卫生技术评估在欧洲4国的应用及对我国的启示

目的为完善卫生技术评估(HTA)在我国医保药品决策中的应用提供参考。方法从HTA机构的设置、HTA的流程两个方面着手,对HTA在英国、法国、德国和瑞典医保药品决策中的应用进行梳理、分析,并结合我国HTA的实施情况提出完善建议。结果与结论英国、法国、德国和瑞典均设置了专门的HTA机构,机构间既各司其职又密切协作;在HTA的实施过程中,上述4个国家均设置了不同的价值评估标准去筛选具有“高性价比”的药品,利益相关方均积极参与,均将评估结果及决策公开,均设置了异议处理环节,均为提高药品可及性开设了快速评估通道,并且为保证医保可持续性均会对已纳入报销目录内的药品进行重新评估。建议我国结合国情,加强HTA机构间的合作及人才培养,综合评估药品价值,促进利益相关方参与,提高决策透明度,完善我国HTA的实施程序。

Application of health technology assessment in 4 European countries and its enlightenment to China

OBJECTIVE To provide reference for improving the application of health technology assessment(HTA)in decision-making for health insurance drugs in China.METHODS The application of HTA in decision-making for health insurance drugs in Britain,France,Germany and Sweden were sorted out and analyzed from two aspects:the establishment of HTA institutions and the process of HTA.The suggestions for improvement were put forward,combined with the implementation of HTA in China.RESULTS&CONCLUSIONS Britain,France,Germany and Sweden have set up special HTA institutions,which perform their respective duties and cooperate closely.During the implementation of HTA,the above four countries have set different value assessment criteria to screen drugs with“high cost performance”,all stakeholders actively participate,make the evaluation results and decisions public,set up objection handling links,open a rapid evaluation channel to improve the accessibility of drugs,and re-evaluate the drugs included in the reimbursement list to ensure the sustainability of medical insurance.It is suggested that China should combine the national conditions,strengthen the cooperation of HTA institutions,focus on talent training and comprehensive value assessment criteria,promote stakeholder’s participation,improve the transparency of decision-making,and improve the implementation procedures of HTA in China.