摘要
我国创新药市场蓬勃发展,公众用药需求与医保覆盖期待日益增长。然而,高值创新药常面临临床证据不足、长期疗效不确定的挑战,如何在保障患者可及性与医保基金可持续性之间实现平衡,成为医保改革的重要议题。英国通过设立癌症药物基金与创新药物基金,将真实世界证据系统性地纳入支付决策,为高值创新药建立了动态的准入与退出机制。本文深入剖析上述英国基金的发展脉络、运行框架与关键设计,以期为我国利用医保数据探索高值创新药支付模式、推动真实世界研究在医疗保障领域的应用提供借鉴。
Abstract
The innovative drug market in China is experiencing robust growth, accompanied by increasing public demand for medications and higher expectations for coverage under the national healthcare security system. However, innovative drugs often face challenges such as insufficient clinical evidence and uncertainty regarding long-term efficacy. Achieving a balance between ensuring patient access and maintaining the financial sustainability of the healthcare security fund has therefore become a pivotal issue in healthcare reform. The United Kingdom establishes the Cancer Drugs Fund and the Innovative Medicines Fund, systematically integrates real-world evidence into reimbursement decision-making, establishing a dynamic mechanism for access and exit of high-value innovative drugs. This paper provides an in-depth analysis of the evolution, operational framework, and key design of these UK funds. It aims to offer insights for China to explore innovative drug payment models leveraging domestic healthcare data and to promote the application of real-world studies within its healthcare security framework.
关键词
真实世界证据 /
创新支付 /
英国癌症药物基金 /
英国创新药物基金
Key words
real-world evidence /
innovative payment /
UK Cancer Drugs Fund /
UK Innovative Medicines Fund
吕兰婷, 王知.
真实世界证据在高值创新药附条件支付中的应用——以英国癌症药物基金和创新药物基金为例[J]. 中国医疗保险. 2026, 0(2): 42-46 https://doi.org/10.19546/j.issn.1674-3830.2026.2.005
Application of Real-World Evidence in the Conditional Payment of High-Value Innovative Drugs ——A Case Study of the UK Cancer Drugs Fund and Innovative Medicines Fund[J]. China Health Insurance. 2026, 0(2): 42-46 https://doi.org/10.19546/j.issn.1674-3830.2026.2.005
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参考文献
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