Page 13 - 2020年21期

医疗保险预算影响分析研究质量的评价体系构建 Δ

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王敏娇 ，李 灿，杜 怿，柳鹏程，曹春烨，曹 阳（中国药科大学国际医药商学院，南京 211198）
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中图分类号 R951 文献标志码 A 文章编号 1001-0408（2020）21-2567-07
DOI 10.6039/j.issn.1001-0408.2020.21.02

摘 要 目的：构建评价医保药品谈判中医保预算影响分析（BIA）研究质量的评价体系，为医保等相关部门提供切实可行的评价
工具。方法：基于国际药物经济学与结果研究协会（ISPOR）和加拿大、波兰、美国等国家的BIA指导性文件及相关实证文献，结合
专家访谈法，确定医保谈判BIA材料相关要素（包括关键要素和辅助要素），并运用层次分析法确定各要素的权重，构建计算BIA
研究质量评价总分的量表及体系。结果：关键要素有目标人群、市场情景和治疗成本三大数据块，包含人口总数、新药情景市场份
额、治疗方案成本等共计14个关键要素；根据符合程度分别赋值0～3分，并以归一化后的最低分作为BIA研究质量的基础分。辅
助要素有标题&摘要、研究背景、分析框架、结果呈现和其他五大数据块，包括标题、摘要、研究角度、研究时限等23个辅助要素；根
据要素是否存在质量等级差异分为A类与B类，分别采用等级评分（0～4分）和0/1评分（是为1分，否为0分），并以此计算后相加
即得BIA研究质量的附加分。根据基础分和附加分乘以不同权重（分别为0.67和0.33）再相加可计算出BIA研究质量评价总分体
系。结论：本研究成功构建了一种全新的BIA质量评价体系，可用于评价医保药品谈判所提交的BIA研究质量。
关键词 医疗保险；预算影响分析；评价体系；关键要素；辅助要素

Construction of the Evaluation System of the Research Quality of Medical Insurance Budget Impact
Analysis
WANG Minjiao，LI Can，DU Yi，LIU Pengcheng，CAO Chunye，CAO Yang（School of International Medical
Business，China Pharmaceutical University，Nanjing 211198，China）

ABSTRACT OBJECTIVE：To construct the evaluation system of the research quality of medical insurance budget impact analysis
（BIA），and to provide feasible evaluation tool for related departments as medical insurance department. METHODS：Based on
BIA guidance documents and relevant empirical literatures of ISPOR，Canada，Poland，the United States and other countries，
combined with expert interview，the relevant elements of medical insurance negotiation BIA material were confirmed（including
key elements and adjuctive elements）. The scale and system was established to calculate total score of BIA research quality
evaluation. RESULTS：Key elements included three data blocks as target population，market situation and treatment cost，involving
14 key elements such as total population，new drug scenario market share，treatment cost，etc.. According to the degree of
compliance，0-3 points were assigned and the lowest score after normalization was taken as the basic score of BIA research quality.
The adjunctive elements included five data blocks as title & abstract，research background，analysis framework，result presentation
and other，including 23 adjunctive elements such as title，abstract，research angle，research time limit，etc.. According to whether
there is quality grade difference，the elements were divided into type A and type B；the grade score（0-4 points）and 0/1 score（1
point for yes and 0 point for no） were used respectively，and the additional score of BIA research quality was obtained after
calculation and addition. According to the addition of different weights（0.67 and 0.33）of basic score and additional score，the
total score system of BIA research quality evaluation could be calculated. CONCLUSIONS：This study successfully constructed a
new BIA quality evaluation system，which can be used for the quality evaluation of BIA research submitted by medical insurance
drug negotiation.
KEYWORDS Medical insurance；Budget impact analysis；Evaluation system；Key element；Adjunctive element

[1]
近年来，国家医保基金运营面临着巨大压力，药品 支出控费受到学者的广泛关注 。2019 年，在国家医保
Δ 基金项目：国家社会科学基金重大项目（No.15ZDB167）；中国 药品目录的调整工作中，国家医疗保障局基于医保基金
药科大学“双一流”学科创新团队建设项目（No.CPU2018GY39） 的可承受程度专门成立了基金测算专家组，评价谈判药
＊ 硕 士 研 究 生 。 研 究 方 向 ：医 保 政 策 、药 物 警 戒 。 E-mail：
品对医保基金预算产生的影响。医保预算影响分析
w123wmj123@163.com
（Budget impact analysis，BIA）是指从医保基金运营方角
# 通信作者：教授，博士生导师，博士。研究方向：经济学、医药产
业发展。E-mail：caoyang6926@sina.com 度出发，在有限的医疗资源约束的前提下，分析将一种

中国药房 2020年第31卷第21期 China Pharmacy 2020 Vol. 31 No. 21 ·2567 ·