管欣 王璐颖 李洪超

中图分类号 R956 文献标志码 A 文章编号 1001-0408（2021）18-2242-06

DOI 10.6039/j.issn.1001-0408.2021.18.11

摘 要 目的：为今后开展相关药物经济学评价提供参考和借鉴。方法：通过4个药物经济学评价典型案例展示可能出现“免费仍不经济”的特殊情况，定义“净价值”的概念来协助进行理论分析，并归纳导致这种情况的可能原因。结果与结论：目标药物之外的背景治疗成本过高、患者存活期间生命质量过低、增量成本-效果比的意愿支付阈值过低、延长生存期间风险事件的成本过高或者健康损失过高以及对照方案价格过低等都有可能影响经济性评价的结果，甚至出现“免费仍不经济”的药物经济学评价困境。药物经济学评价讨论的是干预方案的經济性而非药物的经济性问题，对于存在多种原因所导致的不经济的结果，需要客观看待;从理论上来说，药物经济学评价中应当将所有“相关”和“不相关”的成本都纳入计算范畴;药物经济学主要解决的是若干治疗方案之间“性价比”问题，而医疗卫生领域常常还需要面对伦理和公平性等问题，故研究者可能需要跳出药物经济学分析的框架，从更高、更广的角度进行深入讨论。

关键词 药物经济学;免费仍不经济;背景治疗;成本;原因分析

Cause Analysis of “Not Cost-effective at a Zero Price” Results in Pharmacoeconomic Evaluation

GUAN Xin1，2，WANG Luying1，2，LI Hongchao1，2（1. School of International Pharmaceutical Business， China Pharmaceutical University， Nanjing 211198， China; 2. Pharmacoeconomic Evaluation Research Center， China Pharmaceutical University， Nanjing 211198， China）

ABSTRACT   OBJECTIVE： To provide reference for the future pharmacoeconomic evaluation. METHODS： Four typical cases of pharmacoeconomic evaluation showed the special situation that “not cost-effective at a zero price”， defined the concept of “net value” to assist in theoretical analysis， and summarized the possible causes of this situation. RESULTS & CONCLUSIONS： The background treatment cost other than the target drug was too high， the patients quality of life during survival was too low， the threshold of willingness to pay of incremental cost-effectiveness ratio was too low， the cost of risk events during extended survival was too high or the health loss was too high， and the price of the control scheme was too low， which might affect the results of economic evaluation， and even led to the dilemma of pharmacoeconomic evaluation of “not cost-effective at a zero price”. Pharmacoeconomic evaluation discusses the economy of intervention programs rather than the economy of drugs. The uneconomic results caused by various reasons need to be treated objectively; theoretically， all “relevant” and “irrelevant” costs should be included in the calculation category in pharmacoeconomic evaluation; pharmacoeconomics mainly solves the problem of “cost performance” comparison among several treatment schemes， and the medical and health field often needs to face problems such as ethics and fairness. Therefore， researchers may need to jump out of the framework of pharmacoeconomics analysis and conduct in-depth discussion from a higher and broader perspective.

KEYWORDS   Pharmacoeconomics; Not cost-effective at a zero price; Background therapy; Cost; Cause analysis

自2016年人力资源和社会保障部发布《2016年国家基本医疗保险、工伤保险和生育保险药品目录调整工作方案》以来，药物经济学评价证据作为价格测算的一项重要科学依据，开始被逐步应用于我国医保药品目录调整过程中[1-2]。……