国家基本药物遴选与药物经济学

介绍了我国国家基本药物遴选概况,阐述了遴选过程中尚需进一步解决的问题,提出引入药物经济学的方法是解决以上问题的有效途径,并结合我国医药卫生行业的实际,讨论了药物经济学的方法在我国国家基本药物遴选中的应用思路.     

Markov模型在肺结核干预措施经济学评价中应用

目的:介绍利用Markov模型对肺结核干预措施进行卫生经济学评价的基本思路.方法:用MarkOV模型中肺结核各状态的转移概率,评价肺结核干预措施的成本效用,将具有吸收状态的转移模型构建和模型参数的确定方法应用于肺结核.结果:Markov模型为肺结核干预措施的卫生经济学评价提供了一种新的方法.结论:可应用Markov模型对肺结核的干预措施进行评价.     

基本药物遴选模型的构建

目的:根据国家基本药物政策,建立基本药物遴选模型。方法:针对基本药物选择的要求,构建基本药物评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建基本药物遴选模型。结果:文中建立了基于模糊群决策的基本药物评价选择模型,并通过实例分析证明了遴选模型的可行性。结论:文中建立了基于模糊群决策的基本药物遴选模型,该模型能够科学、有效进行基本药物的遴选,为促进合理用药、满足公众的基本医疗需求奠定基础。     

国家基本药物遴选的方法遴选

目的 2009—2011年我国初步建立基本药物制度,对广大公立医院的药品管理和运作影响巨大,但是目前相关的方法体系研究却很少;药物遴选是新医改向纵深推进中实施国家药物政策的起点、重点、难点,旨在系统评价和分析各种方法,完善基本药物的遴选。方法基于＂结构—过程—结果＂的指标体系,设计了评分模型,定量比较。结果量化排序为：背包模型法、专家委员会、循证评价法、层次分析法、专家库抽组、经济学方法。结论总结了每种方法的特点,并给出了各种方法使用的特定条件和建议。     

效率边界分析在基本药物遴选决策中的应用研究

目的:探索效率边界分析在药物遴选决策中的应用,为基本药物遴选提供方法参考。方法:通过查阅国内外相关文献,介绍效率边界分析的方法、过程及应用。结果:效率边界分析结合循证医学和药物经济学证据从投入-产出的角度可以实现对同一治疗领域的多种药物进行综合评价。结论:效率边界分析在基本药物遴选决策中具有重要的应用价值。     

分区生存模型在药物经济学评价中的应用

目的:对分区生存模型进行具体介绍,以期为相关药物经济学研究的开展提供参考。方法:对分区生存模型的概念和与Markov模型的区别联系进行了介绍,并对计算方法开展了实例分析。结果:不同于Markov模型需要通过计算转移概率来获取各健康状态的人数分布,分区生存模型借助生存曲线可以更加简便直接地求得各健康状态下的人数比例。结论:分区生存模型是决策分析模型的重要方法,可广泛应用于晚期或转移性癌症治疗的药物经济学评价。     

药物经济学评价Markov模型中转移概率计算的探讨

Markov模型作为决策分析模型之一,被广泛应用于药物经济学评价中,而不同Markov健康状态间转移概率参数的获取往往是模型构建的难点,通常无法直接得到。通过探讨现有Markov模型转移概率,特别是对时间依赖的动态模型转移概率计算方法进行实例分析,为开展相关研究的学者提供思路。     

浅谈药物经济学在药学领域中的应用

目的阐述如何运用药物经济学的分析方法遴选安全有效、物美价廉的药品,避免医疗资源的浪费,促进合理用药。方法详细描述药物经济学的各种分析方法及其衡量指标的侧重点和药学意义。结果通过对最小成本分析、成本-效果分析、成本-效用分析、成本-效益分析、预算-影响分析等药物经济学研究方法的比较,根据实际需求,选取适合的方法对药品进行经济学评价,优化成本效果,提高治疗效率。结论药物经济学在今后的药学服务中将会越来越受到重视,在药物遴选和治疗方案的确定中发挥更积极的作用。     

高值药物支付机制的国际比较及启示

目的:介绍美国、澳大利亚、德国的高值药物支付机制,为完善我国高值药物支付机制提供参考。方法:基于文献,从共付模式、药物遴选标准、谈判定价方式、药物使用管理办法四个方面,探索三国高值药物支付主要内容和特点,并针对我国高值药物支付现状,提出启示及建议。结果:医疗保障制度不同决定了各国共付模式、谈判主体层次的差异,但其药物遴选均与药物经济学评价密切结合,并构建了防止药物滥用的配套管理方法。结论:我国应在大病医疗保险的基础上探索可持续的共付模式,在国家层面探索适宜的药物经济学评价方法,建立相关指标体系,为药物遴选及退出提供科学依据。发挥国家专利高值药集中谈判优势,构建"风险共担"机制降低基金风险,平衡各方利益;探索以明确适应症为主的高值药物使用管理方法。     

基于经济性评价的药品遴选经验介绍及对我国的启示

目的:介绍国外药物经济评价在药品遴选中的应用,探索我国药品遴选中存在的问题及解决思路。方法:运用比较分析方法,研究了世界卫生组织澳大利亚、英国及泰国等国家的药品目录遴选过程以及药物经济学方法在其中的作用。结果:利用药物经济评价结果进行药品遴选是各国普遍采取的方法 ,?药物经济学的发展在各国也比较成熟。结论:引入经济性评价方法完善我国药品遴选流程,需要增加政府投入、推动药物经济学科发展、破除以药补医。     

