The difference between low-priced drugs and basic drugs
1. 1 Drugs are internationally recognized as special commodities, and the management of drugs in all countries in the world is stricter than that of general commodities. In order to facilitate management, drugs are usually divided into different categories according to different standards, such as patented drugs and generic drugs, prescription drugs and over-the-counter drugs. In the practice of drug price management in China, the National Development and Reform Commission divides drugs into low-priced drugs and non-low-priced drugs according to the average daily cost.
According to the National Development and Reform Commission's Notice on Improving the Price Management of Low-priced Drugs * * 856 [20 14] * *, it can be seen that the daily average cost standard of low-priced drugs at this stage is: western medicine does not exceed 3 yuan, and Chinese patent medicine does not exceed 5 yuan. Based on this, the National Development and Reform Commission took the lead in canceling the maximum retail price limit for low-priced drugs before canceling the pricing or maximum retail price limit for most drugs, allowing producers and operators to set specific purchase and sale prices according to production costs, market supply and demand and competition within the daily average cost standard. In addition, there are related documents suggesting that medical institutions and medical personnel should be mobilized to actively save costs, give priority to the use of low-priced drugs, and promote the clinical use of low-priced drugs.
1.2 essential drug system: concept and framework
Since its birth 30 years ago, the WHO List of Essential Drugs has been widely recognized. Among the 193 member countries of WHO, 156 countries have drawn up daily lists of essential drugs, and some of them have also drawn up provincial or national lists of essential drugs. Many international organizations such as UNICEF and non-international organizations have adopted the concept of essential drugs, and professional organizations such as the International Federation of Red Cross and Red Crescent Societies, the British Pharmaceutical Society and the International Pharmaceutical Union have also provided drugs according to the WHO Catalogue of Essential Drugs, which has played an important guiding role in drug procurement and supply, medical insurance reimbursement, drug donation and production. In 2002, the concept of essential drugs developed greatly. Essential drugs are "drugs that can meet people's basic health needs and are selected according to the present situation, effectiveness and safety of public health and the evidence of cost-benefit comparison." It has sufficient quantities and suitable dosage forms at any time, and its price is affordable for individuals and communities. " This concept emphasizes the principle of evidence-based selection of essential drugs, making the selection process more transparent, fair and scientific. At the same time, in order to express essential drugs more accurately, WHO changed essential drugs into essential drugs.
The highest goal of drug use is rational drug use. As early as the 20th century, the World Health Organization * * * WHO * * gave an easy-to-understand definition of rational drug use-safe, effective, economical and appropriate use of drugs. Therefore, rational drug use includes four key elements: safety, effectiveness, economy and appropriateness, which are indispensable. At the same time, rationality is a dynamic concept, and the connotations and requirements of these four elements change with the progress of medical science and technology. Among the four elements, the connotation of economy has long been ignored, misread or not widely and correctly understood. Economy refers to the ratio of the drug effect obtained to the input cost, and the focus of economy is the total cost * * * expense * * and the total result, not the simple drug price.
Drug prices are closely related to drug costs or expenses, but low drug prices do not mean low drug costs or expenses, while high drug prices do not necessarily mean high drug costs or expenses. It can be seen that simple drugs with low prices are doomed to be uneconomical. The essential difference between low-priced drugs and non-low-priced drugs lies in "low price", so low-priced drugs are doomed not to be the most scientific and reasonable clinical first choice.
Low-priced drugs have become the first choice in clinic.
Under what circumstances are low-priced drugs the most scientific and reasonable clinical first choice? As far as the elements of rational drug use are concerned, there are usually two situations: first, compared with other alternative drugs, the safety, effectiveness and suitability are equivalent, and the cost of using low-priced drugs is lower than that of using other alternative drugs, so the economy of using low-priced drugs is better than that of using other alternative drugs, that is, low-priced drugs should be the first choice in clinic; Two, compared with other alternative drugs, the use of other alternative drugs in one or more aspects of safety, effectiveness and suitability is better than low-cost drugs, but its cost * * * is higher than the use of low-cost drugs * * * *. At this time, if the cost or expenditure of using other alternative drugs is * * * compared with the safety and effectiveness obtained. However, if the cost of using other alternative drugs is worthwhile, then the low-priced drugs are not as economical as other alternative drugs. At this time, low-priced drugs are not necessarily the first choice in clinic.
For example, suppose there are three kinds of drugs for treating influenza, A*** Radix Isatidis * * * and B*** *, which are all conventional therapies for symptomatic treatment. For example, Novocontech * * * and C*** new neuraminidase inhibitors, such as oseltamivir * * *, are all listed drugs that meet the effectiveness and safety standards of the national drug supervision and administration department, and the total cost of the three drugs includes hanging.
