2015-2017年长江流域六市样本医院国产及进口噻托溴铵的使用情况及预算影响分析

目的：基于2015-2017年长江流域六市共273家样本医院噻托溴铵的使用情况进行分析，结合此地区的经济学评价结果和数据模拟的预测影响分析，明确国产和进口噻托溴铵两者相对的经济学价值，为临床噻托溴铵的合理使用及医改选药提供参考。方法：抽取2015-2017年长江流域六市273家样本医院噻托溴铵的通用名、剂型、规格、使用数量、销售金额及生产厂商性质等，分析上述医院国产和进口噻托溴铵的销售金额、使用频度（DDDs）及其构成比等，利用理想模型费用数据模拟与预算影响分析模型进行数据处理及分析。结果：长江流域六市样本医院2015-2017年噻托溴铵总DDDs和总销售金额呈增长趋势，且具有统计学意义。六市样本医院噻托溴铵的总销售金额按照其在长江流域的地理位置（即从长江下游至上游）逐步递减的，沿海东部地区总销售金额及DDDs高于中西部地区，国产噻托溴铵在使用频度方面占主导地位，销售金额处于从属地位。从卫生服务提供者的角度考虑，国产噻托溴铵在治疗费用上相对进口噻托溴铵具有成本优势。通过预算影响分析，在假设完全规范慢性阻塞性肺疾病（COPD）管理情况下，国产噻托溴铵对进口噻托溴铵的替换具有节约费用的作用。结论：从医保基金的高效使用以及病人的经济负担角度，临床使用国产噻托溴铵更合理有效。

The use and budget impact analysis of domestic and imported tiotropium bromide in sample hospitals of six city around Yangtze river basin from 2015 to 2017

OBJECTIVE To analyze the use of thiotropium bromide in a total of 273 sample hospitals in six cities of the Yangtze River Basin from 2015 to 2017,and to clarify the relative economic value of domestic and imported thiotropium bromide in combination with the economic evaluation results in this region and the predictive impact analysis of data simulation,so as to provide a reference for the rational use of clinical thiotropium bromide and the selection of drugs for medical reform.METHODS The generic name,dosage form,strength,quantity of use,sales amount and nature of manufacturers of thiotropium bromide in 273 sample hospitals in six cities of the Yangtze River Basin from 2015 to 2017 were selected to analyze the sales amount,frequency of use (DDDs) and their constituent ratios of domestic and imported thiotropium bromide in the above hospitals,and the ideal model cost data simulation and budget impact analysis model were used for data processing and analysis.RESULTS The total DDDs and total sales amount of thiotropium in the sample hospitals of the six cities of the Yangtze River Basin showed an increasing trend from 2015 to 2017,and there was statistical significance.The total sales amount of thiotropium in the sample hospitals of the six cities gradually decreased according to their geographical location in the Yangtze River Basin (i.e.,from the lower reaches of the Yangtze River to the upper reaches),the total sales amount and DDDs in the eastern coastal areas were higher than those in the central and western areas,the domestic thiotropium bromide was dominant in terms of frequency of use,and the sales amount was subordinate.From the perspective of health service providers,domestic thiotropium had a cost advantage over imported thiotropium in terms of treatment costs.Through budget impact analysis,under the assumption of completely standardizing the management of chronic obstructive pulmonary disease (COPD),domestic thiotropium bromide has a cost-saving effect on the replacement of imported thiotropium bromide.CONCLUSION From the perspectives of the efficient use of the health insurance fund and the economic burden for patients,the clinical use of domestic tiotropium bromide is more reasonable and effective.