基于层次分析法的国家基本药物遴选

目的;探讨国家基本药物的遴选方法。方法：采用层次分析法优化遴选方法。结果：目前我国基本药物目录的遘选评价体系存在内在缺陷,通过应用层次分析法减少《国家基本药物目录》,增强遴选方法的可操作性。结论：优化国家基本药物遴选方法,完善国家基本药物制度。     

Availability of essential drugs in two regions of Minas Gerais, Brazil]

OBJECTIVE: To investigate the availability of essential drugs in municipalities with a human development index < 0.699. METHODS: We surveyed 69 institutions, including municipal pharmacies, public clinics, private and philanthropic health units, and commercial pharmacies, in 19 municipalities of the state of Minas Gerais, Brazil. The municipalities were chosen according to the following selection criteria: (1) a human development index (HDI) < 0.699 (the HDI for the entire state of Minas Gerais in 1991) in the microregion where the municipality was located; (2) the municipality had to be the seat of government for the microregion where it was located; (3) there had to be at least two eligible institutions (belonging to the public, private, or philanthropic sectors) in full functioning in the municipality during the survey period. Health professionals who were directly responsible for stock control and drug dispensation at the institutions surveyed were interviewed. Institutional documents and records were also reviewed. A list of 21 tracer essential drugs, which were selected among the drugs most widely employed in the State of Minas Gerais' Basic Pharmacy Program, was used to measure availability. The availability of each tracer drug was calculated at the time of the site visit and for the 12-month period immediately before the survey. In addition, the availability of tracer drugs was calculated for each type of institution surveyed. RESULTS: The availability of essential drugs in municipal pharmacies was 52.0%; in public health clinics, 46.9%; and in philanthropic and private health units, 41.0% and 38.1%, respectively. In commercial pharmacies, the availability of essential drugs reached 81.2%. CONCLUSION: The availability of essential drugs in public facilities is low and varies widely, with the result that persons who need such drugs the most are often those who lack access to them. Private pharmacies are the main source of essential drugs. The results of this study point to the need to seek increased awareness and implementation of the concept of essential drugs throughout the country.     

Bayesian adaptive group lasso with semiparametric hidden Markov models

This paper presents a Bayesian adaptive group least absolute shrinkage and selection operator method to conduct simultaneous model selection and estimation under semiparametric hidden Markov models. We specify the conditional regression model and the transition probability model in the hidden Markov model into additive nonparametric functions of covariates. A basis expansion is adopted to approximate the nonparametric functions. We introduce multivariate conditional Laplace priors to impose adaptive penalties on regression coefficients and different groups of basis expansions under the Bayesian framework. An efficient Markov chain Monte Carlo algorithm is then proposed to identify the nonexistent, constant, linear, and nonlinear forms of covariate effects in both conditional and transition models. The empirical performance of the proposed methodology is evaluated via simulation studies. We apply the proposed model to analyze a real data set that was collected from the Alzheimer's Disease Neuroimaging Initiative study. The analysis identifies important risk factors on cognitive decline and the transition from cognitive normal to Alzheimer's disease.     

江西农村基本药物零售价价位的调查与分析

目的:为了检查江西省贯彻落实国家基本药物制度的实施意见后,江西农村基本药物零售价情况。方法:自拟调查表,采用分层随机抽样的方法,以江西省农村药品"监督与供应"网络建设40个示范县为样本,对其基本药物零售价进行现场调查,以各种药品国家药品指导价为参数,计算各品规药品的相对价位,用SPSS统计软件进行统计分析。结果:不同涉药单位基本药物零售价相当于国家指导价的价位是:乡镇卫生院为56.6%,零售药店为53.16%,村诊所为52.4%。结论:虽然基本药物的零售价格得到合理有效的控制,但仍存在少数药品零售价超国家指导价现象。     

低成本广覆盖是基本药物精选之精髓

目的:到2015年使95％的人口获得支付得起的基本药物是联合国千年发展目标之一,但是基本药物的遴选和人口覆盖目标之间的联系并没有建立.方法:原创性地建立了以人口、药费和药物目录等为变元的数学模型.结果:将世界卫生组织、我国2004和2009年的基本药物目录数据代入模型,测算结果表明,我国2004年目录药费总开支最大,而2009年目录药费总开支最小,年均可比2004年目录药费节约1 400亿元.结论:削减基本药物却反而可扩大其人口覆盖率,并使药费支出总额减少,这恰是基本药物政策的精髓所在.     

The antibacterial paradox: essential drugs, effectiveness, and cost

The concept proposed by WHO of an essential drugs list that should comprise drugs corresponding to the health needs of the majority of the people has been embraced by countries, which have adapted it to their needs. In this study, the essential antibacterial drug lists of 16 countries chosen from the six WHO regions are reviewed. Most of these countries include 73% of WHO-recommended essential antibacterials on their lists. However, most are lacking reserve antibacterials, and even some main list antibacterials, which are essential when empirical therapy fails in cases of bacterial resistance. Many factors that may be responsible for the lack of selection of these drugs, not least cost considerations, are discussed.