The check-up fee was paid in 280 yuan, 570 yuan and 780 yuan respectively, and its curative effect was 3 days, 5 days and 6 days, respectively, compared with placebo. Assuming that each remission day represents a unit utility, drug B is 1.7 times that of A, but its cost is twice that of A; The curative effect of drug C is 1.2 times that of drug B, but its cost is 1.4 times that of drug B.
If the basic drug is selected according to the standards of safety, effectiveness and cheapness, then the drug A should be selected as the basic drug, because the absolute utility of A is low, and the basic drug A*** can only get a lower price in the market. The consumer * * * or the payer * * * is deciding, "Is this drug worth buying?" When considering, it is not the cost-effectiveness ratio of drugs, but the "incremental cost-effectiveness ratio". That is, the effect of one more unit, how much does the patient have to pay? Of course, consumers with higher incomes are more likely to choose drugs with higher absolute utility and higher cost, but the above analysis shows that consumers with different income levels should choose different grades of drugs from the perspective of efficiency. But from a fair point of view, * * * has the responsibility to help the poor people get basic drugs through various measures, because basic drugs are the most cost-effective and the lowest cost, and the club can afford them. It is worth noting that the choice of essential drugs is related to the socio-economic level. In a relatively developed society, drug A will be eliminated and drug B will become the basic drug, which shows that the basic drugs are relative.
In the above two cases, the first case is simple and easy to understand, and the key is how to judge whether the extra cost of using other alternative drugs is worthwhile compared with the advantages of safety, effectiveness and appropriateness. It is impossible to judge whether the extra cost of using other alternative drugs is worthwhile only by using relevant standards and measures. Theory and practice have proved that the judgment of "whether it is worthwhile" can be realized through pharmacoeconomic evaluation.
Pharmacoeconomic evaluation can provide basis for clinical medication.
The costs and benefits that need to be determined and measured in pharmacoeconomic evaluation fully consider the safety and effectiveness of drug schemes, including adverse reactions, compliance, dosage forms and many other factors. Therefore, the evaluation results of pharmacoeconomics can provide scientific basis for the selection of essential drugs, the determination of reimbursement drug list, the centralized procurement of drugs and the selection of clinical drugs. Therefore, it is expected to realize scientific and reasonable judgment and selection of low-priced drugs.
To sum up, low-priced drugs should not be the first choice of clinical drugs just because of their low prices, and whether they should be the first choice of clinical drugs needs pharmacoeconomic evaluation to provide the basis. It is worth mentioning that the evaluation conclusion of pharmacoeconomics can provide the basis of economic advantages and disadvantages between drug-related intervention programs for relevant decisions, rather than the only basis for final decisions.
The problem of low-priced drugs
The price of drugs is determined by manufacturers, which is often too high, leaving room for kickbacks in all aspects. Xie Hong said. It is understood that GlaxoSmithKline executives involved in the case admit that "operating costs" account for one-third of the drug price; According to the medical representative who was investigated in Zhangzhou, Fujian, "In the proportion of drug prices, the cost price is often less than 20%."
High drug prices have increased the burden on the people. Is low drug price a good thing? Xie Hong said that at present, the prices of some essential drugs are "artificially depressed", which actually harms the interests of patients.
In 2009, the National Development and Reform Commission and other nine ministries and commissions issued the "Implementation Opinions on Establishing the National Essential Drug System". The National Development and Reform Commission sets the national retail guidance price of essential drugs, and reduces unreasonable marketing expenses on the basis of maintaining the reasonable profits of production enterprises. This move aims to "open the knife" to some drugs with inflated prices in the pharmaceutical market.
"The basic drug system has reduced the burden of patients' medication, but it should be noted that some basic drugs have disappeared and pharmaceutical companies are no longer supplying them. "Xie Hong said that due to the unified bidding of * * *, many pharmaceutical companies kept their prices very low in order to compete. However, after winning the bid, some stopped supplying because the profit was too low, while others reduced the cost, and some * * * behaviors appeared, which harmed the interests of patients.
Ren Wuxian said that the basic drug system really benefited the people. And * * * procurement bidding is "the lowest price wins", blindly paying attention to low prices without considering high quality, squeezing out the real medicine.
Jia Aiqin, deputy to the National People's Congress and president of the Fourth People's Hospital of Linfen City, also said that the profits of essential drugs are thin and enterprises are unwilling to produce them, resulting in an embarrassing situation in which patients are eager to use drugs but cannot find them. Cheap drugs such as tabazole and salbutamol are hard to buy. "Some manufacturers have slightly changed the formula of these drugs, changed their names, changed their faces, and entered the market with new drugs, and the price may have doubled."
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