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OBJECTIVE： To investigate the feasibility of multi-payment for drugs for rare diseases and also provide reference for rare disease treatment and the formulation of related policy. METHODS： Taking Gaucher’s disease in Qingdao as an example， the relevant medical insurance policies and drug supply were analyzed； according to the sources of financing， the economic burden of treatment drugs for patients with Gaucher’s disease in Qingdao was estimated. Based on the average total cost of patients with Gaucher’s disease in Qingdao， the drug cost burden of patients with Gaucher’s disease in the whole country was simulated according to the relevant epidemiological survey data， and the problems of medical insurance model for rare diseases in Qingdao were analyzed. RESULTS & CONCLUSIONS： A series of medical insurance policies were formulated in Qingdao. The financing mode of medical insurance includes social funds （from Qingdao Charity Federation， drugs are provided by pharmaceutical manufacturers）， medical insurance funds （used for personal self-payment assistance within the scope of medical insurance co-ordination） and civil assistance （used for assistance outside the scope of medical insurance co-ordination）. Imidase is currently the only approved specific drug for Gaucher’s disease in China. The designated physician， treatment and drug-taken system is adopted in Qingdao. By the end of 2017， the annual drug consumption of 8 patients in Qingdao was 38-170 bottles， totaling 686 bottles. The annual cost of treatment ranged from 786 600 to 3 519 000 yuan， totaling 1 420 200 yuan. The self-paid expenses ranged from 9 800 to 197 400 yuan （the self-paid ratio ranged from 0.46％ to 8.87％）， totaling 661 400 yuan. The reimbursement cost by supplementary medical insurance was 509 800 to 1 789 800 yuan （accounting for 54.59％ to 65.94％）， totaling 8 577 800 yuan. Three patients received civil assistance， the amount of which ranged from 23 100 to 13 000 yuan （accounting for 1.89％ to 4.18％）， totaling 241 400 yuan. According to the relevant epidemiological survey data （the prevalence rate was 0.15 per 100 000）， it is estimated that there are about 2 093 patients with Gaucher’s disease in China. Referring to Qingdao multi-payment model， it is estimated that the total cost of drugs for Gaucher's disease in China is about 3.715 billion yuan， charitable assistance can bear 1.238 billion yuan， while medical insurance expenditure is about 2.255 billion yuan， and individual self-payment is about 222 million yuan. From the point of view of drug cost burden， the multi-payment model in Qingdao has lightened the personal burden of patients’ has achieved significant results. There are problems in Qingdao’s multi-payment model， such as “medical insurance immigration”， low drug accessibility， drug price monopoly， three-level disease prevention needs to be strenghten， etc. The state or provinces and cities can refer to Qingdao model when formulating policies related to rare diseases. Great importance should be paid attention to the existing problems.
