Walley T, Barton S
Department of Pharmacology and Therapeutics, University of Liverpool.
BMJ. 1995 Sep 23;311(7008):796-9. doi: 10.1136/bmj.311.7008.796.
Many new drugs in the future will be very expensive and have major resource implications. Given current structures and legislation covering the prescribing of drugs, there are no clear means of controlling the use of these drugs to avoid diverting money away from other health care services and into drug treatment. This paper considers what mechanisms might be used by a purchaser to manage the introduction of an expensive new drug and uses interferon beta-1b for treating multiple sclerosis as an example. The most likely mechanism is the prescribing of the drug by a general practitioner on the advice of a neurologist. This would achieve a good benefit for the resources invested but would not control total expenditure. Devolving a limited budget for the drug to a specialist centre so that neurologists may prescribe it directly would be preferable, as this would link clinical, prescribing, and budgetary responsibility. These issues need to be addressed urgently by purchasers if major disruptions of services are to be avoided.
未来许多新药将会非常昂贵，并且会对资源产生重大影响。鉴于目前涵盖药物处方的结构和立法，尚无明确方法来控制这些药物的使用，以避免资金从其他医疗服务领域转移到药物治疗上。本文探讨了采购方可能会采用哪些机制来管理昂贵新药的引入，并以干扰素β-1b治疗多发性硬化症为例进行分析。最有可能的机制是全科医生根据神经科医生的建议开具该药物。这将为投入的资源带来良好效益，但无法控制总支出。将有限的药物预算下拨给专科中心，以便神经科医生可以直接开具处方，这种方式会更好，因为这将临床、处方和预算责任联系起来。如果要避免服务受到重大干扰，采购方需要紧急解决这些问题。
