成本-效果可支付曲线的理论与应用

目的:从理论和应用角度对一种新兴分析工具——成本-效果可支付曲线进行介绍,以期为我国药品决策研究与实践提供新思路。方法:通过分析成本-效果平面中成本-效果阈值线和可支付线的含义来引出和分析成本-效果可支付曲线,并借助已有实证研究对其含义进行分析和解释。结果:成本-效果可支付曲线结合了可支付线与阈值线二者提供的信息,是成本-效果阈值和预算限制的函数。结论:成本-效果可支付曲线可同时提供经济性与可支付性信息,在给定预算下随成本-效果阈值的变化而变化。     

Food taxes: what type of evidence is available to inform policy development?

Summary Once dispatched to the bottom draw of policy options to address unhealthy eating, food taxes now seem back in the out tray of European policy makers. Even David Cameron made an offhand quip recently suggesting that this is something the British Government might explore. While the purpose of developing food taxes is likely their potential to raise money for national treasuries, governments have justified them on health grounds. But, what evidence is available that can inform policy development in this area from a health perspective? Most obvious are the studies that model different scenarios for taxes. Yet these studies form a relatively small part of the potential evidence‐base. The largest proportion of existing research on food prices has simply measured food prices in the marketplace and drawn hypotheses about the dietary implications. Other studies have estimated the costs of actually consumed diets. Another set of studies have quantified an association between price of specific foods and diet from real world data. Others have likewise taken a quantitative approach, but in experimental settings. A particularly large group of studies are qualitative – those asking consumers if and/or how their food choices are influenced by prices. The final type of study combines qualitative and quantitative methods. This paper examines the relevance of these different types of evidence as information for policy development in this area.     

Factors Affecting Buprenorphine Utilization and Spending in Medicaid, 2002-2018

ObjectiveBuprenorphine is an essential medication for the treatment of opioid use disorder (OUD), but studies show it has been underused over the last 2 decades. We sought to evaluate utilization of and spending on buprenorphine formulations in Medicaid and to evaluate the impact of key market and regulatory factors affecting availability of different formulations and generic versions.MethodsWe first identified all buprenorphine formulations approved by the Food and Drug Administration for OUD using Drugs@FDA. We then used National Drug Codes to identify each drug in the Medicaid State Drug Utilization Data and extracted annual utilization rates and spending between 2002 and 2018 by drug and according to whether a brand-name or generic version was dispensed. We compared these trends to market and regulatory factors that affected competition, which we identified through searching the Federal Register, Westlaw, PubMed, and Google News.ResultsBrand-name buprenorphine-naloxone sublingual tablet and film formulations (Suboxone) were dispensed 2.7 times more (n = 634 213 140) and reimbursed 4.4 times more (n = $4 440 556 473) than all other formulations combined (n = 237 769 689; $1 018 988 133). We identified numerous market and regulatory factors that contributed to an estimated 9-year delay in generic versions of the tablet formulation and 6-year delay for generic versions of the film formulation.ConclusionsBrand-name buprenorphine formulations have been widely used in Medicaid, leading to substantial costs, in part because generic versions were delayed by multiple years owing to market and regulatory factors. Timely availability of low-cost generics could have helped encourage OUD treatment with buprenorphine during the height of the opioid crisis.     

农民工社会医疗保险承受力及其改善体制机制

国家为了改善农民工医疗保险的问题制定了系列的政策法规,并最终以社会保险立法的形式加以强制约束。但中国农民工医疗保险仍处于较低的参保状态,说明农民工医疗保险仍然面临较大的压力。改善和提高农民工医疗保险的相关利益主体的承受力,有助于提高并稳定农民工参保。     

Financially independent primary health care drug supply system in Cameroun

The drug supply system in the North-west Province of Cameroun differs from 'simple' health financing projects in three important respects. Firstly, the system does not promote drug sales for cofinancing purposes but aims at supporting the prescribers to provide better medical care, and patients' access to the most essential drugs at fair prices. Secondly, the project guarantees equal prices and services throughout the Province regardless of distance from the central warehouse and sales at a given location. Thirdly, along with the revolving fund-financed drug supply system, a community-based legal framework has been established. Built-in management alert mechanisms helped the project resist common causes of collapse such as uneconomic behaviour and political interference. The drug supply system has gained full independence from subsidies and external authorities. Its strong community participation promotes good governance.     

山西省某县级医疗卫生机构基本药物价格水平与可负担性研究

目的:为国家基本药物制度在公立医院的进一步完善提供参考。方法:参考世界卫生组织/国际健康行动机构的方法和西太平洋地区核心药品目录,用中位价格比值(MPR)评价药品价格水平,以当地城镇居民人均可支配收入和农村居民人均纯收入为基准,评价药品的可负担性;以农村居民人均纯收入为基准,分析2008-2013年常用药的可负担性动态变化。结果:实施国家基本药物制度以后,基本药物价格有一定的下降,MPR由5.838降到3.670,但总体仍高于国际参考价格;城镇和农村居民可负担性均得以改善,一个疗程的药品费用由相当于0.492 d城镇居民人均可支配收入降到0.352 d,1.457 d农村居民人均纯收入降到0.928 d;常用药农村居民的可负担性均有不同程度的提高。结论:国家基本药物制度实施以后,药品价格呈现一定程度下降,但与国际价格参考标准相比仍有改善空间;药品可负担性虽然有所改善,但仍需进一步提高低收入人群的可负担性。