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抗肿瘤联合疗法价值评估的困境分析及建议
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| 篇名： | 抗肿瘤联合疗法价值评估的困境分析及建议 |
| TITLE： | Analysis of dilemmas and recommendations for value assessment of antitumor combination therapies |
| 摘要： | 目的 系统梳理抗肿瘤联合疗法价值评估的困境，为医保准入、药品定价和临床决策提供依据。方法引入“剩余价值空间”概念，构建价值评估框架，分析3种评估情境下抗肿瘤联合疗法的价值评估困境，并结合国际相关研究困境提出优化建议。结果与结论抗肿瘤联合疗法的价值评估困境在于剩余价值空间不足，当主干治疗成本超过对应的健康价值时，附加药物会出现“免费仍不经济”难题；现有国际价值评估方法存在评估框架具有缺陷、质量调整生命年分配框架实施难以落地“、免费仍不经济”难题频发等局限，难以适配抗肿瘤联合疗法的复杂场景。针对上述困境，建议实施调整支付阈值、探索折扣定价、进行多产品联动谈判及延迟医保准入等策略，以提升抗肿瘤联合疗法价值评估的合理性与可操作性。 |
| ABSTRACT： | OBJECTIVE To systematically identify the dilemmas in value assessment of antitumor combination therapies， and to provide evidence for health insurance coverage， drug pricing， and clinical decision-making. METHODS The concept of “surplus value space” was introduced to cons truct a value assessment framework， under which the dilemmas in three assessment scenarios were analyzed. Optimization recommendations were proposed by drawing on international research addressing similar challenges. RESULTS & CONCLUSIONS The core dilemma of value assessment for antitumor combination therapies lies in insufficient surplus value space. When the cost of the backbone therapy exceeds its corresponding health value， the add-on drug encounters a “free but uneconomical”problem. Existing international value assessment methods have limitations such as flawed evaluation frameworks， difficulty in operationalizing the quality-adjusted life year allocation framework， and frequent occurrence of the “free but uneconomical”problem， rendering them inadequate for the complex scenarios of antitumor combination therapies. To address these dilemmas， strategies such as adjusting payment thresholds， exploring discounted pricing， conducting multi-product linkage negotiations， and delaying insurance access are recommended to improve the rationality and feasibility of value assessment for antitumor combination therapies. |
| 期刊： | 2026年第37卷第11期 |
| 作者： | 汪雪蓉；周挺；李严；李洪超 |
| AUTHORS： | WANG Xuerong，ZHOU Ting，LI Yan，LI Hongchao |
| 关键字： | 抗肿瘤治疗; 联合疗法; 价值评估; 成本; 免费不经济; 药物经济学 |
| KEYWORDS： | antitumor therapy; combination therapy; value assessment; cost; free but uneconomical; pharmacoeconomics |
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