Page 17 - 《中国药房》2021年2期

基于价值定价的多适应证药品医保支付国际经验及启示 Δ

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代展菁 ，薛天祺，向贵圆，常 峰，路 云（中国药科大学国际医药商学院，南京 211198）
中图分类号 R95 文献标志码 A 文章编号 1001-0408（2021）02-0139-07
DOI 10.6039/j.issn.1001-0408.2021.02.03

摘 要 目的：为完善我国多适应证药品基于价值定价的医保支付提供参考。方法：梳理多适应证药品价值定价的理论基础和实
现流程，分析法国、德国、英国、意大利和瑞典的价值评估指标和基于价值定价的医保支付策略，为我国多适应证药品医保支付提
出建议。结果与结论：价值定价的实现首先需要制定一个价值框架以定义、测量、整合价值，再通过建立模型将总价值转化为价
格。各国多适应证药品根据价值定价的整体思路一致，但价值评估指标存在差异。英国和瑞典主要以药物经济学方法测得的质
量调整生命年（QALYs）和增量成本-效果比（ICERs）为价值标准，法国、德国和意大利则更侧重于以药品的临床治疗价值和临床指
标改善程度为标准。在多适应证药品的医保支付策略方面，法国采取的是基于预期使用量的单一加权法，德国采取的是基于价值
和使用量的组合加权法，英国采取的是名义医保支付标准结合患者准入协议法，意大利采取的是名义医保支付标准结合管理准入
协议法，瑞典则采用不同适应证不同商品名的独立支付法。我国可在借鉴上述多国经验的基础上，探索适应我国国情的多适应证
药品的价值定价策略，综合借鉴和使用多种医保支付策略，完善患者及药品使用信息收集机制，为实施多适应证药品价值定价和
医保支付策略提供信息支持。
关键词 多适应证药品；价值定价；医保支付；法国；德国；英国；意大利；瑞典；启示

International Experience and Enlightenment of Medical Insurance Reimbursement for Multi-indication
Drugs Based on Value-based Pricing
DAI Zhanjing，XUE Tianqi，XIANG Guiyuan，CHANG Feng，LU Yun（School of International Pharmaceutical
Business，China Pharmaceutical University，Nanjing 211198，China）

ABSTRACT OBJECTIVE：To provide reference for improving medical insurance reimbursement for multi-indication drugs based
on value-based pricing in China. METHODS：The theory and practice of value-based pricing for multi-indication drugs were sorted
out，and the value standards and medical insurance reimbursement strategies based on value-based pricing in France，Germany，
UK，Italy and Sweden were analyzed，so as to provide the suggestions for medical insurance reimbursement of multi-indication
drugs in China. RESULTS & CONCLUSIONS：The realization of value-based pricing first needed to develop a value framework to
define，measure and integrate value，and then established a model to convert the total value into price. The overall idea of
value-based pricing for multi-indication drugs was consistent，but there were differences in the value standard. In the UK and
Sweden， quality-adjusted life years （QALYs） and incremental cost-effectiveness ratios （ICERs） measured by
pharmacoeconomicsare used as the value standard. France，Germany and Italy were more focused on the therapeutic value and
clinical benefit improvement. As for medical insurance reimbursement strategies，France adopted single weighting method based on
expected volume. Germany adopted combination weighting method based on value and volume. UK introduced the Patient Access
Schemes and Italy introduced the Managed Entry Agreements，both based on the nominal reimbursement standard. Sweden adopted
independent reimbursement for different indications by different brand names. It is suggested that China can explore the value-based
pricing strategies of multi-indication drugs on the basis of the above international experiences，reference and use these variety of
medical insurance reimbursement strategies comprehensively. Simultaneously，the information collection mechanism of patients and
drug use should be improved to provide data support for the implementation of China’s value-based pricing and reimbursement
strategies for multi-indication drugs.
KEYWORD Multi-indication drugs；Value-based pricing；Reimbursement；France；Germany；UK；Italy；Sweden；Enlightment

多适应证药品（Multi-indication drugs）是指可用于 者症状的药品。近年来，多适应证新药上市数量和上市
预防、治疗、诊断、缓解或者辅助治疗多种疾病（状态）或 后又获批新适应证的药品数量显著增加，2015年美国艾

美仕医疗保健信息研究所（IMS Institute for Healthcare
Δ 基金项目：国家医疗保障局医药价格和招标采购司政府购买服
务合同（No.JCS-ZCHT-2020-010） Informatics）的研究报告指出，2014年全球上市的抗癌药
＊硕士研究生。研究方向：医疗保障制度、药物经济学。E-mail：
物中有50％以上可用于多种适应证，并预计这一比例到
kaydaizj@163.com
2020年末将增至75％ 。在我国，也有越来越多的多适
[1]
# 通信作者：教授，博士生导师。研究方向：医疗保障制度、药物
经济学。E-mail：luyuncpu@163.com 应证药品被纳入《国家基本医疗保险、工伤保险和生育

中国药房 2021年第32卷第2期 China Pharmacy 2021 Vol. 32 No. 2 ·139 ·