目的: 基于医疗机构真实世界数据,评估丙型肝炎医保报销政策实施效果,为丙型肝炎防治工作和医保政策提供参考和依据。方法: 提取四川省成都市某三甲医院2014年1月至2020年12月的电子病历数据,采用间断时间序列分析等方法,从诊疗情况、医疗费用、药物使用和治疗效果等方面分析丙型肝炎患者诊疗行为和疾病负担的变化情况。结果: 在诊疗情况方面,成都市门诊特病报销政策实施后就诊人次和治疗人次均出现瞬时增长,实行口服直接抗病毒药物（direct-acting antiviral agents, DAA）单行支付政策后诊疗情况无显著变化;在医疗费用方面,丙型肝炎患者的门诊疗程总费用、自付费用和药品费用均在单行支付政策实施后明显降低。结论: 成都市丙型肝炎医保报销政策能够促进丙型肝炎患者积极就医,推动DAA方案的广泛使用,减轻患者负担,提高丙型肝炎的治疗效率。
Abstract
Objective: To evaluate the implementation effect of hepatitis C medical insurance reimbursement policy in Chengdu, and to provide reference and basis for hepatitis C prevention and treatment and medical insurance policy. Methods: The electronic medical record data of a three tertiary hospital in Chengdu from January 2014 to December 2020 were extracted, and the interrupted time series model was used to analyze the changes of diagnosis and treatment behavior and disease burden of hepatitis C patients from the aspects of diagnosis and treatment, medical expenses, drug use and treatment effect. Results: In terms of diagnosis and treatment, the number of visits and treatments increased instantaneously after the implementation of the outpatient reimbursement policy in Chengdu, and there was no significant change after the implementation of the single line payment policy for oral direct antiviral (DAA) drugs. In terms of medical expenses, the total cost of treatment, out of pocket expenses and drug expenses of hepatitis C patients have been significantly reduced after the implementation of the single line payment policy. Conclusion: Chengdu hepatitis C medical insurance reimbursement policy can promote hepatitis C patients to actively seek medical treatment, promote the widespread use of DAA scheme, reduce the burden of patients, and improve the treatment efficiency of hepatitis C.
关键词
丙型肝炎 /
政策绩效 /
报销政策 /
间断时间序列分析
Key words
hepatitis C /
policy performance /
reimbursement policy /
interrupted time series
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 王贵强,魏来.健康中国2030消除丙肝威胁行动白皮书[EB/OL].(2020-07-30)[2023-01-11].http://www.cphcf.org.cn/zgcb/contents/650/30644.html?x=y.
[2] Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection[M].Geneva: World Health Organization, 2018.
[3] 陈园生,李黎,崔富强,等.中国丙型肝炎血清流行病学研究[J].中华流行病学杂志, 2011(09):888-891.
[4] 付露阳,马爱霞.盐酸达拉他韦联合阿舒瑞韦治疗慢性丙型肝炎的经济学评价[J].中国药物经济学, 2018,13(06):5-9.
[5] CHEN G F, WEI L, CHEN J, et al.Will sofosbuvir/ledipasvir (harvoni) be cost-effective and affordable for chinese patients infected with hepatitis C virus? an economic analysis using real-world data[J].Public library of science one, 2016,11(6):e155934.
[6] 魏来,段钟平,王贵强.丙型肝炎防治指南(2019年版)[J].实用肝脏病杂志,2020,23(01):33-52.
[7] Hepatitis Cguidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection[J].Clinical infectious diseases, 2018,67(10):1477-1492.
[8] EASL recommendations on treatment of hepatitisC 2015[J].Journal of hepatology, 2015,63(1):199-236.
[9] 庄焱,卢捷,谢青,等.我国丙型肝炎肝硬化患者DAA治疗现状及短期预后的研究[J].肝脏, 2020,25(03):249-253.
[10] 宗楠.终末期肾病血液透析和腹膜透析疾病经济负担及影响因素[D].郑州:郑州大学, 2017.
[11] EASL recommendations on treatment of hepatitisC 2018[J].Journal of hepatology, 2018,69(2):461-511.
[12] IYENGAR S, TAY-TEO K, VOGLER S, et al.Prices, costs, and affordability of new medicines for hepatitis C in 30 countries: an economic analysis[J].Public library of science medicine, 2016,13(5):e1002032.
[13] PALMGREEN P.Interrupted time-series designs for evaluating health communication campaigns[J].Communication methods and measures, 2009,3(1-2):29-46.
[14] WAGNER A K, SOUMERAI S B, ZHANG F, et al.Segmented regression analysis of interrupted time series studies in medication use research[J].Journal of clinical pharmacy and therapeutics, 2002,27(4):299-309.
[15] PENFOLD R B, ZHANG F.Use of interrupted time series analysis in evaluating health care quality improvements[J].Academic pediatrics, 2013,13(6 Suppl): S38-S44.
[16] DURBIN J, WATSON G S.Testing for serial correlation in least squares regression II[J].Biometrika, 1951,38(1-2):159-178.
[17] WILCOX R R.Multiple hypothesis testing based on the ordinary least squares regression estimator when there is heteroscedasticity[J].Educational and psychological measurement, 2003,63(5):758-764.
[18] 冯宇轩,魏霞,杨莉.丙型肝炎创新药医保准入支付政策对医药费用的影响研究[J].中国卫生政策研究,2020,13(08):75-79.
[19] GREBELY J, DALGARD O, CONWAY B, et al.Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial[J].Lancet gastroenterol hepatol, 2018,3(3):153-161.
[20] 卢捷,陈立畅,周惠娟,等.我国慢性丙型肝炎患者抗病毒治疗现状及药物选择策略分析[J].肝脏, 2019,24(11):1230-1233.
[21] THONG V D, POOVORAWAN K, TANGKIJVANICH P, et al.Influence of host and viral factors on patients with chronic hepatitis C virus genotype 6 treated with pegylated interferon and ribavirin: a systematic review and meta-analysis[J].Intervirology, 2015,58(6):373-381.
[22] 王奕璇,王建军,闫涛,等.直接抗病毒药物治疗基因1b型慢性丙型肝炎病毒感染的真实世界临床研究[J].军事医学,2020,44(07):534-540.
基金
四川省科技厅重点研发项目“丙型病毒性肝炎治疗方案综合评价及全程化诊疗模型的建立研究”（2021YFS0145）