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OBJECTIVE： To evaluate the effects of ivabradine in the treatment of heart failure on medical insurance fund budget in China， and to provide support evidence of related economical evaluation for medical insurance department to solve the problem of reimbursement admission of the drug in hospital outpatient department and the establishment of drug list in hospital. METHODS： Excel decision tree model was used. Pharmacoeconomic analysis was conducted based on the data reported in domestic literatures over the years. Firstly， according to the prevalence rate of heart failure in China， the number of patients with heart failure was estimated， which accorded with NYHA cardiac function class Ⅱ-Ⅳ， systolic blood pressure dysfunction and ivabradine indication. Then the cost of ivabradine was estimated. Secondly， the total number of hospitalizations and the cost of hospitalization due to heart failure were estimated. Finally， the cost of ivabredine and the cost of treatment saved by avoiding re-hospitalization due to the use of ivabredine were considered comprehensively. Static budget impact analysis was conducted to evaluate the effects of the use of ivabredine on medical insurance fund budget. RESULTS： The prevalence rate of heart failure in China was raised to 1.3％ in 2013. It was estimated that the number of heart failure patients between 35-75 years old in China could be about 8.51 million and total hospitalization times was about 4.32 million per year. The economic burden of hospitalization in heart failure patients was about 168.940 billion yuan in whole country. Since 18％ of patients could be avoided re-hospitalization after treatment with ivabradine， the cost of hospitalization could be saved by about 30.410 billion yuan， while the total cost of taking ivabradine was about 17.525 billion yuan. Therefore， the use of ivabradine could save the hidden medical cost budget by about 12.886 billion yuan， which had obvious cost-effectiveness. Static budget impact analysis results showed that by 2019-2020， the expected proportion of patients with heart failure covered by ivabradine would increased to 8.70％， and the total consumption sum would reach about 1.797 billion yuan. The incremental cost savings ratio （ICSR） showed that the cost of hospitalization could be saved by about 11 951 yuan for each additional case of heart failure treated with ivabradine； there could be 5 711 yuan of balance by deducting drug cost 6 240 yuan of ivabradine. CONCLUSIONS： The cost savings of hospitalization treated by ivabradine is not only enough to offset the cost of ivabradine itself， but also has a premium effect. The drug is of certain economy for the treatment of heart failure in China.
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OBJECTIVE: To conduct the economic evaluation of recombinant human type Ⅱ tumor necrosis factor receptorantibody fusion protein (trade name: Etanercept) in the treatment of rheumatoid arthritis.METHODS: By literature retrieval, foreign literatures about Etanercept "head to head" research or Chinese literatures about the comparison of recombinant human type Ⅱ tumor necrosis factor receptor-antibody fusion protein with infliximab and adalimumab were collected. The costs were localized, indicators of effectiveness were converted into quality-adjusted life year (QALY), then cost-utility analysis (CUA) and incremental cost-utility ratio (ICUR) were conducted. RESULTS: Three qualified literatures were acquired. The translational research of the first report of WU B and so forth (2012 year) showed that CUA of Etanercept, infliximab and adalimumab were 48. 2, 36. 6 and 104. 6 thousand yuan/QALY, and ICUR were 119. 8, 116. 4 and 313. 4 thousand yuan/QALY, respectively. The translational research of the second report of Santos-Moreno P and so forth (2015 year) showed that CUA of Etanercept, infliximab and adalimumab were 93. 1, 118. 2 and 249. 2 thousand yuan/QALY, and ICUR were 117. 5, 151. 3 and 327. 9 thousand yuan/QALY, respectively. The translational research of the third report of Santos-Moreno P and so forth (2016 year) showed that CUA of Etanercept, infliximab and adalimumab were 107. 0, 131. 6 and 273. 8 thousand yuan/QALY, and ICUR were 139. 6, 172. 5 and 369. 8 thousand yuan/QALY, respectively. ICUR of Etanercept were all smaller than 3 times of GDP 148. 1 thousand yuan in 2015. CONCLUSIONS: From the results of the study of these 3 literatures, compared with infliximab and adalimumab, Etanercept shows economy for rheumatoid arthritis.
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Objective:To analyze the impact of Recombinant Human Tumor Necrosis Factor-α Receptor Ⅱ:IgG Fc Fusion Protein (rhTNFR:Fc) on medical insurance budget.Methods:Rheumatic drugs were select from the IMS data 2015.The drug quantity unit was converted to defined daily dose(DDD).The quantity of rhTNFR:FC in IMS data 2015 was taken as the baseline.The expenditure growth and its impact on rheumatic drugs and all drugs were calculated under 90％ and 80％ reimbursement rate as the different incremental proportion of the quantity of rhTNFR:Fc.National health insurance expenditure data was derived from statistical data of government departments.Results:According to 90％ reimbursement rate,medical insurance expenditure increased by 5.22～10.43 billion yuan.rheumatic drugs and all medical insurance drugs expenditure increased by 63.44～126.87％ and 0.04～0.08％ respectively while the consumption of rhTNFR:Fc increased 0-100％ in 2015.The increment of medical insurance expenditure reduced accordingly under the reimbursement ratio of 80％.Conclusion:The budget impact of rhTNFR:Fc was great on medical insurance expenditure of rheumatic drugs,which was very limited on the medical insurance expenditure of all drugs.
