药品定价机制之我见

目的:通过改革药品定价机制解决药品价格虚高的问题。方法:对药品定价机制进行历史性回顾并分析其存在的问题,揭示药品价格居高不下的原因,同时分析各相关部门对药价虚高所负的责任,在此基础上提出新的药品定价机制。结果与结论:新的定价机制可以很快地大幅度降低药品价格;同时,可在不增加医院财政拨款的情况下使医院收入有所增加,而不需要从大检查中获取利润,从而降低百姓的医疗费用支出。     

药品单独定价机制的合理性研究

目的:分析我国目前药品单独定价机制的合理性。方法:比较筛选出的167种政府定价药品的单独定价价格和普通价格,统计、分析其价格差异。结果与结论:此次统计范围中,单独定价药品与普通药的价格差距大,约1/3的普通药品价格低于单独定价药品价格的50%;其中,有10个品种的单独定价药品价格高出普通药价格5倍以上;此外,单独定价的药品中,不同企业生产的相同剂型相同规格的同种药品价格差异也十分显著。因此,有必要深入研究药品价格,建立等效等价的药品价格定价机制,限制单独定价范围,完善药品价格监督制度。     

药品定价机制及控制管理分析

近年来随着生活品质的提升,人们对身体健康看得越来越重,与此同时,"看病难,看病贵"这一现象一直是我国医疗事业上最大的困难."看病贵",如今的医疗费用、药品价格越来越贵,让许多百姓都喊看不起病.看一次,少则几十元,多则上百上千元,住院更是容易上万元. 针对药价虚高的问题,本文预想针对药品的价格制定过程,讨论解决方法,进而解决因药价太高导致的一系列问题.     

国内外药品定价体系比较研究

药品价格管理是当前的热门话题,不仅关系到制药行业的发展,更与医疗改革的核心内容密切相关.比较国内外药品的定价体系,总结经验,为完善我国药品价格制订原则、建立药品价格动态调节机制、实行药品价格分类管理提供参考.     

药品自主定价是与非

新的药品价格形成机制并非完美的，它是在假设国内医药市场完全市场化的虚拟前提下制定的，但仍具备了一定的先进性。     

虚高定价要降低生产发展要保证--对药品国家定价的思考和建议

入世,将促进我国市场经济的进一步发展和完善,药品价格也不可避免地将由市场决定和调节。     

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。     

药品"虚高定价"辨析

药品价格是一个十分重要又十分敏感的话题 ,它一方面与广大病患者的经济利益休戚相关 ,另一方面又维系着药品生产企业、经营企业和医疗单位的生存与发展。基本上每年都要发一份的国家药品价格管理法规、条例使得药品价格被“上升”为国家“大事” ,连篇累牍有关药价的报道渲染着一个主题 ,即药品“虚高定价”。当我们在进行药品价格的分析时 ,反思一下 :我们是否已经建立了一个基本的假定 ,即药品“虚高定价” ?我们应该对药品“虚高定价”本身这一命题进行讨论。如果连分析的基本依据都不成立或仅在一定条件下成立 ,那么 ,我们就应该重新认…     

基于价值的多适应证药品医保准入与定价方法研究

目的 探讨多适应证药品的医保准入与定价方法。方法 梳理我国多适应证药品在历年医保谈判中的准入情况,参考基于价值定价的经济学理论和其他国家的相关经验,总结3类共5种在我国可能适用的多适应证药品定价方法。以头孢他啶-阿维巴坦为例,针对该药的不同适应证开展成本-效用分析,并探讨该药合适的定价方法。结果与结论 目前我国多适应证药品均为单一定价。可探索的定价方法包括基于产品的单一定价方法(如基于低价值适应证的单一定价和混合/加权的单一定价)、基于适应证的定价方法(如按适应证协议不同折扣的单一定价和根据不同适应证以不同商品名上市并分别定价),以及补偿准入限制的定价方法。每种定价方式各有优势和局限性。通过头孢他啶-阿维巴坦的案例分析可知,多适应证药品首先要对各个适应证分别开展价值评估,再基于价值综合考量合适的准入情况与定价方法。单一的定价方法虽然简单,但是难以完全反映价值;而基于适应证的定价方法和补偿准入限制依赖于完善的信息系统和多部门的配合。我国应逐步应用基于价值的多适应证药品的定价方法,不断探索合理的准入方式,提高整体社会福利。     

