In the field of tumors, how to allocate limited resources at high efficiency?

In recent years, with the development of my country's economic development, meeting the growing multi -level and diversified health needs of the people has become the key point of the reform of the medical system. With the strong support of a series of medical policies, the approval of drug research and development and listing accelerated, and the innovative pharmaceutical industry has developed vigorously in recent years. In 2021, the number of innovative drugs approved in my country has reached a record high. After more innovative drugs are listed, the prices of innovative drugs, especially in the fields of anti -tumor and rare diseases, make most patients be out of reach. The accessibility and burden of drugs have become the difficulty of reform of the new medical system.

In order to solve the problem of payment of drugs, in recent years, the national medical insurance department has actively carried out medical insurance negotiations for innovative drugs. It is committed to patients as the center, increasing the accessibility of high -value drugs and consumables, and improving the level of clinical diagnosis and treatment. Enterprises actively carry out projects such as patient assistance and innovative payment to reduce the burden on patients. The use of the evaluation tools of health economics to carry out the multi -dimensional evaluation of the clinical value of drugs, which is also one of the important basis for the government to conduct medical insurance catalog selection and drug economics calculation. What role of this discipline tools plays in it and how to play a role? Recently, a reporter from the "Medical Daily" specifically interviewed Zhou Jifang, an associate professor of China University of Pharmacy, an associate professor of the University of Pharmacy for health economics and pharmaceutical epidemiology.

Health economics set up "relatively effective"

The "bridge" between "limited resources"

Health Economics, a cross -disciplinary discipline of sanitation and economics, is the core problem of concern to solve the problem of high -efficiency distribution of limited sanitary resources. The main purpose of the research of health economics is to improve the efficiency of health resources, thereby helping stakeholders to choose more reasonable and more efficient solutions for the use of resources. This is also the basic core concept of health economics assessment.

Taking HER2 -positive breast cancer as an example, patients have benefited from anti -HER2 targeted therapy in the past two decades. Evidence -based medical evidence has proved that the scheme can greatly improve the prognosis of patients and get longer survival. The opportunity to obtain long -term control through standard treatment is the conclusions that have been verified by rigorous clinical research. So what important conclusions can we get from the perspective of health economics? Professor Zhou pointed out that, in fact, the evaluation of the survival status of tumor patients in health economics is also an important epidemiological indicator for evaluating tumor treatment. We can quantitative assessment of the causes of death and death risk through epidemiological data. For example, for HER2 positive early breast cancer patients, after treatment (targeted therapy), the analysis of epidemiological diseases shows that the most important cause of early breast cancer patients in Western countries is no longer the recurrence of breast cancer, but has become cardiovascular disease At the same time, the overall risk of these patients is close to the normal population. As a result, the tumors were well controlled after using this scheme.

How to understand the conclusion of the risk of death from "normal crowd"? Professor Zhou further explained that from the theoretical analysis of health economics, if people with tumors and people who do not have tumors have compared the survival rate, at the same time corrected other factors to obtain excess mortality or risk of death for patients with tumor patients. The risk of the background death of the normal crowd is believed that the tumor problems of these patients are no longer the first risk factor that leads to their death.

The perspective of health economics studies from the perspective of reasonable allocation of sanitary resources, and more comprehensively evaluate the clinical comprehensive value of different treatment methods, including traditional effectiveness and security, as well as the value of economy (cost and benefits). Based on this resource allocation of different therapeutic modes, so that patients can achieve the greatest health benefit. Therefore, from the perspective of health economics, we can conclude that early HER2 -positive breast cancer patients have obtained long -term stability control of the disease in the early diagnosis, early intervention and sufficient dose of standardization. Some patients returned to society and participated in normal work, study and entertainment. It also has long -term significance and value to the development of society, which can largely increase the output of limited sanitary resources at the health level.

The analysis of health economics can also provide evidence of medical insurance to consider the significance of medical insurance decision -making. A recent real world study found that after a series of national medical insurance policies were launched, the targeted drugs of early breast cancer patients in my country have further improved. From the perspective of health economics, my country is facing the contradiction between the many patients with tumor patients and the ability to pay in developing countries. Thanks to the country's purchase, the Chinese government can integrate the domestic market as a "strategic buyer" and use a strong administrative administration with a strong administrative administration Organizational capabilities and innovative pharmaceutical companies carry out price negotiations. Compared to the lower cost of reaching similar health output, the use of limited health budgets is very efficient.