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There is a unification of the social pooling accounts and personal saving accounts of Urban Employees' Basic Medical Insurance ( UEBMI) in Shanghai. In recent years, the revenue and expenditure of UEBMI funds increased, and the fund balance sprouted year by year, and mostly concentrated in personal health insurance saving accounts. On the whole, the vast majority of insured personal saving accounts have balances, but the balance is not high, i. e. less than 1000 yuan accounted for 52. 3%. Judging from the age group, the personal health insur-ance saving account funds is mainly concentrated in the 30-year-old and over working population. Because of its par-ticularity, the personal health insurance saving accounts can only be invested in current deposit (bank live), time deposit and national debt, bonds and other hedge. Compared with the price index devaluation, the personal health insurance saving accounts somehow failed to give full play to the personal attributes. It is suggested to explore the use function of personal health insurance saving accounts by establishing family saving accounts-family coexistence, pur-chasing of supplementary medical insurance and so on. Simultaneously, the channels of maintaining and increasing the value of personal health insurance saving accounts could be broadened.
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The study introduced the general evaluation indicator system for community health services in Shanghai and its characteristics,analyzing the results of the comprehensive evaluation from the aspects of regions and institutions.From six aspects of financial input,human resource construction, operation mechanism,family doctor system,information system construction and the application of the comprehensive evaluation results,the paper recommended on deepening the reform of community health services.
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Objective: To compare utility values measured by different instruments. Methods: Different instruments were used to measure utility values in 350 patients who were diagnosed as age-related macular degeneration at the same time. The median of utility values measured by different instruments was regarded as relative standard utility value to process comparison, analysis of variance, correlation analysis and curve estimation. Results: Most differences and correlations among utility values measured by different instruments were significant, as well as equations estimated from relative standard utility value and utility values measured by different instruments, but the degree of fitting was not high. Conclusion: The utility values of the same subject measured by different instruments are quite different. The results of the study could provide correction reference to the utility value measured by single instrument in the absence of absolute standard.
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Shanghai began to strengthen the community health service system in 1997 , and had officially en-tered the period of “connotation construction” with the core policy of family doctor system in 2011 after the period of“service framework and network establishment” and“operational mechanism reform”. Through summarizing the poli-cy files related the family doctor system and based on 2013 report on monitoring and evaluation of family doctor system in Shanghai, the paper presented the progress of the system from aspects of system coverage, signature relationship, service mode and operational mechanism, and analyzed the development bottlenecks of the system from aspects of the policy itself, service principal, service supervision and service objects. Finally, the paper proposed some suggestions in order to give some references for further development of national general practitioner system.
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An integration of British healthcare and social services has been underway in recent years, and a typical methodology has been formed in the process of regional explorations . Using qualitative research methods of on-site observation and in-depth interviews, the paper studies the Care Programme Approach ( CPA) system of mental health and emergency multidisciplinary teams of Oxfordshire, a typical case of the integrated healthcare system re-forms in the British healthcare system. England’s integrated healthcare reforms have placed primary care and commu-nity health services at the center of the healthcare system and have included social services within the system. The ex-periences of multidisciplinary teams, integrated care pathways, personalized care planning and patient involvement and independence from the reforms are worthy subjects of study for China’s own healthcare delivery system reforms.
