我国采用伊伐布雷定治疗心力衰竭对医保基金的预算影响分析
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摘要
目的:评估我国采用伊伐布雷定治疗心力衰竭对医保基金的预算影响,为医保部门解决该药在医院门诊的报销准入以及医院制定进药目录提供相关经济学评价的支持证据。方法:采用Excel决策树模型,基于国内历年来的文献报道数据进行药物经济学分析。首先根据中国心衰患病率估算患病人数,并估算符合纽约心脏病协会(NYHA)心功能Ⅱ～Ⅳ级、收缩压功能失常、符合伊伐布雷定适应证的心衰患者人数,进而估算出患者使用伊伐布雷定而产生的药品费用;其次,估算住院总人次以及因心衰住院所产生的住院医疗费用;然后综合考虑伊伐布雷定的药品费用与因使用该药而使患者避免再次住院从而节省的治疗费用,并进行静态预算影响分析,以评估该药的使用对医保基金预算产生的影响。结果:2013年我国心衰患病率已上升到1.3%,全国35～75岁心衰患者人数估算为约851万,年总住院次数为约432万次。全国心衰患者住院的直接经济负担约为1 689.40亿元。因使用伊伐布雷定治疗后可避免18%患者再次住院从而可节省住院费用约304.10亿元,而服用该药的总药费约为175.25亿元,因此该药的使用可节省隐性医疗费用预算约128.86亿元,具有非常明显的成本-效益。静态预算影响分析结果显示,到2019-2020年,期望伊伐布雷定覆盖心衰患者的比例将增至8.70%,其销售总金额将达到约17.97亿元。增量病例节省费用比值(ICSCR)显示,每增加1例采用伊伐布雷定治疗的心衰患者,则可以节省住院费用约11 951元,扣除伊伐布雷定药品费用6 240元后,还可节余约5 711元。结论:采用伊伐布雷定治疗心衰患者节约下来的住院成本不仅足以抵消伊伐布雷定本身的药费,而且还有溢价的效果;该药在我国治疗心衰患者具有一定经济性。
OBJECTIVE:To evaluate the effects of ivabradine in the treatment of heart failure on medical insurance fund budget in China,and to provide support evidence of related economical evaluation for medical insurance department to solve the problem of reimbursement admission of the drug in hospital outpatient department and the establishment of drug list in hospital.METHODS:Excel decision tree model was used. Pharmacoeconomic analysis was conducted based on the data reported in domestic literatures over the years. Firstly,according to the prevalence rate of heart failure in China,the number of patients with heart failure was estimated,which accorded with NYHA cardiac function class Ⅱ-Ⅳ,systolic blood pressure dysfunction and ivabradine indication. Then the cost of ivabradine was estimated. Secondly,the total number of hospitalizations and the cost of hospitalization due to heart failure were estimated. Finally,the cost of ivabredine and the cost of treatment saved by avoiding re-hospitalization due to the use of ivabredine were considered comprehensively. Static budget impact analysis was conducted to evaluate the effects of the use of ivabredine on medical insurance fund budget. RESULTS:The prevalence rate of heart failure in China was raised to 1.3% in 2013. It was estimated that the number of heart failure patients between 35-75 years old in China could be about 8.51 million and total hospitalization times was about 4.32 million per year. The economic burden of hospitalization in heart failure patients was about 168.940 billion yuan in whole country. Since 18% of patients could be avoided re-hospitalization after treatment with ivabradine,the cost of hospitalization could be saved by about 30.410 billion yuan,while the total cost of taking ivabradine was about 17.525 billion yuan. Therefore,the use of ivabradine could save the hidden medical cost budget by about 12.886 billion yuan,which had obvious cost-effectiveness. Static budget impact analysis results showed that by 2019-2020,the expected proportion of patients with heart failure covered by ivabradine would increased to 8.70%,and the total consumption sum would reach about 1.797 billion yuan. The incremental cost savings ratio(ICSR)showed that the cost of hospitalization could be saved by about 11 951 yuan for each additional case of heart failure treated with ivabradine;there could be 5 711 yuan of balance by deducting drug cost 6 240 yuan of ivabradine. CONCLUSIONS:The cost savings of hospitalization treated by ivabradine is not only enough to offset the cost of ivabradine itself,but also has a premium effect. The drug is of certain economy for the treatment of heart failure in China.
