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近年来,在医疗保健计划中,管理者不得不面对不断涌现的新型药品和不断增长的控费压力之间的矛盾。为此,许多经济合作发展组织(OECD)国家开始采用药物经济学评估技术,以帮助选择合适的药品报销目录或者帮助进行药品定价。本文分析了11个OECD国家中药物经济学评估的开展状况,对其开展评估活动的目标、程序和所产生的影响进行了综述。本文的研究方法包括文献研究和一个探索性的实证调查。本研究所得的主要结论概况如下:(1)从被调查各国的开展情况看,药物经济学评估已经在OECD国家中获得了广泛的应用。无论是对于公立保健计划还是私立保险机构,药物经济学评估都已经成为一个有效的决策支持工具。(2)从调查结果看,各国开展药物经济学评估的最主要意图,是为了保证在卫生服务中使用的药品能够“物有所值”。在部分国家中,主要是评判新药的投入产出比是否能达到一个满意的值;在另一些国家,则主要是把经济学评估结果应用在药品定价协商中,以保证新药具有经济学优势。医药厂商对药物经济学评估存在一定顾虑,包括担心政府的目的是单纯的抑制药品费用,以及采用这项技术可能会阻碍创新。从本调查结果看,单纯的抑制药品费用并非政府的主要目的。当然,对药品费用水平及其增长率的影响,是开展药物经济学评估的一个自然结果。而对于创新问题,如果药物经济学评估能够促使厂商开发出价值更精准的新药,那自然会对公众有益。(3)药物经济学评估是正在发展的技术,它还有很大的改善空间。需要注意的是,开展经济学评估本身就是增加了成本,并且经济学评估也延缓了新药投入使用的时间。所以,对这项技术的运用必须注意平衡:提高药品投入产出比所产生的利益与开展研究所增加的成本与所导致的延迟之间。当然,有效地保持这种平衡并不容易。(4)调查中发现,各国对于加强国际交流均非常感兴趣,这可能是因为各国都希望通过技术交流提高药物经济学评估的质量并节约研究成本。
In the healthcare plan in recent years, managers have had to deal with the conflict between emerging new drugs and rising pressure on control. To this end, many OECD countries have begun to adopt pharmacoeconomic assessment techniques to help select the appropriate drug reimbursement catalog or to help with drug pricing. This article analyzes the status of the assessment of drug economics in 11 OECD countries and summarizes the objectives, procedures and impacts of the assessment. The research methods of this article include literature research and an exploratory empirical investigation. The main conclusions of this study are summarized as follows: (1) According to the development of countries surveyed, the evaluation of pharmacoeconomics has been widely used in OECD countries. Whether for public health programs or private insurance agencies, pharmacoeconomic assessment has become an effective decision support tool. (2) According to the survey results, the most important intention of the countries in carrying out the assessment of drug economics is to ensure that the medicines used in health services can be “worth the money”. In some countries, it is mainly to judge whether the input-output ratio of new drugs can reach a satisfactory value. In other countries, the economic evaluation results are mainly used in drug pricing negotiations to ensure that the new drugs have economic advantages. Pharmaceutical manufacturers have some concerns about pharmacoeconomic assessment, including concerns that the government’s goal is simply to curb drug costs and that the adoption of this technology may hinder innovation. From the results of this survey, it is not the government’s main purpose to simply reduce drug costs. Of course, the impact on the level of drug costs and their rate of growth is a natural consequence of carrying out a pharmacoeconomic assessment. And for innovation, if the pharmacoeconomic assessment can force vendors to develop new drugs with more accurate value, then it will of course be good for the public. (3) Pharmacoeconomic assessment is a developing technology, and it still has a lot of room for improvement. It is important to note that conducting an economic assessment alone adds cost and the economic assessment delays the time it takes to bring the new drug into operation. Therefore, the use of this technology must pay attention to the balance between increasing the profit-generating ratio of pharmaceutical products to the costs incurred and the delays caused by carrying out the research. Of course, maintaining that balance effectively is not easy. (4) The survey found that all countries are very interested in strengthening international exchanges. This may be because all countries hope to improve the quality of pharmacoeconomic assessment through technical exchanges and save research costs.