如何正确理解肝癌医保报销范围的“不能手术”
|
摘要
肝细胞癌(以下简称HCC, hepatocellular carcinoma)是最常见的恶性肿瘤之一,具有起病隐匿、恶性程度高、发展速度快等特点,多数患者一经诊断便已无法手术切除。因此,非手术治疗起着越来越重要的作用。随着分子生物学、基因组学及蛋白质组学的发展,分子靶向治疗已广泛应用于肿瘤领域。索拉非尼是治疗HCC的靶向药物,在其进入医保报销目录前因价格较高,患者负担沉重,其临床应用受到限制。医保药品谈判政策旨在帮助患者进一步降低就医经济负担,普及规范化诊疗,从而使患者获益。索拉非尼纳入国家医保目录后,患者的治疗费用显著降低,但在实际报销时仍存在一些障碍,例如医保可报销范围仍不够明确,病理报告是否为报销必备材料,患者是否能真正享受到索拉非尼纳入医保带来的经济负担减轻。本文将对索拉非尼治疗肝癌医保报销相关问题进行深入分析。
Hepatocellular carcinoma(HCC) is one of the most common malignant tumors with the characteristics of occult onset, high degree of malignancy and rapid development. Most patients can not be resected once diagnosed. Therefore, nonoperative treatment is playing a more and more important role. With the development of molecular biology, genomics and proteomics, molecular targeted therapy has been widely used in the field of cancer. Sorafenib is a targeted drug for the treatment of HCC, and its clinical application is limited because of its high price and heavy burden before entering the reimbursement list. Medical insurance drug negotiation policy aims to help patients further reduce the financial burden of medical treatment, popularize standardized treatment, so that patients can get tangible benefits. After sorafenib was listed in the national medical insurance catalogue, the treatment cost of patients was significantly reduced, but there are still some obstacles in the actual reimbursement, such as the scope of reimbursement is still not clear enough, whether the pathological report is the necessary material for reimbursement, whether patients can really enjoy the economic benefits of sorafenib included in the medical insurance? This article will carry out in-depth analysis of Sola Fini liver cancer medical insurance reimbursement related issues.
Hepatocellular carcinoma(HCC) is one of the most common malignant tumors with the characteristics of occult onset, high degree of malignancy and rapid development. Most patients can not be resected once diagnosed. Therefore, nonoperative treatment is playing a more and more important role. With the development of molecular biology, genomics and proteomics, molecular targeted therapy has been widely used in the field of cancer. Sorafenib is a targeted drug for the treatment of HCC, and its clinical application is limited because of its high price and heavy burden before entering the reimbursement list. Medical insurance drug negotiation policy aims to help patients further reduce the financial burden of medical treatment, popularize standardized treatment, so that patients can get tangible benefits. After sorafenib was listed in the national medical insurance catalogue, the treatment cost of patients was significantly reduced, but there are still some obstacles in the actual reimbursement, such as the scope of reimbursement is still not clear enough, whether the pathological report is the necessary material for reimbursement, whether patients can really enjoy the economic benefits of sorafenib included in the medical insurance? This article will carry out in-depth analysis of Sola Fini liver cancer medical insurance reimbursement related issues.
引文
[1]国家卫生计生委办公厅.关于印发原发性肝癌诊疗规范(2017年版)的通知,国卫办医函[2017]553号.2017原发性肝癌诊疗规范[J].中国实用外科志,2017,37(7):705-720.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015.[J].CA Cancer J Clin2016 Mar-Apr;66(2):115-32.
[3]Lan T,Chang L,Rahmathullah MN,et al.Comparative Efficacy of Interventional Therapies for Early-stage Hepatocellular Carcinoma:A PRISMA-compliant Systematic Review and Network Metaanalysis.Medicine(Baltimore),2016,95(15):e3185.doi:10.1097/MD.0000000000003185.
[4]秦叔逵,龚新雷.索拉非尼治疗国人晚期肝细胞癌的临床研究进展[J].临床肿瘤学杂志,2015;20(2):175-84.
[5]官孝熙.靶向抗癌药推广应用的瓶颈及思考[J].中国医疗保险,2013,60-62
[6]Forner A,Reig ME,de Lope CR,et al.Current strategy for staging and treatment:the BCLC update and future prospects.Semin Liver Dis.2010 Feb;30(1):61-74.
[7]Kudo M,Matsui O,Izumi N,et al.Transarterial chemoembolization failure/refractoriness:JSH-LCSGJ criteria 2014update.Oncology;2014;87(Suppl):22-31.
[8]甲苯磺酸索拉非尼片说明书.2017年3月修订版本.