OBJECTIVE:To evaluate the effects of ivabradine in the treatment of heart failure on medical insurance fund budget in China,and to provide support evidence of related economical evaluation for medical insurance department to solve the problem of reimbursement admission of the drug in hospital outpatient department and the establishment of drug list in hospital.METHODS:Excel decision tree model was used. Pharmacoeconomic analysis was conducted based on the data reported in domestic literatures over the years. Firstly,according to the prevalence rate of heart failure in China,the number of patients with heart failure was estimated,which accorded with NYHA cardiac function class Ⅱ-Ⅳ,systolic blood pressure dysfunction and ivabradine indication. Then the cost of ivabradine was estimated. Secondly,the total number of hospitalizations and the cost of hospitalization due to heart failure were estimated. Finally,the cost of ivabredine and the cost of treatment saved by avoiding re-hospitalization due to the use of ivabredine were considered comprehensively. Static budget impact analysis was conducted to evaluate the effects of the use of ivabredine on medical insurance fund budget. RESULTS:The prevalence rate of heart failure in China was raised to 1.3% in 2013. It was estimated that the number of heart failure patients between 35-75 years old in China could be about 8.51 million and total hospitalization times was about 4.32 million per year. The economic burden of hospitalization in heart failure patients was about 168.940 billion yuan in whole country. Since 18% of patients could be avoided re-hospitalization after treatment with ivabradine,the cost of hospitalization could be saved by about 30.410 billion yuan,while the total cost of taking ivabradine was about 17.525 billion yuan. Therefore,the use of ivabradine could save the hidden medical cost budget by about 12.886 billion yuan,which had obvious cost-effectiveness. Static budget impact analysis results showed that by 2019-2020,the expected proportion of patients with heart failure covered by ivabradine would increased to 8.70%,and the total consumption sum would reach about 1.797 billion yuan. The incremental cost savings ratio(ICSR)showed that the cost of hospitalization could be saved by about 11 951 yuan for each additional case of heart failure treated with ivabradine;there could be 5 711 yuan of balance by deducting drug cost 6 240 yuan of ivabradine. CONCLUSIONS:The cost savings of hospitalization treated by ivabradine is not only enough to offset the cost of ivabradine itself,but also has a premium effect. The drug is of certain economy for the treatment of heart failure in China.
引文
[1]张修宝,陈扬.心绞痛治疗药:盐酸伊伐布雷定(Ivabradine hydrochloride)[J].世界临床药物,2008,29(10):639-640.
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[4]GRIFFITHS A,PARACHA N,DAVIES A,et al.The costeffectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective[J].Heart,2014,100(13):1031-1036.
[5]顾东风,黄广勇,何江,等.中国心力衰竭流行病学调查及其患病率[J].中华心血管病杂志,2010,3(1):3-6.
[6]张秀娟,康乃民,吴凌云.慢性心衰患者住院费用构成及影响因素分析[J].北京医学,2012,34(1):76-77.
[7]宣建伟,朱水清,王韶屏,等.我国一线城市心力衰竭患者住院费用调查及其影响因素分析[J].中国医疗保险,2017(12):52-56.
[8]宣建伟,陶立波,朱水清,等.真实世界中我国心力衰竭患者非直接医疗费用和患者生命质量研究[J].中国医疗保险,2017(3):61-64.
[9]MCMURRAY JJ,ADAMOPOULOS S,ANKER SD,et al.ESC guidelines for the diagnosis and treatment of acute and chronic heart failure2012:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure2012 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association(HFA)of the ESC[J].Eur Heart J,2012,33(14):1787-1847.
[10]MOATERED A,HOES AW.Clinical epidemiology of heart failure[J].Heart,2007,93(9):1137-1146.
[11]医脉通.高润霖谈心力衰竭的现状和治疗进展[EB/OL].(2015-07-06)[2018-05].http://news.medlive.cn/heart/info-progress/show-80694_129.html.
[12]BORER JS,B?HM M,FORD I,et al.Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure:the SHIFT Study[J].Eur Heart J,2012,33(22):2813-2820.
[13]刘铭雅,李云婧,朱伟,等.强化门诊随访对心力衰竭患者预后及依从性的影响[J].中华心血管病,2012,38(7):588-591.
