Hong Liang, Dean of Urban Development Research Institute of Fudan University.
Shi Luwen, Head of Department of Pharmacy Management and Clinical Pharmacy, Peking University Pharmaceutical College.
Zeng Xiaofeng, Director of Rheumatology and Immunology Department of Peking Union Medical College Hospital
In the winter of 20 17, Beijing is still very cold. Yao Yuan braved the cold and went to the hospital early in the morning to queue up for registration. He suffers from ankylosing spondylitis, often suffering from backache in the middle of the night, difficult to sleep, and has symptoms of morning stiffness, which is extremely painful. Yao Yuan went back and forth for several years, tried all kinds of drugs, and almost exhausted his savings. The doctor prescribed him an expensive drug called "adalimumab". Yao Yuan said, "I tried all western medicines, but I never had the courage to hit adalimumab. I'm worried that as long as I use it, I can't stop, and the cost is beyond my ability. I want to regard it as the last line of defense. "
A course of treatment is equal to a Rolls Royce.
Yao Yuan's "last line of defense" is the "drug Lord" in the world at present. In the past five years, adalimumab has been ranked first in the global drug sales list. A foreign outlook report says that adalimumab will continue to occupy the leading position in 20 18 years, and its sales will exceed125.8 billion yuan. This has a lot to do with its high price. At present, the price of adalimumab in China is 7700 ~ 7800 yuan/tablet, two tablets are a course of treatment, and the annual treatment cost is 65438+ 10,000 ~ 200,000 yuan. But this medicine is not covered by medical insurance, and many people can only watch it. Zeng Xiaoying, director of the Department of Rheumatology and Immunology of Peking Union Medical College Hospital, often meets patients like Yao Yuan. "Sometimes I can't help some patients, not only because of the disease itself, but also because of economic problems."
In the pharmaceutical industry, the price in adalimumab has been regarded as "close to the people". In the list of the world's most expensive drugs from 2065438 to 2007 given by American family doctor think tank, the top five drugs are aripotine, phenylbutyrate, brucella, glutamine and α-glucosidase. The top Alipogin is used to treat apolipoprotein lipase deficiency. A course of treatment is about 7.62 million yuan, enough to buy a Rolls-Royce car. Even the tenth-ranked gold monoclonal antibody costs as much as 2.9 million yuan per year.
How complicated the human body is, how complicated the disease is. At present, there are more than 7000 rare diseases diagnosed in the world, accounting for 10% of human diseases. Most of the most expensive medicines in the world are medicines for treating rare diseases. They are called "orphan drugs", including adalimumab and Alipotin. In addition, some drugs for treating major diseases such as cancer are not cheap. For example, Iressa, a targeted drug for lung cancer treatment, costs more than 500 yuan per tablet; Gleevec for treating leukemia costs about 23,500 yuan a month. Although it is reduced to 72,000 yuan a year through relevant preferential measures, it is still a huge burden for most patients. Lenalidomide, a drug used in the United States to treat multiple myeloma, costs nearly 59,000 yuan (25 mg, 2 1 pill) per box, and more than 700,000 yuan a year, which is not affordable for most patients.
Many factors of expensive drugs.
Why is a small pill expensive? Shi Luwen, director of the Department of Pharmacy Administration and Clinical Pharmacy of Peking University Pharmaceutical College, said: "Pharmaceutical factories are not charitable organizations, and only on the premise of ensuring profits can they have enough motivation to invest in R&D and promotion. Some drugs are expensive because of the adjustment of market mechanism. Generally, it is necessary to comprehensively consider various factors such as research and development costs, market capacity, and profit recovery time. "
Monopoly of protection period. In order to encourage pharmaceutical companies to actively research and develop and ensure the recovery cost, drugs have a patent protection period, generally 20 years. In the meantime, unless there are special circumstances, other pharmaceutical companies may not copy them. This will inevitably lead to the monopoly of drug pricing.
Research and development costs are high. There is a wonderful question and answer on the Internet, which vividly illustrates this point: "The cost of a pill is only 5 cents. Why sell 500 yuan? " "Because you bought the second one, the cost of the first one is 5 billion." Developing new drugs requires a lot of resources. From the preliminary drug experiment to the third phase clinical research, it takes an average of more than ten years and costs several billion yuan, while the success rate of new drugs is only 1/4000. In other words, much of the money spent by pharmaceutical companies has gone to Shui Piao. Take Novartis Pharmaceutical as an example. During the period of 1997-20 1 1, the total R&D expenditure was $83.6 billion, and finally 2 1 new drugs were approved for marketing, with an average R&D expenditure of $4 billion per new drug. However, not every new drug sells well, and if it is priced according to the average R&D cost, there will be a risk of loss. In order to understand the pricing strategy of common expensive drugs such as Gleevec and Iressa, the reporter called the relevant responsible persons of Novartis Pharmaceutical and AstraZeneca, but both parties said it was inconvenient to disclose.
Small market capacity. Take the orphan drug aripotine as an example, the prevalence rate of its indications is only one in a million, so the market capacity of this drug in the EU is only 150 ~ 200 people. In order to maintain profits, the price must be high, but so far, only one patient has been treated.
