目的: 探讨在DRG支付方式改革背景下,抗耐多药结核创新药物贝达喹啉在临床应用中的经济可及性,为完善医保支付方式改革政策提供决策参考。方法: 以国家医保局DRG付费示范点B市为研究现场,回顾性收集样本医院呼吸系统结核住院患者的医疗费用信息,分析耐多药结核相关DRG的患者收治分布和资源消耗现况,结合医保支付标准,比较医院的药费预算空间与贝达喹啉单药费用区间。结果: 研究纳入9家样本医院,呼吸系统结核住院患者的医技和药品费用占比较高,在ES11和ES15两个DRG分组中,理想水平下各样本医院的例均药品费用弹性区间分别为[4690.98,9998.85]元和[1418.71,7731.09]元,而耐多药结核患者使用贝达喹啉的现实费用区间分别为[9800,19600]元和[8400,16800]元。仅有1家医院在ES11组支付下处方贝达喹啉具有经济可及性。结论: DRG付费后医院需加强与医保部门的沟通,探索提升抗耐多药结核创新药物临床应用经济可及性的适宜政策。医保部门在推进支付方式改革的过程中,需关注相关政策的叠加效应,提升政策执行的协同性。

Objective: The paper analyzes the economic accessibility of bedaquinoline, an innovative drug for the treatment of multidrug resistant tuberculosis (MDR-TB) in clinical prescriptions under the DRG payment system, so as to provide evidence for improving the reform policy of medical insurance payment. Methods: Taking the DRG payment model city B of National Healthcare Security Administration as the research site, the medical cost information of respiratory tuberculosis inpatients in the sample hospital was retrospectively collected, the patient distribution and resource consumption of MDR-TB-related DRG were analyzed. The hospital-level drug budgets for the patient were compared with the single-drug budgets of bedaquinoline, based on the medical insurance reimbursement criteria. Results: Nine hospitals were included in this study, and hospitalized patients with respiratory tuberculosis had a higher proportion of medical technology and drug costs in the DRG groups of ES11 and ES15. Under ideal circumstance, the elastic intervals of average drug cost per case for each sample hospital were [4690.98, 9998.85] yuan and [1418.71, 7731.09] yuan, respectively, while the realistic cost intervals of using bedaquiline for MDR-TB patients were [9800, 19600] yuan and [8400, 16800] yuan, respectively. Only one hospital had economic accessibility to prescribe bedaquiline under the payment of ES11 group. Conclusion: After the implementation of DRG payment system, hospitals are required to enhance communication with the medical insurance department and design appropriate policies to improve the economic accessibility of innovative drugs for MDR-TB in clinical applications. The medical insurance department needs to pay attention to the synergistic effect of relevant policies and improve the synergy of policy implementation.