Pharmacoeconomics: easy to land, difficult to root

Source: medical economics Daily September 4, 2014 "the problem of the landing of pharmacoeconomics is whether chicken or egg comes first." With the development of the discipline in the past 20 years, the guiding role and significance of pharmacoeconomics in macro policies, such as pricing policies and reimbursement policies, are significant "But no one really knows the analytical methods of pharmacoeconomics Now a lot of drug economists are talking about theory, or introducing a lot of ideas from abroad, but there is still a long way to go to implement it in practice " Song Ruilin, executive chairman of China Pharmaceutical Industry Research and Development Promotion Association and executive director of China Pharmaceutical Policy Research Center, met with Xuedi for a while to analyze the biggest problems faced by pharmacoeconomics in China So, how to get through the last kilometer? Recently, when the reporter of medical economics interviewed relevant experts on the development of pharmacoeconomics in China, some experts said frankly that to promote the development of pharmacoeconomics, the country needs to determine a direction, a strategy, and a policy, not just an appeal at the academic level Hard to get to the ground: China began to introduce the concept of pharmacoeconomics in the late 1980s and early 1990s In the process of formulating more and more drug and health policies, we also heard the constant mention of pharmacoeconomics But why are there few successful cases and large-scale development in China? Song Ruilin: many people say that the difficulty of pharmacoeconomics is due to the lack of clinical data and the inability of data analysis in China In fact, China has a large population and rich clinical data, which reveals the fact that clinical data management is relatively closed From the perspective of scientific decision-making, rational decision-making and administration according to law, we need to dredge the way in addition to data issues, perhaps there are many At the same time, only when we are determined to apply pharmacoeconomics to guide our specific work can we truly realize the importance of clinical data management, pharmacoeconomics evaluation methods, customized standardized guidelines At present, the talent of pharmacoeconomics in China is also scarce When a discipline cannot find its use value in the society, it is difficult to develop Once the country wants to promote its development, the talents of the subject will be naturally delivered The essential driving force for the development of pharmacoeconomics is to raise the spirit and determination of landing to the level of national operation, so the development of this discipline will not be so high and low Xuanjianwei: the landing of pharmacoeconomics in China is not only a problem of the development of the discipline itself As a discipline providing scientific decision-making basis for national health policy, the degree of attention and supporting degree of relevant health policies should not be underestimated Take the national basic medical insurance and industrial injury insurance drug catalogue as an example The catalogue is evaluated every two years or even adjusted only once every four years in China, while the similar drug catalogue in foreign countries is a dynamic drug catalogue, constantly introducing new drugs For example, when the FDA approves a new drug, the insurance company needs to make a decision whether to introduce the drug within three months Sometimes, the insurance company will even introduce a new drug first, and then make a new drug evaluation, and then reject it if the effect is not good This provides the soil and the necessity of growth for pharmacoeconomic evaluation China should also gradually move towards the direction of dynamic directory In the early stage, it is not necessary to adopt a comprehensive dynamic catalog adjustment, which can be carried out with emphasis and hierarchy Lack of evaluation value pharmaceutical economic report: at present, what is the development level of pharmaceutical economics in China? From the perspective of organizational system, standardization construction and the possibility of implementation, what can relevant organizations accomplish? Song Ruilin: academically speaking, the Chinese Pharmaceutical Association is as early as 2010 The evaluation guide of pharmacoeconomics was published in, and now more and more departments are looking forward to the application of pharmacoeconomics to guide policy-making But frankly, there is not much that can be done In the final analysis, the government and enterprises do not have a good understanding of pharmacoeconomics Throughout the world, the application value of pharmacoeconomics is reflected in two aspects: first, the needs of enterprises, to prove the cost-effectiveness between their own products and other products; second, the needs of the government, the evaluation results of pharmacoeconomics have a great help to the scientific decision-making of the government China has not yet put forward compulsory or even encouraging policies to promote the landing and rooting of pharmacoeconomics However, in Taiwan, the local government does not force enterprises to make pharmacoeconomic evaluation If enterprises do it voluntarily, the government will encourage them to increase pricing From this point