基于疗程费用测算耐药结核病患者药物负担

目的 从宏观层面上测算不同化疗方案与药品价格来源下耐药结核病患者治疗的疗程费用。方法 基于中国《耐多药肺结核临床路径(2012年版)》和2018年WHO发布的《耐多药和利福平耐药结核病的治疗(更新版)》(以下简称“2012版中国指南”和“2018版WHO指南”)推荐的治疗方案,分别测算中国大陆市场价格和WHO集中采购价格下耐药结核病治疗的疗程费用,以“灾难性卫生支出(指家庭现金支付医疗费用占家庭消费支出的比例≥40%)”为指标评估耐药结核病患者的药物可负担性。结果 在2012版中国指南治疗方案及中国大陆市场价格下,耐药结核病治疗总疗程费用的区间为1.95万元(人民币,下同)/例~12.70万元/例,总疗程自付费用区间为5322元/例~78482元/例,其中,部分治疗方案下,仅药物费用的支出就产生灾难性卫生支出,城镇居民的卫生支出占比为2.19%~32.25%,农村居民为5.87%~86.60%。在相同治疗方案下(2018版WHO指南),中国大陆市场价格下的耐药结核病的全疗程自付费用为74.5万元/例~77.0万元/例,且所有治疗方案均导致灾难性卫生支出,而WHO集中采购价格下耐药结核病的全疗程自付费用为8.07万元/例~9.59万元/例。结论 对比WHO集中采购价格,国内二线抗结核药物价格较为昂贵,耐药结核病治疗给患者带来了沉重的经济负担,且农村情况更为严峻。

Drug affordability study in drug-resistant tuberculosis patients: based on the cost of treatment

Objective The purpose of this study is to measure the cost of treatment for drug-resistant tuberculosis under different treatment options and price sources.Methods Based on the recommended treatment plans by China’s Multidrug-Resistant Pulmonary Tuberculosis Clinical Path (2012 edition) and WHO Drug-Resistant Tuberculosis Treatment Guide (2018 edition), the treatment costs of drug-resistant tuberculosis were measured under the market price in China Mainland and the WHO centralized purchase price, respectively, and the catastrophic health expenditure (refers to the proportion of household cash payment medical expenses to household consumption expenditure ≥40%) was used to evaluate drug affordability of patients.Results Under the treatment plan and market price in China (2012 edition), the total cost range of drug-resistant tuberculosis patients was 19500-12700 million yuan/person, and the self-paying interval was 5322-78482 yuan/person. Among them, under some treatment programs, only the expenditure of drugs caused catastrophic health expenditure. The proportion of health expenditure in urban residents ranged from 2.19% to 32.25%, and it ranged from 5.87% to 86.60% in rural residents. Under the same treatment plan (2018 WHO Guide), the self-paying interval of drug-resistant tuberculosis patients under the market purchase price in China Mainland was 745000-770000 yuan/person, and all treatment programs had reached catastrophic health expenditure, while the patient’s self-paying interval under the WHO centralized purchase price was 80700-95900 yuan/person.Conclusion Compared with the WHO centralized purchase price, domestic second-line anti-tuberculosis drugs are more expensive, and the drug-resistant tuberculosis treatment imposes a heavy economic burden on patients, especially in rural area.