Page 59 - 2021年17期

·药物经济学·

基于队列模型生存率数据的跨年度生存患者干预方案医保基金

支出的计算方法 Δ

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黄元楷 ，陈 磊，李 莹，席晓宇（中国药科大学国家药物政策与医药产业经济研究中心，南京 211198）
中图分类号 R956 文献标志码 A 文章编号 1001-0408（2021）17-2097-06
DOI 10.6039/j.issn.1001-0408.2021.17.09

摘 要 目的：构建一种能够较为准确地反映跨年度生存患者干预方案医保基金支出的计算方法，为医保预算影响分析（BIA）研
究提供参考。方法：基于队列模型的生存率数据，以各年份中每个周期确诊的患者作为一个队列，计算各队列患者在研究年份内
各状态下的人均生存周期数，即平均生存时间；在此基础上，再根据各队列的人数和各状态下的周期人均费用计算研究年份内所
有队列的患者产生的总费用。以某癌症的干预方案作为示例，按所构建的计算方法进行演算，并将计算结果与目前几种常见算法
结果进行比较；同时，对所构建的算法在特殊情形下的拓展情况提出应用建议。结果与结论：所构建的算法相比目前几种常见算
法，其计算过程更符合真实世界中药物干预方案相关医保基金支出的过程，且其能够灵活适应多种特殊情形下的计算需求。该算
法可较为准确地计算特定年份下某一干预方案的医保基金支出，在一定程度上解决了原有算法未充分考虑跨年度生存患者或计
算过程简易、粗略而导致医保基金支出预测不准确的问题，可为我国医保BIA相关研究提供更准确的方法选择。
关键词 预算影响分析；跨年度生存；医保基金支出；计算方法；生存率

Calculation Method of Medical Insurance Fund Expenditure of Intervention Scheme for Cross-year
Survival Patients Based on Survival Data of Cohort Model
HUANG Yuankai，CHEN Lei，LI Ying，XI Xiaoyu（The Research Center of National Drug Policy&Ecosystem，
China Pharmaceutical University，Nanjing 211198，China）

ABSTRACT OBJECTIVE：To construct a calculation method which can accurately reflect the medical insurance fund expenditure
of intervention scheme for cross-year survival patients，and to provide reference for the research of medical insurance budget impact
analysis（BIA）. METHODS：Based on survival data of cohort model，taking the patients diagnosed in each cycle in each year as a
cohort，the number of per capita survival cycle of cohort patients in each state in the study year was calculated，i.e. the average
survival time；on this basis，the total cost of patients in all cohorts in the study year was calculated according to the number of
people in each cohort and the per capita cost each cycle in each state. Taking the intervention scheme of a cancer as an example，
the calculation was carried out by the established algorithm，and the calculation results were compared with the results of several
common algorithms；at the same time，the application suggestions were put forward for the expansion of the constructed algorithm
in special cases. RESULTS & CONCLUSIONS：Compared with the several common algorithms，the calculation process of the
constructed algorithm is more in line with the process of medical insurance fund expenditure related to drug intervention scheme in
the real world，and it can flexibly adapt to the calculation needs in a variety of special situations. This algorithm can more
accurately calculate the medical insurance fund expenditure of a intervention scheme in a specific year，and to a certain extent solve
the problem of inaccurate prediction of medical insurance fund expenditure due to insufficient consideration of cross-year survival
patients or simple and rough calculation process. It can provide a more accurate method choice for the research of medical insurance
BIA in China.
KEYWORDS Budget impact analysis；Cross-year survival；Medical insurance fund expenditure；Calculation method；Survival
rate

药品的医保预算影响分析（budget impact analysis， 支出的影响，是药物经济学评价的重要补充。《2020年国
BIA）可评价医保目录外药品进入医保目录对医保基金 家医保药品目录调整工作方案》要求在药品医保准入工
作中，由地方医保部门和相关学术团体推荐医保管理、
Δ 基金项目：国家自然科学基金资助项目（No.72004230）
药物经济学等方面的专家组成评审专家，分为基金测算
＊讲师，博士。研究方向：卫生经济学、医药卫生政策。电话：
组和药物经济学组，分别从医保基金影响和药品经济学
025-83271310。E-mail：1831040140@stu.cpu.edu.cn
[1]
# 通信作者：副教授，硕士生导师，博士。研究方向：卫生经济学、 评价两方面针对谈判药品和竞价药品提出评估意见 ，
医药卫生政策。电话：025-83271310。E-mail：xixy@cpu.edu.cn 可见药品医保BIA日益受到我国医保部门的重视。

中国药房 2021年第32卷第17期 China Pharmacy 2021 Vol. 32 No. 17 ·2097 ·