[9]中华人民共和国卫生部(卫办医政发[2011]121号).原发性肝癌诊疗规范(2011年版).临床肿瘤学杂志.2011,16(10):929-946.
[10]程树群,杨甲梅,沈锋等.肝细胞癌合并门静脉癌栓多学科诊治--东方肝胆外科医院专家共识[J].中华肝胆外科杂志,2015,9:60-62.
[11]全国肝癌合并癌栓诊治研究协作组.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版).中华消化外科杂志,2016,15(5):411-416.
[12]Llovet JM,Ricci S,Mazzaferro V,et al.Sorafenib in Advanced Hepatocellular Carcinoma.N Engl J Med.2008 Jul 24;359(4):378-90.
[13]Cheng AL,Kang YK,Chen Z,et al.Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinom a:a pha se III randomised,double-blind,placebo-controlled trial.Lancet Oncol.2009 Jan;10(1):25-34.
[14]Wang SN,Chuang SC,Lee KT.Efficacy of sorafenib as adjuvant therapy to prevent early recurrence of hepatocellular carcinoma after curative surgery:A pilot study.Hepatol Res.2014,44(5)523-31.
[15]Kudo M,Matsui O,Izumi N,et al.JSHConsensus-Based Clinical Practice Guidelines for the Management of Hepatocel lular Carcinoma:2014 Update by the Liver Cancer Study Group of Japan.Liver Cancer.2014Oct;3(3-4):458-68.
[16]European Association For The Study Of The Liver;European Organisation For Research And Treatment Of Cancer.EASL-EORTC clinical practice guidelines:management of hepatocellular carcinoma.JHepatol.2012 Apr;56(4):908-43.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015.[J].CA Cancer J Clin2016 Mar-Apr;66(2):115-32.
[3]Lan T,Chang L,Rahmathullah MN,et al.Comparative Efficacy of Interventional Therapies for Early-stage Hepatocellular Carcinoma:A PRISMA-compliant Systematic Review and Network Metaanalysis.Medicine(Baltimore),2016,95(15):e3185.doi:10.1097/MD.0000000000003185.
[4]秦叔逵,龚新雷.索拉非尼治疗国人晚期肝细胞癌的临床研究进展[J].临床肿瘤学杂志,2015;20(2):175-84.
[5]官孝熙.靶向抗癌药推广应用的瓶颈及思考[J].中国医疗保险,2013,60-62
[6]Forner A,Reig ME,de Lope CR,et al.Current strategy for staging and treatment:the BCLC update and future prospects.Semin Liver Dis.2010 Feb;30(1):61-74.
[7]Kudo M,Matsui O,Izumi N,et al.Transarterial chemoembolization failure/refractoriness:JSH-LCSGJ criteria 2014update.Oncology;2014;87(Suppl):22-31.
[8]甲苯磺酸索拉非尼片说明书.2017年3月修订版本.
[9]中华人民共和国卫生部(卫办医政发[2011]121号).原发性肝癌诊疗规范(2011年版).临床肿瘤学杂志.2011,16(10):929-946.
[10]程树群,杨甲梅,沈锋等.肝细胞癌合并门静脉癌栓多学科诊治--东方肝胆外科医院专家共识[J].中华肝胆外科杂志,2015,9:60-62.
[11]全国肝癌合并癌栓诊治研究协作组.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识(2016年版).中华消化外科杂志,2016,15(5):411-416.
[12]Llovet JM,Ricci S,Mazzaferro V,et al.Sorafenib in Advanced Hepatocellular Carcinoma.N Engl J Med.2008 Jul 24;359(4):378-90.
[13]Cheng AL,Kang YK,Chen Z,et al.Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinom a:a pha se III randomised,double-blind,placebo-controlled trial.Lancet Oncol.2009 Jan;10(1):25-34.
[14]Wang SN,Chuang SC,Lee KT.Efficacy of sorafenib as adjuvant therapy to prevent early recurrence of hepatocellular carcinoma after curative surgery:A pilot study.Hepatol Res.2014,44(5)523-31.
[15]Kudo M,Matsui O,Izumi N,et al.JSHConsensus-Based Clinical Practice Guidelines for the Management of Hepatocel lular Carcinoma:2014 Update by the Liver Cancer Study Group of Japan.Liver Cancer.2014Oct;3(3-4):458-68.
[16]European Association For The Study Of The Liver;European Organisation For Research And Treatment Of Cancer.EASL-EORTC clinical practice guidelines:management of hepatocellular carcinoma.JHepatol.2012 Apr;56(4):908-43.