Analysis of the medication situation of common chronic diseases in A third-grade hospitalunder the pilot work of volume procurement
带量采购下某三甲医院常见慢性病用药情况分析

摘要

目的 分析带量采购试点工作开展前后某三甲医院ACEI类和ARB类降压药物以及他汀类调血脂药物的使用情况，为临床药学服务和医院药事管理以及政策制定提供参考。方法 采用药物经济学方法进行回顾性分析，对2019年带量采购施行开始后6个月（2019-3-25至2019-9-24）和2018年同期6个月（2018-3-25至2018-9-24）某三甲医院他汀类调血脂药物、ACEI类和ARB类降压药物的销售数量、销售金额、用药频度（DDDs）、日均费用（DDC）等药物经济学指标进行统计和同比分析。结果 国家集中带量采购后，中选品种厄贝沙坦氢氯噻嗪片（正大天晴）的DDDs由带量采购前的9800增加到带量采购后的40950，增长率317.9%；DDC由带量采购前的2.55降到带量采购后的1.02，降幅60%；中标品种价减量增，非中标药品的价格除小部分保持不变外大部分出现不同幅度的降低，无价格增加品种；销售数量也由于药品价格的下调，呈不同程度的增长。所有降压类药物中临床对缬沙坦胶囊的选择倾向性最大，所有调血脂类药物中对阿托伐他汀钙片的选择倾向性最大。非中选品种厄贝沙坦片、福辛普利钠片、坎地沙坦酯片、盐酸贝那普利片的DDDs呈梯度递减式降低，说明倾向选择中选品种；缬沙坦氨氯地平片、奥美沙坦酯氢氯噻嗪片和厄贝沙坦氢氯噻嗪片的DDDs增加比较明显，但其DDC降幅并不大，说明临床更倾向于选择复方制剂来降压，提示价格只是影响药品选择的主要因素，但不是唯一因素。结论 临床对中选品种的选择倾向性高于或等于非中选品种，对复方制剂的降压药的选择高于单方制剂。国家集中带量采购政策实施后患者的用药经济负担明显降低。

Abstract

Objective To analyze the use of ACEI and ARB antihypertensive drugs and statin lipid drugs in our hospital before and after the pilot work of volume procurement, so as to provide reference for clinical pharma- ceutical service, hospital pharmaceutical management and policy formulation.
Methods The pharmacoeconomic analysis was used to conduct statistical and year-on-year analysis, so that a comparison on sales quantity, sales amount, medication frequency (DDDs) and average daily cost between statistics of 6 months after the Purchase with quantity procurement (2019-3-25 to 2019-9-24) and 6 months before Purchase with quantity procurement 2018 (2018-3-25 to 2018-9-24).
Results After national centralized volume procurement, the DDDs of irbesartan hydrochlorothiazide tablets (Zhengda Tianqing) increased from 9800 to 40950 after volume procurement, with a growth rate of 317.9%; DDC decreased from 2.55 before volume procurement to 1.02 by 60%; the decrease of the price of non-winning drugs except for the small part; the sales quantity also increased to different degrees due to the reduction of drug price. Among all antihypertensive drugs, the greatest clinical selection bias for valsartan cap- sules, The selection bias for atorvastatin calcium tablets was the greatest among all dyslipidaemic drugs. The DDDs of irbesartan, forisingriril, candesartan, and benaapril hydrochloride decreased, indicating that the DDDs of valsartan amlodipine, olmesartan and irbesartan increased significantly, but the decrease in DDC was not large, indicating that it was more inclined to choose compound preparation for antihypertensive, suggesting that the price is only the main factor, but not the only factor.
Conclusion   The clinical selection tendency of the selected varieties was higher than or equal to the non-selected varieties, and the selection of antihypertensive drugs for compound preparations was higher than that of unilateral preparations. The economic burden of the patients are greatly reduced after the implement of "4+7" procurement policy.