基于WHO/HAI标准化法的陕西省零售药店儿童基本药物可获得性及价格研究

目的:为我国儿童基本药物目录的出台及改善儿童药物使用现状提供参考。方法:采用世界卫生组织和国际健康行动组织共同制定的WHO/HAI标准化法,于2012年对陕西省6个城市的60家零售药店的28种儿童基本药物进行调研,将零售药店药品零售价格与国际参考价进行对比研究。结果:儿童基本药物在陕西省零售药店的可获得性低;原研药零售价格远高于国际参考价,而最低价格仿制药零售价格较为合理;治疗急性病的儿童基本药物的可负担性较好。结论:应尽快出台儿童基本药物目录;加大研发适宜儿童使用的剂型、规格及包装;对原研药合理定价;鼓励零售药店采购和销售基本药物。     

基于5种罕见病可负担性评价的我国罕见病保障机制研究

目的:为我国建立完善罕见病保障机制提出政策建议,以解决因其所致的"因病致贫、因病返贫"问题。方法:分别通过世界卫生组织/国际健康行动组织(WHO/HAI)标准调查法、灾难性支出评价法和致贫作用评价法3种方法对我国城镇和农村居民多种羧化酶缺乏病、苯丙酮尿症等5种罕见病的可负担性进行分析。结果:按WHO/HAI标准调查法,5种罕见病年治疗费用都很高,费用最低的疾病也相当于城镇居民0.28年的收入,农村居民比城镇居民疾病负担更重;按灾难性支出评价法,5种罕见病在全国范围内造成灾难性支出的人口比例均不超过0.060 6‰,但对部分罕见病,一旦居民患病并采用药物治疗,即陷入灾难性卫生支出;按致贫作用评价法,5种罕见病在城镇、农村的致贫率均很低,但仅这5种罕见病在全国范围内会导致超过20万人陷入贫困。结论:我国罕见病及罕用药的可负担性较差,不同收入水平的居民均有一定的支付困难,因病致贫、因病返贫现象普遍。因此应完善罕见病患者保障机制,建立专门针对罕用药的费用负担方式。     

Cost-effective management of rheumatoid arthritis in India

Rheumatoid arthritis (RA) affects approximately 0.5% of adult Indian population. The last few decades have seen significant advances in the treatment of RA. Pari-pasu, the goals of treatment have moved from symptomatic relief and disease modification to remission and even possible cure. One major hurdle in providing effective therapy is the high cost of medications. In a developing country like ours, cost-effective management of RA patients becomes an important issue. Paucity of trained rheumatologists, poverty, inaccessibility etc. are added hurdles in the delivery of cost-effective treatment. This communication is an overview of the various issues and the possible ways to address them.     

云南西盟佤族居民患疟求医的现状、费用支付能力和障碍

目的　评价佤族患疟求医的现状、费用支付能力和障碍。　方法　对社区居民进行问卷调查和参与式行动评估 ,对关键人员进行半结构深度访谈。　结果　自己治疗是村民治疗疟疾的第一行动 ,只有自己治疗无效后才到卫生机构求医 ;5 1% (95 %CI :2 6～ 8 9% )问卷调查回答者从不求医 ,8 8% (95 %CI :5 4～ 13 3 % )仅靠自己治疗 ;3 7 4% (95 % :3 0 9～ 44 3 % )付不起疟疾治疗费 ;村民提出的疟疾治疗费为平均RHB 64 15± 7 0 6(范围 :0～ 5 0 0 )元 ,88 5 % (95 %CI :82 4～ 93 0 % )的人认为不能超过RHBl0 0元。　结论　佤族中的患疟求医行为不当 ,障碍为经济 ,地理 ,知识和技术上的不可及性 ;疟疾病例的家庭管理是改善疟疾治疗现状的方法之一。     

2010—2012年陕西省常见慢性病用药的可获得性及可负担性调查分析

目的：了解实施国家基本药物制度以来常见慢性病用药的可获得性及可负担性情况,为后续制订和完善相关政策提供数据支撑。方法：采用世界卫生组织／国际健康行动机构的标准化调查方法,分别于2010年和2012年对陕西省6个城市的公立医院和零售药店中的26种慢性病用药的可获得性及可负担性进行调查和评价。结果：陕西省常见慢性病用药的可获得性情况不容乐观,与2010年相比,2012年部分慢性病用药的原研药（OBs）可获得性升高,但所有慢性病用药的最低价格仿制药（LPGs）可获得性均降低;与2010年相比,2012年慢性病用药的可负担性明显提高,虽然使用OBs治疗慢性病可负担性仍较差,但使用LPGs治疗除心血管疾病以外的慢性病可负担性良好。与其他发展中国家相比,陕西省慢性病用药的可获得性相对较低,但可负担性相对较好。结论：建议公立医院提高慢性病用药的采购效率,保障药物的可获得性;政府部门加大政策扶持力度,鼓励慢性病仿制药的生产供应;进行慢性病用药药品价格成分调查,提高药品定价的科学性;改善慢性病用药结构和报销水平,进一步提升慢性病用药的可负担性。     

Costs of introducing pneumococcal,rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: Are expansions sustainable?

BackgroundIntroduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi’s co-financing and eligibility policies.MethodsData on ‘one-time’ costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures.Results‘One-time’ costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008–2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases.ConclusionWhile the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision.