目的: 研究冠脉支架集采前后经皮冠状动脉介入（PCI）病种费用的长期变动趋势,评估集采政策实施效果并提出政策建议。方法: 提取2019—2024年浙江宁波某市级三甲综合医院PCI病种出院患者病案首页费用数据,通过结构变动度及灰色关联分析法分析病种费用、构成比以及费用关联度等,并采用统计学方法分析集采前后各项费用变化情况。结果: 共纳入14476例出院患者病案首页,PCI病种冠脉支架集采前（2019—2020年）费用中位数为41559元,集采初期（2021—2022年）降至28988元,集采长期（2023—2024年）进一步下降至25730元,呈持续下降趋势且具有统计学意义（J-T=-38.63,P<0.001）。从长期数据看,冠脉支架集采政策实施后PCI病种费用结构保持基本稳定,耗材费对病种费用的结构变动度贡献率最高为50.00%。药品费与病种费用关联度最高为0.825。结论: 冠脉支架集采政策对降低PCI病种费用具有持续效应,对改善“看病贵”、提高医疗服务收入占比等医改目标有积极意义,但医疗服务收入占比的提升主要依赖于耗材费下降推动。建议利用集采带来的“腾笼换鸟”契机,及时推进医疗服务价格调整改革,并按照技术难度及风险情况科学制定病种付费标准,避免创新技术在临床应用中受到限制。

Objective: The paper studies the long-term trend of changes in the cost of percutaneous coronary intervention (PCI) before and after coronary stent centralized procurement, so as to evaluate the implementation effect of the centralized procurement policy, and propose policy recommendations. Methods: We extracted the cost data of the first page of medical records of discharged patients undergoing PCI in a tertiary comprehensive hospital in Ningbo City of Zhejiang Province from 2019 to 2024. The disease cost, composition ratio, and cost correlation degree were analyzed through structural change degree and grey correlation analysis, and statistical methods were used to analyze the changes in various costs before and after centralized procurement. Results: A total of 14476 discharged patients were included. The median cost of PCI before coronary stent centralized procurement (2019-2020) was 41559 yuan, which decreased to 28988 yuan in the initial period of centralized procurement(2021-2022), and further decreased to 25730 yuan in the long-term period of centralized procurement(2023-2024), showing a continuous downward trend with statistical significance (J-T=-38.63, P<0.001). From long-term data, it can be seen that after the implementation of the centralized coronary stent procurement policy, the structure of PCI disease expenses has remained basically stable, and the contribution rate of consumables to the structural changes of disease expenses is the highest at 50.00%. The highest correlation between drug costs and disease costs is 0.825. Conclusions: The policy of centralized procurement of coronary stents has a sustained effect on reducing the cost of PCI, and has a positive significance in achieving healthcare reform goals such as alleviating the "high cost of medical treatment" and increasing the proportion of medical service income. However, the increase in the proportion of medical service income mainly depends on the reduction of consumable costs. It is suggested to take advantage of the opportunity brought by centralized procurement to timely promote the reform of medical service price adjustment, scientifically formulate disease payment standards according to technical difficulty and risk, in order to avoid limitations on innovative technologies in clinical application.