Takayama Akane, Narukawa Mamoru
1 Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
Ther Innov Regul Sci. 2017 Sep;51(5):604-611. doi: 10.1177/2168479017706716. Epub 2017 May 2.
A common concern about universal health insurance coverage is how to control health expenditure. The escalation of health care costs raises public awareness of the optimization of drug price and increased demand for cost-effectiveness assessment. In this paper, we show the differences in patient access to new drugs and drug price among countries, in which the situation of introduction of cost-effectiveness assessment scheme is different.
We investigated the health insurance coverage proportion of newly approved drugs in Japan, France, Germany, and the United Kingdom (UK). Then, we calculated the ratios of the European to the Japanese price for products that were reimbursed in both countries.
Japan had the highest health insurance coverage proportion (98.6%) in the 4 countries. In Japan, all the drugs that were approved in 2015 had been already listed in the latest formulary of February 2016. As for drug price, there wasn't much difference between Japan and the European countries in many cases.
From the viewpoint of the health insurance coverage proportion and the speed of reimbursement decision, the hurdle to access new drugs in Japan is lower than that in major European countries. While extensive coverage of health insurance and prompt reimbursement decision lower the hurdles to access new drugs and expand treatment options, they could lead to the increased medical expenditure. We should continue to discuss sustainable health insurance systems and drug price calculation schemes that properly reflect the drug's clinical value while keeping the availability of new drugs to patients.
对全民医疗保险覆盖范围的一个普遍担忧是如何控制医疗支出。医疗费用的不断攀升提高了公众对优化药品价格的认识,并增加了对成本效益评估的需求。在本文中,我们展示了在引入成本效益评估方案情况不同的国家之间,患者获取新药的情况和药品价格的差异。
我们调查了日本、法国、德国和英国(UK)新批准药物的医疗保险覆盖比例。然后,我们计算了在两国均获得报销的产品的欧洲价格与日本价格的比率。
日本在这4个国家中医疗保险覆盖比例最高(98.6%)。在日本,2015年获批的所有药物均已列入2016年2月的最新药品目录。至于药品价格,在很多情况下日本与欧洲国家之间并没有太大差异。
从医疗保险覆盖比例和报销决策速度的角度来看,日本获取新药的障碍低于主要欧洲国家。虽然广泛的医疗保险覆盖范围和迅速的报销决策降低了获取新药的障碍并扩大了治疗选择,但它们可能导致医疗支出增加。我们应该继续讨论可持续的医疗保险系统和药品价格计算方案,在确保患者能够获得新药的同时,合理反映药品的临床价值。