Health economics is an applied science that focuses on empirical

It is also an effective tool for auxiliary decisions

In the process of implementing medical reform, decision -making risks under information uncertainty, including political and financial risk management, have attracted more attention. How to use professional tools to balance the opinions and stances of all parties, bridge the demands of different stakeholders, and finally obtain consensus as much as possible, which is also the research field of health economics. In health economics, two "tools" have to mention. First, the health technology evaluation (HTA), which, this evaluation method is widely used in various countries and administrative institutions, to determine a certain health technology, including medicines, including medicines , Medical equipment or a certain electronic health product enters the formal process under the policy framework covered by the government; second, the multi -dimensional decision -making analysis mechanism (MCDA) is a mechanism to help decision makers weigh between different dimensions between different dimensions. From a relatively scientific perspective to demonstrate the rationality and economy of medical technology, take into account macro and micro, and facilitate the rapid and efficient advancement of decision -making. These two methods can effectively integrate the perspectives and positions of all parties, and seek a win -win optimization decision -making analysis of multiple parties. It can help the government demonstrate the rationality and economy of a certain medical technology from a scientific perspective. Europe's more popular policy tools. It was applied in the practice of medical insurance negotiations in the past and has also achieved good results. From the perspective of economics, a comprehensive evaluation of a certain treatment method than other treatment methods, the safety and economy of patients' health benefits can better make as effective, scientific, rigorous as possible under the premise of limited resource budgets Decisions.

Nevertheless, the use of tools for the evaluation of health economics is still controversial, especially for quantitative assessment patients to re -obtain labor ability to evaluate the long -term health value of these therapies after treatment. Because the reference tool is suspected of materializing the patient, it may underestimate the health benefits of patients in psychological health and social functions. The ability to entertain patients to entertain again and enjoy family life is also reflecting the health concept of "people -oriented", and transforming the health value of this area into the cost of a certain economy will inevitably cause controversy. Professor Zhou believes that on the one hand, better tools need to be used to evaluate the description of patients in different health values; second, the society requires a greater extent to discuss values ​​and form consensus from all walks of life. However, health economics does not replace the government for decision -making, but provides the best evidence synthesis at the time of government decision -making to help decision makers make a decision that meets the interests of all aspects more quickly and accurately.

Health economics focuses on the relative positioning of value and price

Both "rigidity" and "temperature"

In the past, we have always focused on drug prices. The "soul bargaining" in national medical insurance negotiations has often become a hot topic for media attention. From an economic point of view, prices are not equal to value. The price is how much money can be paid. Value refers to how much money is willing to buy, the price is floating on the surface, and the value is a deeper consideration.

Professor Zhou believes that it is meaningless to pay attention to the actual validity and safety of drugs if you only pay attention to drug prices and separate the actual validity, safety and other dimensions. For example, if some drugs are harmful to some people, even if this drug is free of charge, we will not accept it because the result is negative healthy output.

Therefore, the development of medical insurance to "value payment" is also a hot topic recently. In fact, from this year's national medical insurance drug catalog adjustment plan, it can be seen that the state has invested a lot of attention to rare diseases, children's medication, and tumor innovation drugs, which reflects that my country's medical insurance is more concerned about serious harm to the people of our country. In the field of healthy treatment, "don't let everyone go behind." Many times, from the perspective of health economics, it is reasonable and acceptable to not only focus on how much price falls to. Is it more important to pay more attention to the health output that the drug can bring with it? People have a sense of "gain". After the analysis of health technology assessment and multi -dimensional decision -making mechanism tools, a more fair price is formulated. Even if the price is relatively high, as long as this drug can have sufficient healthy output for society and patients, we should also acknowledge that health economics The rationality of fair prices under evaluation.

Health economics evaluation cannot be inverted upside down

In the field of breast cancer new drugs, as the development of new drugs has continued to grow, everyone is paying attention to the progress of new therapy and new drug research and development, but ignores very important issues: for the group of breast cancer patients in China, lack of detailed epidemiology physics Data to evaluate the burden on the disease; lacks the impact of breast cancer from the perspective of patients' psychology, physiological and social functions; and lack of qualitative and quantitative comparisons such as different breast cancer intervention modes, treatment effects, and adverse reactions.