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Objective: To analyze the atrial fibrillation(AF) and the burden of illness(BOI) led by AF, to scientifically recognize the current situation of management and treatment for AF, to provide scientific references for designing the AF prevention and control strategy for Chinese people and effectively improve the reasonable allocation of medical resources. Methods: The disability adjusted life years(DALY)was used to evaluate the BOI of AF. The method of population attributable risk percent-age was applied to estimate the treatment cost of AF cerebral apoplexy. Results: In China, the loss of DALY brought by AF was 4 599 687 yuan, which is higher than the loss of DALY brought by hypertensive heart disease(3 348 925 yuan)and close to the loss of DALY brought by diabetes(4 769 127 yuan). The DALY of group over 30 is 7.15/1000 person. Cerebral apoplexy is the main reason for the BOI of this disease. It is estimated that the annual treatment cost of AF cerebral apoplexy is 4.9 billion yuan(about 800 million dollars), 89%of treatment cost come from patients over 60 years old with AF and cerebral apoplexy. Conclusion: AF brought heavy BOI to Chinese society. Cerebral apoplexy is the main reason for the burden of this disease. The loss of DALY led by AF cerebral apoplexy is more than the BOI of many chronic disease in India and European countries. The diagnosis and treatment cautious of AF need to be strengthened. The correct treatment results in restoring sinus thymes, so as to decrease complication like cerebral apoplexy. That would be the target of AF treatment in future China.
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This paper presented both the theoretical basis and the technical route of the study for health system reform in Shanghai via system monitoring and evaluation.By way of two rounds of expert consultation and joint liaison meetings,the study initially established framework indicators of such based on the following four aspects,including inputs and activities,outputs,outcomes and impact.Also,the study identified 13 grade-2 indicators and 133 grade-3 indicators.Based on the main results of the baseline survey,the paper preliminary analysed the problems and challenges that may be faced in the field of Shanghai health system reform,and proposed suggestions for carrying out monitoring and evaluation of the health system reform respectively on both a research and practical level.
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Background & Objective: Multiple sclerosis is a relatively rare disease in China as compared to other nations throughout the world. This study aimed to assess the depth and breadth of knowledge of multiple sclerosis and its consequences specifi cally in China via a review and synthesis of existing literature. Methods: We conducted a literature search and reviewed studies that either were published in MEDLINE-indexed, English-language journals, or China National Knowledge Infrastructure databaseindexed, Chongqing VIP Information Co., Ltd database-indexed, or Wanfang Data database-indexed Chinese-language journals, or appeared in the grey literature including medical society websites and scientifi c meeting abstracts from 2005−2010. Results: The only study reporting epidemiological burden reported a prevalence rate of multiple sclerosis to be 1.39 per 100,000 persons. Multiple sclerosis was more prevalent among females as compared to males. Most of the studies used Poser criteria to diagnose multiple sclerosis. Corticosteroids were the mainstay used by physicians for the treatment of multiple sclerosis. Little data is available on epidemiological burden and no data is available on the economic and humanistic burden of multiple sclerosis in China. Conclusions: Diagnostic practices and treatment of multiple sclerosis in China appear to lag behind those in Western countries. There is signifi cant room for improvement in bettering those suffering from multiple sclerosis in China.
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OBJECTIVE:To explore WHO western pacific region to essential drugs available and the framework of regional action (2010～2015) and the implications of China's essential drug policy.METHODS:Discuss WHO western pacific region to essential drug available and the framework of regional action of 2010～2015,and to help WHO western pacific regional expert consultation of member states including China can obtain the essential drug which was afforded,quailty assurance,use properly,fair,and available.RESULTS & CONCLUSION:As a key member of WHO western pacific region,we support the plan and framework,but we need to do with the implementation of national conditions.
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OBJECTIVE:To summarize the experiences of Ningxia's drug tender policy reform in unifying tender operation,price,and distribution("Trinity" reform).METHODS:Review of the reform process with discussion from the perspective of extension of tender policy objective,essential medicine policy as well as existing problems and corresponding countermeasures.RESULTS & CONCLUSIONS:In addition to the functions that Ningxia's "Trinity" reform of drug tender policy solidifies the price-lowering role of drug tender policy and benefits the construction of essential medicine policy,the reform still needs to be improved with regards to some existing problems.
