国家医疗保险覆盖政策如何影响中国曲妥珠单抗和利妥昔单抗的使用：一项双中心回顾性研究
How National Health Insurance Coverage Policy Affected the Use of Trastuzumab and Rituximab in China: A Bicentric Retrospective Study.
作者信息
Shang Linlin, Lin Yingtao, Fang Wenqing, Liu Yanyan, Bao Yuwen, Li Xin, Zhang Yuanyuan
机构信息
Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China.
Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China.
出版信息
Risk Manag Healthc Policy. 2023 Sep 4;16:1739-1753. doi: 10.2147/RMHP.S420899. eCollection 2023.
BACKGROUND
Cancer is a significant health concern and is China's leading cause of mortality. Targeted therapies, such as trastuzumab and rituximab, have enhanced clinical treatment efficacy. However, their high costs burden patients and healthcare systems considerably. Patient demographic factors further influence the utilization of these expensive drugs. On September 1, 2017, China implemented the National Health Insurance Coverage (NHIC) policy, necessitating additional real-world evidence to assess its impact on patients.
METHODS
Data on human epidermal growth factor receptor 2-positive breast cancer and CD20-positive non-Hodgkin B-cell lymphoma patients were gathered in Jiangsu Cancer Hospital and Fujian Cancer Hospital from September 2015 to August 2019, including demographic and clinical information. All eligible patients were divided into two groups. Univariate analysis and multivariable logistic regression were used to investigate the differences between subgroups. An interrupted time-series regression was used to examine the change in trastuzumab and rituximab utilization percentages.
RESULTS
Before and after the NHIC policy, utilization of trastuzumab increased from 61.13% to 75.10%, and the increase was statistically significant. Rituximab therapy increased statistically significantly from 64.79% to 74.88%. The key factor influencing trastuzumab and rituximab use was the NHIC policy. With policy implementation, medical insurance status, occupations, and cancer disease stage affected trastuzumab and rituximab use.
CONCLUSION
The NHIC policy is essential to the utilization of trastuzumab and rituximab, and the patient's income level and repayment abilities continue to impact the use of innovative anti-cancer drugs. Appropriate steps, such as reducing the urban-rural gap and broadening medical insurance coverage, would enable more people to access novel anti-cancer drugs.
背景
癌症是一个重大的健康问题，也是中国主要的死亡原因。曲妥珠单抗和利妥昔单抗等靶向治疗提高了临床治疗效果。然而，它们的高成本给患者和医疗系统带来了相当大的负担。患者人口统计学因素进一步影响了这些昂贵药物的使用。2017年9月1日，中国实施了国家医保覆盖（NHIC）政策，因此需要更多真实世界证据来评估其对患者的影响。
方法
收集了2015年9月至2019年8月在江苏省肿瘤医院和福建省肿瘤医院的人表皮生长因子受体2阳性乳腺癌和CD20阳性非霍奇金B细胞淋巴瘤患者的数据，包括人口统计学和临床信息。所有符合条件的患者分为两组。采用单因素分析和多变量逻辑回归研究亚组间的差异。采用中断时间序列回归分析曲妥珠单抗和利妥昔单抗使用百分比的变化。
结果
NHIC政策实施前后，曲妥珠单抗的使用率从61.13%提高到75.10%，且增幅具有统计学意义。利妥昔单抗治疗的使用率从64.79%提高到74.88%，具有统计学意义。影响曲妥珠单抗和利妥昔单抗使用的关键因素是NHIC政策。随着政策的实施，医疗保险状况、职业和癌症疾病分期影响了曲妥珠单抗和利妥昔单抗的使用。
结论
NHIC政策对曲妥珠单抗和利妥昔单抗的使用至关重要，患者的收入水平和还款能力继续影响创新抗癌药物的使用。采取适当措施，如缩小城乡差距和扩大医疗保险覆盖范围，将使更多人能够获得新型抗癌药物。
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