At present, epidemiology only pays attention to the treatment effect of the crowd level, but each breast cancer patient is a diverse, complex, and heterogeneous group. For example, a patient in her 80s, her primary concern, is no longer extending the degree of life, and she also hopes to receive a lower adverse reaction rate in a soothing situation and less conflict with other combined disease treatment. For young breast cancer patients who do not reach menopause, because patients have a longer life expectancy, patients are willing to accept more aggressive, but the long -term effect is better. They pay more attention to whether the treatment of breast cancer affects fertility, the effects of breast -keeping and breast cutting surgery on prognosis, as well as breast reconstruction surgery. If the long -term and in -depth study of different patients of patients is lacking, it is actually difficult for health economics to play a role. Especially after the new drug enters the market, if the pricing of the drug cannot truly reflect the comprehensive clinical value of the drug, if the price of the drug's price discovery mechanism cannot be dynamically adjusted based on the changes in the competition pattern in the treatment field, if the media, medical institutions and patients are only from simple, Financially emphasizes the price reduction and ignores the actual value of the drug, then discussions on medical insurance policies will actually lose focus. Therefore, it can better describe the distribution and treatment preferences of patients with breast cancer, which can better reduce the uncertainty of the quantitative assessment of the financial risk quantitative financial risk after entering the market.

Through real -world research, better evaluate the treatment effects of different Asian groups, different intervention models and different diseases, and can better help the precise prevention and control of breast cancer, optimize individualized and precise medical care, and at the same time can accelerate the low -value medical model. The speed of mainstream breast cancer treatment schemes improve the efficiency of limited medical resources.

We know that the study of epidemiology is always inseparable from a lot of data. Although the base of patients with breast cancer in my country is large, it lacks real data, especially long -term follow -up data and high -quality integrated clinical data. This is not matched with my country's huge breast cancer groups and huge breast cancer medical expenditures. Compared with Western countries, many data are still difficult to obtain in China. Multi -centered specialties databases based on hospital electronic medical records are important development directions, including key information of disease molecular biology information, pathological information, clinical diagnosis and treatment records, and are the key to breast cancer drug research and development and market access. The future research direction should be focused on the construction of a database database of multi -source, multi -mode state, not only assessing the prognosis of patients, but also in the long -term follow -up process. According to the status and the ending of the patient's survival report, because the current data collection on this level is lacking, for the drug value of the comprehensive system, these indicators are the important basis for the benefit or risk of the patient's benefits or risks. Important reference. Based on the existing optimal data, the breast cancer database compared with China and the United States and other countries and regions, it also helps us to better find the shortcomings in the current treatment field and how to improve the update and improvement of the comprehensive prevention plan of breast cancer. Applying data to medical insurance decisions, helping us out of the pharmaceutical field, and pay more attention to the whole life cycle treatment of patients in the field of disease treatment.

The purpose of medical security is to concentrate the common funds of the whole society to help individuals in need. From the perspective of risk probability, everyone is a contributor and a potential beneficiary. Health economics is not simply helping medical insurance to save money, but to help it put money more efficiently to maximize health. This is the significance of social security, and it is also the embodiment of social fairness and basic guarantee. How to choose to maximize the efficiency of health economics, and this efficiency not only refers to the efficiency of health, but also pays great attention to whether the distribution of the people is fair. People with a low level of education. Medical insurance does not mean "bargaining" in the general sense, because medical services and drug consumables are not ordinary goods. We are more concerned about using the same budget, but let these money be promoted to the healthy level of health, efficient and fairness through the efficient use of the medical field and to promote the entire society. This is what we often call social fairness, social justice, common prosperity, and people -oriented, and can actually be reflected in medical security.

Expert Introduction

Zhou Jifang

Associate Professor of China Pharmaceutical University, researcher at pharmaceutical epidemiology

In 2020, he obtained a doctorate degree in health economics and pharmaceutical epidemiology at the University of Illinois School of Pharmacy at the University of Illinois; in 2016, he obtained a master's degree in public health policies and management of the University of Michigan; graduated from Shanghai Jiaotong University Medical College (seven -year clinical clinical clinical clinical Medical French Class), obtained a master's degree (clinical blood internal science -hematopoietic stem cell transplantation). Research field covers clinical medicine, health economics, health policies and health management theories. He has been internship or work at the Shanghai Jiaotong University Clinical Medical College, the Seventh University of Paris, the San Louis Hospital of France, the World Health Organization, the South African Project of the South Africa, and the South Sudan and the Congo (Gold) Project.

Capture: Guan Yanqing

Edit: Qin Miao

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