从不确定性分析视角看成本效果阈值的应用

目的介绍成本效果平面在不确定性分析中的作用,明确成本效果阈值λ对成本效果平面以及不确定性分析中成本效果可接受曲线、成本效果可接受边界等方法的意义。方法从成本效果平面、成本效果可接受曲线、成本效果可接受边界的基本原理出发,分析成本效果阈值在3种方法中的应用。结果与结论成本效果阈值的设定可以决定成本效果平面中经济性区域的联合密度分布,提高成本效果可接受曲线、成本效果可接受边界等不确定性分析方法的实用性,从而可以更好的为决策制定提供服务。     

Cost-effectiveness of atypical antipsychotics for the management of schizophrenia in the UK

ABSTRACT

Objective: To evaluate the cost-effectiveness of atypical antipsychotic treatment sequences for the management of stable schizophrenia in the UK.

Research design and methods: A Markov model was developed to assess the cost per quality-adjusted life year (QALY) gained from 12 alternative treatment sequences each containing two of four atypical antipsychotics (aripiprazole, olanzapine, quetiapine and risperidone), followed by clozapine. The main model parameters were populated with data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and a recent trial comparing aripiprazole with olanzapine. Patients enter the model with stable schizophrenia and may relapse, discontinue or continue and experience adverse events (AEs), or develop diabetes. Population mortality was adjusted for schizophrenia and diabetes. Utility decrements applied to stable schizophrenia, relapse, diabetes and treatment-related AEs were taken from a direct UK utility elicitation study. Resource use and unit costs were taken from published sources. A time horizon of 10 years was adopted. Results are based on 10,000 probabilistic iterations of the model.

Results: Aripiprazole followed by risperidone produced the greatest number of QALYs, an additional 0.03 compared with risperidone followed by olanzapine, at an incremental cost of £257 (incremental cost/QALY: £9,440). Aripiprazole followed by risperidone had the greatest probability among evaluated sequences of being cost-effective at a threshold of >£10,000/QALY. All other strategies were dominated by at least one of these strategies. The impact of lower pricing for risperidone (based on generic availability) did not impact results.

Conclusions: Modelling the cost-effectiveness of different treatment sequences for stable schizophrenia is appropriate given that patients rarely remain on one treatment for long periods. The treatment sequence aripiprazole followed by risperidone was the most cost-effective option for patients with stable schizophrenia in the UK.     

Real or perceived impediments to minimum pricing of alcohol in Australia: Public opinion,the industry and the law

A burgeoning body of empirical evidence demonstrates that increases in the price of alcohol can reduce per capita alcohol consumption and harmful drinking. Taxes on alcohol can be raised to increase prices, but this strategy can be undermined if the industry absorbs the tax increase and cross-subsidises the price of one alcoholic beverage with other products. Such loss-leading strategies are not possible with minimum pricing. We argue that a minimum (or floor) price for alcohol should be used as a complement to alcohol taxation. Several jurisdictions have already introduced minimum pricing (e.g., Canada, Ukraine) and others are currently investigating pathways to introduce a floor price (e.g., Scotland). Tasked by the Australian government to examine the public interest case for a minimum price, Australia's peak preventative health agency recommended against setting one at the present time. The agency was concerned that there was insufficient Australian specific modelling evidence to make robust estimates of the net benefits. Nonetheless, its initial judgement was that it would be difficult for a minimum price to produce benefits for Australia at the national level. Whilst modelling evidence is certainly warranted to support the introduction of the policy, the development and uptake of policy is influenced by more than just empirical evidence. This article considers three potential impediments to minimum pricing: public opinion and misunderstandings or misgivings about the operation of a minimum price; the strength of alcohol industry objections and measures to undercut the minimum price through discounts and promotions; and legal obstacles including competition and trade law. The analysis of these factors is situated in an Australian context, but has salience internationally.     

