2009年4月,中国政府推出了药品零加价政策(ZMDP),以调整医疗机构的收支结构。
■本研究从医疗保健提供者的角度评估了实施ZMDP(作为干预措施)对治疗帕金森病(PD)及其并发症的药物成本的影响。
使用2016年1月至2018年8月中国某三甲医院的电子健康数据,估算了每次门诊就诊或住院治疗PD及其并发症的药物费用。进行了中断的时间序列分析,以评估干预后的即时变化(阶跃变化,β1)和斜率的变化,将干预后与干预前进行比较(趋势变化,β2)。在不同年龄段的门诊患者中进行了亚组分析,有或没有健康保险的患者,以及药物是否被列入国家基本药物目录(EML)。
■总的来说,包括18,158次门诊就诊和366次住院。实施ZMDP时,门诊(β1=-201.7,95CI:-285.4,-117.9)和住院患者(β1=-372.1,95%CI:-643.6,-100.6)管理PD的药物费用显着降低。然而,对于没有医疗保险的门诊病人,治疗PD(β2=16.8,95%CI:8.0,25.6)或PD并发症(β2=12.6,95%CI:5.5,19.7)的药物费用变化趋势显著增加.当对EML中列出的药物(β2=-1.4,95%CI:-2.6,-0.2)或不(β2=6.3,95CI:2.0,10.7)进行分层时,管理PD的门诊药物成本的趋势变化有所不同。在EML中列出的药物中,管理PD并发症的门诊药物成本的趋势变化显着增加(β2=14.7,95%CI9.2,20.3),没有医疗保险的患者(β2=12.6,95%CI5.5,19.7),年龄在65岁以下(β2=24.3,95%CI17.3,31.4)。
■实施ZMDP时,管理PD及其并发症的药物成本显着降低。然而,药物成本的趋势在几个亚组显著增加,这可能会抵消实现时的减少。
In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions\' revenue and expenditure structures.
This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson\'s disease (PD) and its complications from the healthcare providers\' perspective.
The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β1) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β2). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML).
Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (β1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (β2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β2 = -1.4, 95% CI: -2.6, -0.2) or not (β2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (β2 = 24.3, 95% CI 17.3, 31.4).
Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.