南京地区医保新增抗肿瘤药物利用分析及医保支付费用预测

目的：分析南京地区34家医院2014-2016年医保新增抗肿瘤药物的利用情况,并预测其医保支付费用。方法：2014-2016年南京地区医保新增抗肿瘤药物及抗肿瘤药物的用药数据来自江苏省医药情报研究所。药物利用情况以用药金额、DDDs、DDC和B/A值表示。结果：新增抗肿瘤药物的利用情况,2015年与2014年基本持平,2016年显著增加。三年来用药金额最高的均为靶向药物,DDDs最高的均为抗肿瘤中成药。销售金额排名靠前的品种为利妥昔单抗、参一胶囊、重组人血管内皮抑制素、曲妥珠单抗和吉非替尼。DDDs排名靠前的为参一胶囊、吉非替尼、重组人血管内皮抑制素、厄洛替尼和达沙替尼。大部分药物的DDC值相对稳定。B/A值较高的是参一胶囊、达沙替尼、吉非替尼和厄洛替尼。纳入"新医保"后,13个品种的价格及DDC值降低,若DDDs不变,用药金额降至87.94百万元,预测医保支付金额为47.70万元。结论：南京地区医保新增抗肿瘤药物的利用基本合理,纳入"新医保"后的降价,有助于降低整体用药金额和医保支付费用。

Applicationanalysis and medicare payments prediction of new selected anti-tumor drugs of medical insurance in Nanjing City

OBJECTIVE To analyze the application of new selected anti-tumor drugs of medical insurance in Nanjing city from 2014 to 2016, and predict their medicare payments. METHODS The consumption of new selected anti-tumor drugs and total antitumor drugs from 2014 to 2016 were obtained from Jiangsu medicine information institute. Drug utilization was expressed as consumption amount, DDDs, DDC and B/A value. RESULTS Drug utilization in 2015 was similar as that of 2014, but increased significantly in 2016. From 2014 to 2016, the top in consumption amount was targeted drugs, while the top in DDDs was antitumor Chinese patent medicine. Rituximab,Shengyi capsule, endostar, trastuzumab and gefitinib were high at consumption amount, while Shengyi capsule, gefitinib, endostar, erlotinib and dasatinib were high at DDDs. DDC of most drugs kept stable relatively. The B/A values of Shengyi capsule, dasatinib, gefitinib and erlotinib were relatively high. The prices and DDC values of 13 kinds of drugs were reduced after included to the health insurance. If DDDs had not changed, the consumption amount reduced to 87.94 millions, estimated medicare payment was 47.70 millions. CONCLUSION The application of new selected anti-tumor drugs of medical insurance in Nanjing city is reasonable from 2014 to 2016. The prices of 13 drugs are reduced after included to the health insurance, which is helpful to reduce the consumption amount and medicare payment.