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OBJECTIVE:To introduce methods of cost categorizing in pharmacoeconomics evaluation and existing controversy METHODS:To compare different cost measurement methods and definition in different pharmacoeconomic guideline RESULTS & CONCLUSION:Choosing appropriate cost spectrum corresponding to different studing aspects
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OBJECTIVE:To provide references for drug pricing and drug administration for Chinese government.METHODS:The drug pricing and administration policies in UK were expounded and the effects of which were analyzed and evaluated,based on which some suggestions were put forward with the consideration of the specific condition of our country.RESULTS&CONCLUSIONS:The rules of market economy should be obeyed and market monitoring should be carried out in China.The non-governmental organizations should play a key role in the support and service for national drug supervision and administration.The drug prices should be controlled according to category so as to make the formula process of drug price policy scientific.The government-set price and the market price monitoring mechanism should be established and the legal system of drug price management should be established as soon as possible.
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Objective To estimate fairness in the financial contributions of suburban households of Shanghai to the health system and the situation throughout the country. Methods A household survey was conducted to obtain data on health expenditure and government health input, which was then analyzed by means of the index for and methodology of fairness in the financial contributions of households in the performance assessment of the health system as introduced by the WHO. Results The coefficient of fairness in the financial contributions of households to the health system was estimated to be 0.735 and the rate of cooperative medical care coverage was positively related to the fairness. Conclusion The fairness level of the financial contributions of suburban households of Shanghai to the health system tallies with the level estimated by the WHO for China while the national level is lower. The calculations of government subsidy for household health, as recommended by the WHO in estimating fairness in the financial contributions to the health system, do not conform to the actual situation in China.
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OBJECTIVE:To evaluate the medical cost of capectabine in treatment of advanced rectocolonic carcino?ma.METHODS:The characteristics of therapeutic effect and medical cost were compared between capectabine and classical MAYO program.RESULTS&CONCLUSION:The capectabine is more expensive than traditional drugs,however,in terms of medical resource,the saving medical cost in use of capectabine would counterbalance the expensive price of drug to maxium limit.The medical cost of capectabine is superior to that of traditional drugs.
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PurposeTo study the effect of gasoline on the extracellular matrix of dermis in rat. Methods45 male Wistar rats were divided into control group, 3 different exposure level groups, which were exposed to gasoline on 2 cm× 3 cm skin area with the dose of 250 mg/cm2 for 1 (group A) ,4(group B)and 8 days (group C) respectively,and an intervention group exposed to 250 mg/cm2 × 8 days gasoline after the application of protective agent on skin. After the treatment, collagen, elastin and glycosaminoglycan (GAG) were assayed in skin departed from intoxicated area.ResultsCompared with control group, collagen was decreased in group C(P<0.05); elastin was decreased in group B and C (P<0.05); glycosaminoglycan was decreased in all exposure groups and intervention group ( P < 0.05 or P < 0.01 )。 Collagen, elastin and glycosaminoglycan(GAG) were significantly lower in group C than in intervention group ( P < 0.05 ). ConclusionsThe extracellular matrix of dermis,including collagen,elastin and GAG were decreased in rat dermal exposed to gasoline.
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Objective To explore appropriate organization and financing models of urban employees supplementary medical insurance under the conditions of the market economy. Methods Employee surveys on willingness to participate in, willingness to pay for, and actual enrolment in supplementary medical insurance were conducted in Shanghai, Wenzhou and Chengdu and nationally different operational models were compared so as to analyze prospectively coverage and operational models of feasible supplementary medical insurance options. Results Characteristics of the employees needs for various supplementary medical insurance options were garnered and appropriate coverage and operational models were put forward. Conclusion It is suggested that the role of the government in the development of supplementary medical insurance be clearly defined, the development of supplementary medical insurance be promoted through policy support and guidance, and the supervision of supplementary medical insurance be strengthened.