3组女性骨质疏松治疗方案的成本-效果分析

目的 比较3组不同方法治疗女性骨质疏松症的成本-效果.方法 将56例女性骨质疏松症患者分为3组,A组:口服阿法骨化醇+钙尔奇D;B组:口服阿法骨化醇+蚝贝钙组;C组:口服阿法骨化醇+凯思立D,疗程为9个月,运用药物经济学原理进行成本-效果分析.结果 3种治疗方法的成本分别为2 239.83、2 188.98、2402.46元;有效率分别为66.67％、45％、77.78％,成本-效果比分别为33.60、48.64、30.89.结论 C组有效率高,成本-效果比低,为治疗女性骨质疏松症较经济的方案.     

Cost-Effectiveness Analysis: A Proposal of New Reporting Standards in Statistical Analysis

Cost-effectiveness analysis (CEA) is a method for evaluating the outcomes and costs of competing strategies designed to improve health, and has been applied to a variety of different scientific fields. Yet there are inherent complexities in cost estimation and CEA from statistical perspectives (e.g., skewness, bidimensionality, and censoring). The incremental cost-effectiveness ratio that represents the additional cost per unit of outcome gained by a new strategy has served as the most widely accepted methodology in the CEA. In this article, we call for expanded perspectives and reporting standards reflecting a more comprehensive analysis that can elucidate different aspects of available data. Specifically, we propose that mean- and median-based incremental cost-effectiveness ratios and average cost-effectiveness ratios be reported together, along with relevant summary and inferential statistics, as complementary measures for informed decision making.     

克拉霉素、阿奇霉素、左旋氧氟沙星临床应用的药物经济学分析

选择分别采用3种不同药物治疗方案（A组克拉霉素500mg,po,bid×7d;B组阿奇霉素,po,第1天顿服1g,第2、3天各服250mg;C组左旋氧氟沙星200mg,po,bid×7d）的非淋菌性尿道（宫颈）炎病例共计159例,运用药物经济学的成本—效果分析方法进行评价。3种方案（A,B,C组）的总成本分别为390.31元,246.90元,276.98元,效果（以治愈率表征）分别为89.33%,80.35%,80.39%。结论方案A为最佳治疗方案。     

成本效果分析在药事管理中的应用

目的阐述成本效果分析在药事管理中的具体实施与完善的建议。方法论述成本效果分析的内容,探讨当前我国药事管理中存在的问题,阐述成本效果分析在我国药事管理中的具体应用。结果与结论成本效果分析在我国药事管理中尚没有得到广泛应用,有必要加强这方面的工作,以促进我国药事管理工作的发展。     

3种药物组合方案治疗小儿肺炎的成本-效果分析

目的探讨3种方案治疗小儿肺炎的成本-效果比率，为临床治疗提供依据。方法对2007年1月-2008年1月间住院的96例小儿肺炎采用的3种治疗方案进行成本-效果分析。结果A组总有效率为90.63％，B组总有效率为87.50％，C组总有效率为81.25％，3组总有效率比较差异无统计学意义（P〉0.05）；不良反应发生率A组为3.13％，B组为6.25％，C组为6.25％，3组不良反应发生率比较差异无统计学意义（P〉0.05）；C组C／E、△C／△E为3组中最低。结论C组方案为较佳治疗方案。     

2种方案治疗皮肤浅表真菌病的成本-效果分析

目的评价2种方案治疗皮肤浅表真菌病的成本-效果,促进合理用药,降低治疗费用.方法采用药物经济学原理对2种治疗方案进行成本-效果分析。结果A方案和B方案在停药时的总有效率分别为89.3%和82.8%,2组间无显著性差异(P>0.05);成本-效果比(C/E)分别为1.33、0.68.与B方案相比,A方案每增加一个单位效果需多花费9.7元.结论B方案的成本-效果比略优于A方案.     

我院2009年国家基本药物使用情况及价格分析

目的:为基本药物目录(非基层版)的制定提供参考。方法:分析我院基本药物的使用数量及价格。基本药物分政府定价品种和单独定价品种,与医院执行价对比,进行销售金额前10位排序。结果:我院使用基本药物品种总数为214,销售金额为3591.37万元,占药品总销售金额的7.10%。基本药物销售金额中,西药占主导,其中又以单独定价品种占大部分。我院使用的基本药物价格为政府零售指导价的73.1%。单独定价品种有的与政府定价相差不大,有的相差很大。同为政府定价品种,相似的剂型价格有的差异很大。结论:价格体系影响基本药物制度推行。