带量采购政策下上海市某二甲综合医院降压药使用结构分析

目的:对比带量采购政策前后3年上海市静安区市北医院降压药使用情况,分析政策对临床用药的影响。方法:以2018至2020年医院降压药品种和数量变化、政策后药品支出节省费用概括该院政策前后降压药使用总体情况。用限定日剂量法对比该院9种通用名(11个规格)中选药在政策前后DDC和DDDs值变化;不同种类降压药DDDs构成比排序变化;CCB、ARB及ACEI 3类常用降压药中中选与未中选药的消耗量、费用结构变化差异。结果:政策后两年该院中选药在降压药品目录中占比提高28.9%,中选药价格最多下降70.88%,价高药(指通用名属于上海市基本医保药品目录,但价格高于中选价格的同通用名未中选药品)降幅最大达26.55%。两年降压药支出费用分别节省28.11万元、71.4万元。政策对中选降压药DDDs、DDC值影响大,中选药DDC显著下降,大部分中选药DDDs增长明显。各类降压药DDDs构成比整体稳定,CCB、ARB和固定配比复方制剂占构成比前3位。同类降压药不同品种使用结构有变化,部分中选药构成比下降,部分未中选消耗片数在同类降压药中构成比增长。结论:带量采购政策显著降低药品费用,降压药品种使用结构未受影响,同类药品消耗结构变化值得关注,中选药药效问题、患者多层次药品需求难满足等问题影响了政策正面作用的发挥,应加强精细管理、推出更柔性的考核政策,以满足患者需求、和谐医患关系、减少患者流失。

Structure analysis of anti-hypertensive drugs used in a general hospital of level Ⅱ in Shanghai under the volume-based procurement

OBJECTIVE To compare the quantity of anti-hypertensive drugs used in Shanghai Shibei Hospital of Jing’an District before and after the implementation of volume-based procurement, analyze the impact of the policy on clinical medication.METHODS The overall use of anti-hypertensive drugs in the hospital before and after the policy was summarized by the changes in the variety and quantity from 2018 to 2020, and the cost savings of drug expenditures after the policy. The defined daily dose method was used to compare the changes of DDC and DDDs values before and after the policy for the selected drugs of 9 generic names with 11 specifications in the hospital, changes in the composition ratio of DDDs of different types of anti-hypertensive drugs, and the differences in consumption and cost structure between the selected and non-selected drugs of common-used CCB, ARB and ACEI.RESULTS In the two years after the policy, the proportion of selected drugs increased by 28.9%. Among the selected drugs, the biggest drop in price was 70.88% in the hospital. Among the high-priced drugs whose generic names are in the catalogue of basic medical insurance drugs in Shanghai, while the prices are higher than those of selected drugs, the biggest drop in price was 26.55%. In 2019 and 2020, the expenses of anti-hypertensive drugs in the hospital were saved by 281 100 yuan and 714 000 yuan, respectively. The policy had a great influence on the DDD index of selected drugs. The DDDs of the selected drugs increased obviously in most cases, and the DDC values decreased significantly. The DDDs and composition ratio structure of all kinds of anti-hypertensive drugs were stable. CCB, ARB and fixed proportion compound preparation were the top three. The structural changes of the same kind of anti-hypertensive drugs appeared. The number of non-selected tablets increased obviously.CONCLUSION The policy of volume-based procurement has a significant effect on reducing drug costs. However, the efficacy of the selected drugs and the difficulties in meeting the multilevel medication demand of patients have affected the positive effect of the policy. We should strengthen fine management, launch more flexible assessment policy to meet the needs of patients, promote harmonious doctor-patient relationship and reduce the loss of patients.