药品外部参考定价的参考篮子与间接参考研究

摘要

目的：对药品外部参考定价国家（地区）的参考篮子及间接参考进行研究，以为我国外部参考定价制度建设提供依据。方法：收集48个国家（地区）的外部参考篮子资料，采用t检验和Pearson分析对直接参考篮子和间接参考篮子的规模大小、高收入国家（地区）比例、同地域国家（地区）比例等情况进行描述、比较与相关性分析；同时，计算重复参考比例与间接参考次数。结果：直接参考篮子平均规模12个，以高收入国家为主。除欧洲国家外，其他国家（地区）参考同地域国家（地区）比例平均约为20％。间接参考篮子的国家（地区）个数主要为20～35个。间接参考篮子的人均国民收入低于直接参考篮子，且间接参考篮子规模扩大与直接参考篮子内高收入国家（地区）数量存在一定相关，平均重复参考比例为88.5％，平均间接参考次数为4.5次。结论：目前药品外部参考定价国家（地区）的参考篮子仍以高收入国家（地区）为主，且普遍存在间接参考现象。在构建外部参考篮子时，应注意间接参考的规模扩大和重复参考等问题。%OBJECTIVE:To provide reference for the establishment of China’s external reference pricing system for pharma-ceuticals by studying on national(local)reference basket and indirect reference. METHODS:The information for the external refer-ence baskets of 48 countries (regions) were collected from the literatures,t-test and Pearson analysis were performed for the de-scription,comparison and correlation analysis of direct and indirect reference baskets in terms of size,rate of high-income coun-tries(regions),rate of countries(regions)in the same geography,etc;meanwhile,the rate of repeated reference and quantitative index of indirect reference were calculated. RESULTS:The average size of direct reference baskets was 12,in which high-income countries(regions)formed the lion’s share. Except for European countries,countries(regions)from the same region accounted for 20% of the reference basket size. The size of most indirect reference baskets were within the range of 20-35. The national income per capita of the indirect reference basket was lower than that of direct reference basket. The increase of the indirect reference bas-ket size was modestly correlated with the proportion of high-income countries(regions)in the direct reference basket. The average rate of repeated reference was 88.5% and the average indirect reference times was 4.5 times. CONCLUSIONS:Main proportion of reference basket were high-income ones. Indirect reference was very common. Effects of the increase of indirect reference basket size as well as the repeated reference might be a concern of China on framing external reference basket.