People have many questions about "expensive"
For many cancer patients, "surviving" is their most important goal, so as long as I hear that there are new drugs on the market, or that some drugs are good for my condition, even if the price is very expensive, many people will use them through overseas purchasing and purchasing generic drugs. But patients' doubts about expensive drugs always exist. After interviewing and browsing a number of "cancer friends", the reporter found that the following two typical cases are more common among patients:
Mr. Wang, a lung cancer patient, said that even if foreign pharmaceutical companies invest a lot of money in research and development, why is the price of the same drug in the United States only 1/4 in China? Does this mean that the price of imported drugs will be raised at will when they arrive in China?
A senior media person said in an interview with reporters: "There are two cancer patients around me, one of whom lived for more than a year without taking expensive targeted drugs; The other spent more than 100,000 yuan to buy Iressa to eat, and ended up staying for more than a year. I seriously doubt the effectiveness of expensive drugs in treating diseases. Is it true that large pharmaceutical companies use the aura of scientific research to exaggerate the efficacy and conduct commercial marketing? "
Of course, some patients expressed their understanding and recognition of your medicine. Ms. Liu from Shanghai posted a message: "My wife has a gastric stromal tumor. In the past, this disease had to wait for death. Now she has a specific medicine, more than 20 thousand a month. My wife insisted on taking it for two years and is still with me now. Although medical insurance can be reimbursed in part, the self-funded part is still very expensive, and our savings will not last long. "
Regarding patients' questions, Hong Liang, Dean of Urban Development Research Institute of Fudan University, explained that the pricing mechanism of drugs is very complicated, and different countries have different strategies. China, the United States and other big countries often set their own prices independently, so there is not much comparability. Some drugs are "sky-high" in China and may be lower in the United States, while others are just the opposite.
Regarding whether expensive medicine is equal to good medicine, Zeng Xiaofeng emphasized that the curative effect cannot be simply measured by price. It is undeniable that with the advent of some new drugs, the survival time of some serious diseases, especially cancer patients, has been greatly improved. For example, Iressa prolonged the median survival time of patients with advanced lung cancer from 14. 1 month to 33.5 months, and increased the five-year survival rate from 8% to 18%. Zeng Xiaoyu said that drugs cannot be guaranteed, and the key to good or bad curative effect depends on whether it is symptomatic. From a few cents of aspirin to 10,000 yuan of "stem cell injection", as long as it is used correctly, it is a good medicine.
When pharmaceutical companies submit applications for new drugs to the regulatory authorities, they must strictly carry out research and phase III clinical trials, and submit data and information at each step. The requirements are extremely strict, and the curative effect cannot be exaggerated.
The state actively intervenes.
Zhan, an academician of China Academy of Engineering and director of Peking University Health Science Center, said: "Among the 44 million poor people in China, 50% are poor due to illness or return to poverty due to illness." Therefore, China's "Thirteenth Five-Year Plan" precision poverty alleviation lists "reducing poverty caused by illness and returning to poverty due to illness" as the main content.
With a huge population base in China, many rare diseases are not uncommon. In 20 16 years, there are about16.8 million patients with rare diseases in China. Shi Luwen appealed that * * * should actively intervene, include drugs for rare diseases in medical insurance, introduce relevant preferential policies and protective measures, and compensate pharmaceutical companies and hospitals to ensure that patients will not fall into a medication crisis due to "market mechanism failure".
Pharmaceutical companies can learn from foreign practices when pricing. Hong Liang introduced that in Britain and Australia, the pricing of essential drugs is negotiated by the state and pharmaceutical companies, which can stabilize the price to a certain extent; In Italy, once many anticancer drugs fail to achieve the expected clinical effect, pharmaceutical companies will compensate patients for part or all of the drug costs; Some European pharmaceutical companies also support installment payment. Patients need to pay a certain amount of advance payment in the first year of treatment. If the treatment is still effective after 20 years, the cost of treatment will be supplemented.
Schluwen added that many old drugs are not necessarily worse than new ones. When an old drug loses or is about to lose its patent protection, the pharmaceutical company will slightly change its molecular formula, rename it and market it as a new drug. Its curative effect is not much better than the old medicine, but its price is many times more expensive. Patients are advised to consider more when choosing. In addition, generic drugs are cheap and have little difference in efficacy, which is also a good choice. For example, there is a generic drug of Gleevec in India, and the price is about110 of the patented drug.
If you master technology, you can be out of control of others.
"Today's China is not a medical power, but a big country in disease prevention and control." According to Zhan, among western medicines in China, 95% of the earliest intellectual property rights are foreign, and less than 5% are completely original in China. In particular, the research and development of orphan drugs in China is in its infancy, and the research and development results are still blank. Many patients need to rely on expensive imported drugs. Once foreign pharmaceutical companies withdraw from the China market, there will be no medicine for patients.
Wu Peixin, deputy director of the Science and Education Department of the National Health and Family Planning Commission, was deeply touched by this: "Only scientific and technological innovation can occupy the high-end position of the health industry value chain; Only technological innovation can enable the industry to create high-quality profits and benefits. " Independent research and development is of great significance for safeguarding national security and strategic interests. Wu Peixin cited an example. In 2005, a concentrated epidemic of H7N9 influenza A occurred in China. In order to prevent a large-scale outbreak, 500,000 people are in urgent need of patented flu drugs. However, foreign pharmaceutical companies replied that all products would not be shipped until 2008 due to multi-country queuing. Wu Peixin said: "We can't buy it or use it at the critical time. We can only rely on technological innovation. " Soon, China established the world's largest production line for influenza-specific drugs. When the flu broke out again in 2009, it took China less than three months to complete the reserve of 2.6 million people. "Only by mastering the core technology can we not be subject to people."
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