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| 我国不同地区阿片类镇痛药物在癌痛治疗中的使用情况及个人经济负担 |
| Utilization and Patient Affordability of Opioid Analgesics for Cancer Pain Treatment in Different Regions of China |
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| DOI： |
| 中文关键词: 阿片类镇痛药 癌痛 使用强度 限定日费用 地区差异 药物利用 |
| 英文关键词:Opioid analgesics Cancer Pain Drug utilization Economic burden Geographic Variation |
| 基金项目:北京协和医学院教育基金项目(编号：1002320170241) |
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| 中文摘要: |
| 摘 要 目的：了解我国不同地区阿片类镇痛药的使用情况与趋势，评估癌痛治疗吗啡临床需要量及满足临床需要的程度，评价个人药费可负担性，为我国合理使用阿片类镇痛药，提高癌痛控制水平和患者生活质量提出政策建议。方法：采用回顾性分析方法，分析2006~2016年我国7个片区的阿片类镇痛药使用强度（MUD）及其各阶段年复合增长率（CAGR）。基于我国7个片区肿瘤登记数据和国际疼痛标准治疗指南，测算2015年不同地区的吗啡需要量。将药品价格以DDD值标化为限定日费用(DDC)，采用改进后的WHO/HAI标准调查法评价阿片类镇痛药用于癌痛治疗的个人药费可负担性。结果：全国MUD从2006年的1.45DDD/10万人天增长至2016年的6.93DDD/10万人天，整体增长率呈现为前高后低。不同地区间MUD差异较大，且MUD极差有逐年加大趋势。2016年MUD最大地区为华南（9.67DDD/10万人天），最小为西北（3.28DDD/10万人天）。2015年，全国吗啡等效当量实际使用量仅占癌痛治疗吗啡需要量的21.5%，华东（26%）和华南（36%）等地区高于西南（11%）和西北（12%）。各类阿片类镇痛药的DDC范围为10.80～848.88元，除吗啡注射剂外，其余药品的疗程自付费用均大于1 d的日均可支配收入。结论：我国阿片类镇痛药用于癌痛治疗整体使用不足，且不同经济水平的地区使用差异较大，癌痛患者长期使用镇痛药物治疗的个人药费负担较重。应全面加快推行癌痛规范化治疗示范病房和疼痛门诊，完善相应保障体系，合理引导广大城乡居民可负担的癌痛治疗药品价格，降低个人费用负担，提高癌症患者生存质量，使更多癌痛患者得到经济有效的治疗。 |
| 英文摘要: |
| ABSTRACT Objective: This study aims to learn the level and trend of opioid analgesics use in different regions of China, as well as the utilization and patient affordability of opioid analgesics for cancer pain treatment. Methods: The study used a retrospective method to analyze the utilization of opioid analgesics in Morphine Use Density (MUD, daily defined doses of morphine used per 100 000 population) and its growth rate from 2006 to 2016 in China and in its 7 regions. Regional needs of opioid analgesics (in morphine equivalents) for cancer pain treatment were measured based on regional cancer registration data and standard treatment course as defined by the international treatment guidelines for cancer pain. The study adopts WHO/HAI method to evaluate the patient affordability of opioid analgesics for cancer pain treatment with the standardized prices (DDC, cost of daily defined doses). Results: The national MUD increased from 1.45 DDDs/100 000/day in 2006 to 6.93 DDD/100 000/day in 2016, with a higher growth rate in early years and lower growth rate in the last 6 years. Southern China had the largest MUD in 2016 (9.67 DDD/100 000/day), Northwest China had the lowest MUD (3.28 DDD/100 000/day). The actual use of morphine equivalents accounted for only 21.5% of the needs of morphine for cancer pain treatment, which was 26% in the Eastern China, 36% in the Southern China, 11% in the Southwest and 12% in the Northwest. The DDC of all studied opioid analgesics ranged from CNY 10.80 to 848.88. Except morphine injection, the out of pocket payments for the standard treatment course of all other opioid analgesics were more than one daily disposable income of all regions of China. Conclusion:The opioid analgesics use for the treatment of cancer pain were insufficient in China, which varies largely in different regions with different economic development. Long term use may lead heavy economic burden to the cancer patients. All these findings call for actions to strengthen the cancer pain treatment and care, and to relief the patient affordability. |
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