返回 
加入收藏
抗肿瘤药物医保限制支付范围内肿瘤分期与临床分期对比分析
x
请在关注微信后，向客服人员索取文件
| 篇名： | 抗肿瘤药物医保限制支付范围内肿瘤分期与临床分期对比分析 |
| TITLE： | Comparative analysis of tumor staging versus clinical staging in reimbursement scope restrictions under medical insurance for antineoplastic agents |
| 摘要： | 目的 对比分析抗肿瘤药物医保限制支付范围内的肿瘤分期与临床分期，以便更好地执行药品支付政策。方法以《国家基本医疗保险、工伤保险和生育保险药品目录（2024年）》（以下简称“医保目录”）收录的抗肿瘤药物为研究对象，整理和分析药物限制支付范围内关于肿瘤分期的限定情况；通过查阅临床诊疗指南和相关文献将医保目录限制支付范围内的肿瘤分期与临床分期进行映射比对。结果与结论共有89个抗肿瘤药物的医保支付限制了肿瘤分期，其中西药86个（包括17个普通西药、68个协议谈判药品和1个竞价药品），中成药3个（包括1个普通中成药和2个协议谈判药品）。非小细胞肺癌涉及的限制支付药品最多，有36个；限制支付范围内的肿瘤分期以“转移性”和“局部晚期”居多，分别涉及67和48个药品。大部分限制支付范围内的肿瘤分期可以和肿瘤临床分期进行对应，但中晚期食管癌、不可切除的胃肠间质瘤、不可切除的局部晚期神经内分泌瘤、局部晚期基底细胞癌、无法手术的Ⅰ型神经纤维瘤病未见有权威指南和高质量临床研究提及有相应的临床分期，需要临床根据患者实际情况进行判定。建议相关部门对限制支付范围内的肿瘤分期进行准确定义和标准化解读，以提高药品医保支付政策在执行过程中的准确性。 |
| ABSTRACT： | OBJECTIVE To comparatively analyze tumor staging versus clinical staging in reimbursement scope restrictions under medical insurance for antineoplastic agents in order to better implement the medicare drug payment policy. METHODS Antineoplastic agents included in the National Basic Medical Insurance， Workers’ Compensation Insurance and Maternity Insurance Drug Catalogue （2024） （hereinafter referred to as the “Medical Insurance Catalog”） were used as research subject to compile and analyze reimbursement scope restrictions regarding tumor staging. By consulting clinical diagnosis and treatment guidelines and relevant literature， the tumor staging in reimbursement scope restrictions of the Medical Insurance Catalog was mapped and compared with clinical staging. RESULTS & CONCLUSIONS A total of 89 antineoplastic agents’ medical insurance payments had tumor staging. Among these， there were 86 western drugs （including 17 ordinary western drugs， 68 negotiated drugs， and 1 competitive drug） and 3 Chinese patent medicines （including 1 ordinary Chinese patent medicine and 2 negotiated drugs）. Non-small cell lung cancer involved the most restricted payment drugs， with 36 drugs. The tumor staging in reimbursement scope restrictions was mostly “metastatic” and “locally advanced”， involving 67 and 48 drugs respectively. Tumor staging in most reimbursement scope restrictions could correspond to the clinical staging of the tumor. However， mid-advanced esophageal cancer， unresectable gastrointestinal stromal tumors， unresectable locally advanced neuroendocrine tumors， locally advanced basal cell carcinoma， and unresectable neurofibromatosis type Ⅰ did not have a corresponding clinical staging mentioned in authoritative guidelines or high-quality clinical studies and need to be determined by the clinic according to the actual situation of the patient. Therefore， it is recommended that the interpretation of tumor staging in reimbursement scope restrictions should be accurately defined and standardized， so as to improve the accuracy of the drug payment policy in the actual implementation process. |
| 期刊： | 2025年第36卷第10期 |
| 作者： | 赵德华；龙小庆；王继生；范红英 |
| AUTHORS： | ZHAO Dehua，LONG Xiaoqing，WANG Jisheng，FAN Hongying |
| 关键字： | 抗肿瘤药物；限制支付范围；肿瘤分期；临床分期；医保 |
| KEYWORDS： | antineoplastic agents； reimbursement scope restrictions； tumor staging； clinical staging； medical insurance |
| 阅读数： | 4 次 |
| 本月下载数： | 1 次 |
* 注：未经本站明确许可，任何网站不得非法盗链资源下载连接及抄袭本站原创内容资源!在此感谢您的支持与合作！