of view, if China's medical insurance department formulates policies that explicitly stipulate that enterprises will get corresponding preferential policies for the evaluation of pharmacoeconomics, then pharmacoeconomics will naturally develop Xuanjianwei: Unfortunately, if we strictly follow the standard of nice (National Institute for health and care excellence, the government department of evaluation of pharmacoeconomics under the Ministry of health of the United Kingdom), the results of pharmacoeconomics evaluation made by colleges and private third-party service institutions are unqualified at present First of all, China's pharmacoeconomics evaluation standards are not standardized, and the third-party services in this field are very underdeveloped, few people really understand pharmacoeconomics At present, this kind of research done by universities in China is only possible to collect data in a certain region The cost of data collection in China is relatively expensive, and enterprises may not be willing to sponsor it In short, there is very little data that can be applied to the whole country For example, the cost of stroke treatment in Shanghai is different from that in Yunnan Therefore, the cost of a new drug prevention in Shanghai will be higher than that in Yunnan, and from the perspective of social security, the payment capacity of the two places will be different Therefore, we need a model, input the local data of Yunnan and Shanghai, and then we can get an evaluation result that is in line with the local situation However, the evaluation results made by general colleges and universities are difficult to meet this requirement Encourage multiple evaluation mechanism medical economic report: in order to promote the development and implementation of the discipline, what efforts should we make? What principles should we follow in the construction of evaluation institutions? What experiences should we learn from? Chen Wen: it is worth affirming that, with the development of the past 20 years, China's pharmaceutical economics has greatly improved its evaluation organization system and research team capacity For example, Fudan University holds the forum of pharmacoeconomics every year, and Beijing Doctors Association and pharmaceutical association also hold the relevant Summit Forum to exchange experience and experience; there are more than a dozen medical colleges and universities in China, such as Beijing Medical University, China Pharmaceutical University and so on, also have the faculty and talents of pharmacoeconomics, and are actively preparing for the establishment of evaluation institutions; In terms of enterprises, there are five or six enterprises in China that can complete this series of pharmacoeconomic evaluation In recent years, with the expiration of a series of patents for original research drugs, especially in the field of Biopharmaceutical Enterprises, they all have the initiative to conduct pharmacoeconomic evaluation, with a good momentum of development Although every country in the world has different organizational models, such as nice in the UK and AMCP in the US However, the models are generally consistent, which can be roughly divided into two categories: one is to conduct pharmacoeconomic research, the other is to evaluate the pharmacoeconomic evidence submitted by other institutions, and the latter is mostly some statutory or quasi statutory institutions established by the government Therefore, there are many institutions to carry out pharmacoeconomics research, which can be enterprises themselves, universities or specific independent academic institutions, or third-party institutions, as long as their research reports can be recognized by official evaluation institutions At present, there is a lack of clinical evidence in China If we encourage such a model to develop pharmacoeconomics, then this multi development mechanism will provide more policy basis for China Song Ruilin: the evaluation institution of pharmacoeconomics can not and should not be run by the government It should be a credit institution of the market, which can be independent institutions such as associations, colleges and universities, and professional institutions The state should establish the certification system of the evaluation institution of pharmacoeconomics In the management of the whole evaluation institution, the government should play a regulatory role If the organization makes false data and fabricates false results, which can not objectively reflect the economic value of the product itself, the government can deny its evaluation results at any time, or even revoke its evaluation qualification This management mode will make the first batch of pharmacoeconomics evaluation institutions grow up in China At present, we can also cooperate with the authoritative institutions of foreign pharmacoeconomics, combine them with foreign countries and use them for doctrine, and recognize some foreign pharmacoeconomics evaluation institutions to provide evidence of evaluation results for China In addition, there is no standard for pharmacoeconomic evaluation in China, so it is impossible to evaluate the existing evaluation institutions in the market But in the market cultivation period, in the spirit of encouraging new things, we should try to be tolerant of the existing market, although it is not the most scientific and objective.