[14]HUANG J,YIN H,ZHANG M,et al.Understanding the economic burden of heart failure in China:impact on disease management and resource utilization[J].J Med Econ,2017,20(5):549-553.
[15]国务院人口普查办公室,国家统计局人口和就业统计司.中国2010年人口普查资料[R].北京:中国统计出版社,2010.
[16]COWIE MR,DAVIDSON L.Clinical perspective:the importance of heart rate reduction in heart failure[J].Int JClin Pract,2012,66(8):728-730.
[17]MAUSKOPF JA,SULLIVAN SD,ANNEMANS L,et al.Principles of good practice for budget impact analysis:report of the ISPOR Task Force on good research practices:budget impact analysis[J].Value Health,2007,10(5):336-347.
[18]SULLIVAN SD,MAUSKOPF JA,AUGUSTOVSKI F,et al.Budget impact analysis:principles of good practice:report of the ISPOR 2012 Budget Impact Analysis Good PracticeⅡTask Force[J].Value Health,2014,17(1):5-14.
[2]施维雅集团.可兰特?:盐酸伊伐布雷定片[EB/OL].[2019-02-25].https://www.servier.com.cn/wp-content/uploads/2018/12/%E5%8F%AF%E5%85%B0%E7%89%B9Corlentor-Dec-2018.pdf.
[3]B?HM M,BORER J,FORD I,et al.Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure:analysis from the SHIFTStudy[J].Clin Res Cardiol,2013,102(1):11-22.
[4]GRIFFITHS A,PARACHA N,DAVIES A,et al.The costeffectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective[J].Heart,2014,100(13):1031-1036.
[5]顾东风,黄广勇,何江,等.中国心力衰竭流行病学调查及其患病率[J].中华心血管病杂志,2010,3(1):3-6.
[6]张秀娟,康乃民,吴凌云.慢性心衰患者住院费用构成及影响因素分析[J].北京医学,2012,34(1):76-77.
[7]宣建伟,朱水清,王韶屏,等.我国一线城市心力衰竭患者住院费用调查及其影响因素分析[J].中国医疗保险,2017(12):52-56.
[8]宣建伟,陶立波,朱水清,等.真实世界中我国心力衰竭患者非直接医疗费用和患者生命质量研究[J].中国医疗保险,2017(3):61-64.
[9]MCMURRAY JJ,ADAMOPOULOS S,ANKER SD,et al.ESC guidelines for the diagnosis and treatment of acute and chronic heart failure2012:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure2012 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association(HFA)of the ESC[J].Eur Heart J,2012,33(14):1787-1847.
[10]MOATERED A,HOES AW.Clinical epidemiology of heart failure[J].Heart,2007,93(9):1137-1146.
[11]医脉通.高润霖谈心力衰竭的现状和治疗进展[EB/OL].(2015-07-06)[2018-05].http://news.medlive.cn/heart/info-progress/show-80694_129.html.
[12]BORER JS,B?HM M,FORD I,et al.Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure:the SHIFT Study[J].Eur Heart J,2012,33(22):2813-2820.
[13]刘铭雅,李云婧,朱伟,等.强化门诊随访对心力衰竭患者预后及依从性的影响[J].中华心血管病,2012,38(7):588-591.
[14]HUANG J,YIN H,ZHANG M,et al.Understanding the economic burden of heart failure in China:impact on disease management and resource utilization[J].J Med Econ,2017,20(5):549-553.
[15]国务院人口普查办公室,国家统计局人口和就业统计司.中国2010年人口普查资料[R].北京:中国统计出版社,2010.
[16]COWIE MR,DAVIDSON L.Clinical perspective:the importance of heart rate reduction in heart failure[J].Int JClin Pract,2012,66(8):728-730.
[17]MAUSKOPF JA,SULLIVAN SD,ANNEMANS L,et al.Principles of good practice for budget impact analysis:report of the ISPOR Task Force on good research practices:budget impact analysis[J].Value Health,2007,10(5):336-347.
[18]SULLIVAN SD,MAUSKOPF JA,AUGUSTOVSKI F,et al.Budget impact analysis:principles of good practice:report of the ISPOR 2012 Budget Impact Analysis Good PracticeⅡTask Force[J].Value Health,2014,17(1):5-14.