. Starting in fiscal year 2013, the Centers for Medicare and Medicaid Services reduces all inpatient prospective payment system reimbursements by 1%. This money then can be returned to hospitals in the form of a bonus through VBP. Value-based purchasing holds hospitals accountable for both cost and quality. With VBP, hospitals get a score that is based on the process of care, the outcomes, and patient-centeredness. This means that reimbursements in health care, which keep hospitals in business, are transitioning from “volume of services” to VBP. Although VBP sounds like a great idea, particularly to politicians in Washington tasked with managing out-of-control health care expenditures, there is very little high-quality evidence that VBP will actually improve care. Nevertheless, this is the way we are going to be moving forward. The perception of pain is a highly personalized phenomenon, and chronic pain affects every aspect of a patient’s life. The biopsychosocial model and the concept of utilizing an interdisciplinary team approach in the management of chronic pain make sense, but there are concerns that it could result in higher overall costs and no measurable improvements in the patient’s perception of care. Both results. could have a negative impact on pain specialists.     

基于价值定价的多适应证药品医保支付国际经验及启示

目的:为完善我国多适应证药品基于价值定价的医保支付提供参考。方法:梳理多适应证药品价值定价的理论基础和实现流程,分析法国、德国、英国、意大利和瑞典的价值评估指标和基于价值定价的医保支付策略,为我国多适应证药品医保支付提出建议。结果与结论:价值定价的实现首先需要制定一个价值框架以定义、测量、整合价值,再通过建立模型将总价值转化为价格。各国多适应证药品根据价值定价的整体思路一致,但价值评估指标存在差异。英国和瑞典主要以药物经济学方法测得的质量调整生命年(QALYs)和增量成本-效果比(ICERs)为价值标准,法国、德国和意大利则更侧重于以药品的临床治疗价值和临床指标改善程度为标准。在多适应证药品的医保支付策略方面,法国采取的是基于预期使用量的单一加权法,德国采取的是基于价值和使用量的组合加权法,英国采取的是名义医保支付标准结合患者准入协议法,意大利采取的是名义医保支付标准结合管理准入协议法,瑞典则采用不同适应证不同商品名的独立支付法。我国可在借鉴上述多国经验的基础上,探索适应我国国情的多适应证药品的价值定价策略,综合借鉴和使用多种医保支付策略,完善患者及药品使用信息收集机制,为实施多适应证药品价值定价和医保支付策略提供信息支持。     

The use of patient-reported outcome tools in Gynecologic Oncology research,clinical practice,and value-based care

Patient-reported outcomes (PRO) are defined as a report of a patient's symptoms, function and general well-being that comes directly from the patient, without interpretation of the response by a medical provider. As greater emphasis is placed on high-quality, patient-centered care, the importance of PROs has become widely accepted by policymakers, third party payers, medical societies, health care systems and clinical researchers. Despite increased recognition of the importance of PROs, they have not become a widely-implemented part of clinical care and their use in clinical research has been limited by methodological concerns. Health service researchers and providers are working to standardize and develop new methods to improve implementation of PROs in clinical and research settings. This article reviews the development of PRO measurement tools, implementation in the healthcare setting and relevance in clinical trials, with a focus on clinical care and research in gynecologic oncology.     

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.