价值医疗视角下国家药品集中带量采购在某公立医院的实施效果评价

赵洁 李巍 王皋俊

中圖分类号 R95 文献标志码 A 文章编号 1001-0408（2021）19-2410-05

DOI 10.6039/j.issn.1001-0408.2021.19.18

摘 要 目的：评价某公立医院对国家药品集中带量采购（以下简称“国采”）政策的执行情况，以期为推进以价值医疗为导向的国采政策提供参考。方法：对重庆市某公立医院涉及的国采中选的抗菌药物共计6个品种、12个品规进行具体分析。调取该医院国采实施前1年（即2019年4月20日-2020年4月19日）和实施后1年（即2020年4月20日-2021年4月19日）的药品使用数据，分析其价格变化、仿制药替代率、日均费用（DDDc）、实际节省费用等指标，提出问题及建议，并评估国采政策实施效果是否体现价值医疗的核心内涵。结果：国采实施后，该医院中选抗菌药物价格平均降幅为63.44%，原研药价格平均降幅为27.38%，仿制药替代率平均为25.59%;该医院中选抗菌药物的DDDc均有不同程度下降，其中4种药物的降幅在10%～40%，盐酸莫西沙星片降幅达到80.14%;6种抗菌药物相较国采前共节省约52.13万元，其中进口药盐酸莫西沙星片和盐酸莫西沙星氯化钠注射液共节省49.53万元（占抗菌药物总节省费用的94.97%）。结论：基于价值医疗角度的国采政策的价值主要体现在药品双通道管理机制提高了药品可获得性，可以有效控制医疗费用不合理增长、减少医保基金支出，有助于进一步减轻患者用药负担。而目前，国采政策实施面临的困难还包括药品价格需回归合理区间、外企需改变策略寻求突破、中选仿制药与原研药之间的质量差异会导致疗效差异等。为此，笔者认为医药市场结构应正向转变、以价值医疗助力医保调控、优化一致性评价体系，从而进一步提高患者健康水平。

关键词 药品;国家药品集中带量采购;价值医疗;实施效果

Effect Evaluation of National Drug Centralized Volume-based Procurement in a Public Hospital from the Perspective of Value-based Healthcare

ZHAO Jie1，LI Wei1，WANG Gaojun2（1. Medical and Social Development Research Center， School of Public Health and Management， Chongqing Medical University，Chongqing 400016，China; 2. Dept. of Pharmacy， First Branch， the First Affiliated Hospital of Chongqing Medical University， Chongqing 400015， China）

ABSTRACT   OBJECTIVE： To evaluate the implementation of national drug centralized volume-based procurement （called “VBP” for short） in a public hospital， so as to provide reference for promoting VBP policy guided by value-based healthcare. METHODS： A total of 6 varieties and 12 specifications of antibiotics included in VBP in a public hospital in Chongqing were analyzed. The drug use data of the hospital one year before the implementation of VBP （i.e. April 20， 2019- April 19， 2020） and one year after the implementation （i.e. April 20， 2020-April 19， 2021） were collected and analyzed in respects of price change， generic drug substitution rate， average daily cost （DDDc）， actual cost savings and other indicators. The problems and suggestions were put forward， and the effects of VBP policy implementation whether reflects the core connotation of value-based healthcare were evaluated. RESULTS： After the implementation of VBP， drug prices fell by an average of 63.44%， the average price drop of original drugs was 27.38%， and substitution rate of generic drugs was 25.59%. DDDc of selected antibiotics in the hospital decreased in varying degrees， of which the decline of four drugs was 10%-40%， and that of Moxifloxacin hydrochloride tablets was 80.14%. Compared with bef VBP， 6 kinds of antibiotics saved about 521 300 yuan， of which the imported Moxifloxacin hydrochloride tablets and Moxifloxacin hydrochloride sodium chloride injection saved 495 300 yuan （accounting for 94.97% of the total cost savings of antibiotics）. CONCLUSIONS： The value of VBP based on the perspective of value-based healthcare is mainly reflected in the dual channel management mechanism of drugs， which improves the availability of drugs， effectively controls the unreasonable growth of medical expenses， reduces the expenditure of medical insurance fund， and helps to further reduce the drug burden of patients. At present， the implementation of VBP still faces difficulties， including the need for drug prices to return to a reasonable range， the need for foreign enterprises to change strategies to seek a breakthrough， and different therapeutic efficacy due to the difference in quality between the selected generic drugs and the original drugs. Therefore， the author believes that the pharmaceutical market structure should be transformed positively， value-based healthcare should help the regulation of medical insurance， and the consistency evaluation system should be optimized， so as to further improve the health level of patients.