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中国 肿瘤 药领域面面观. Professor Dr. Zhao Ping Cancer Hospital CAMS P.R. China 2013 11 16 广州. Present Post. Former President of Cancer Institute & Hospital CAMS Secretary-in-Chief of Cancer Foundation of China

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slide1
中国肿瘤药领域面面观

Professor Dr. Zhao Ping

Cancer Hospital CAMS P.R. China

2013 11 16 广州

slide2

Present Post

Former President of Cancer Institute & Hospital CAMS

Secretary-in-Chief of Cancer Foundation of China

Director of National Cancer Prevention and Control Office

Former Director of National Cancer Registration Center

Directorial Committee Member of China Cancer Hospital Association

General secretary of Asian National Cancer Center Alliance

Former Chief Editor of Chinese Journal of Oncology

Chief Editor of China Tumor Clinical Year Book

Representative of Beijing Municipal Peoples’ Congress

Representative of CPPCC

slide4
中国癌症的发病率与死亡率

数据来源:(中国2012年肿瘤登记年报)

china is the largest market for the drugs for tumors in the world

China is the largest market forthe drugs for tumors in the world

1.3 billion population

3 million new patients

with cancer/year

25 billion yuan/year for drugs for tumors in China

slide6

中国常见恶性肿瘤发病率与死亡率

数据来源:(中国2012年肿瘤登记年报)

cancer therapies
Cancertherapies
  • Others

Traditional medicaltherapy

Immune therapy

Gene therapy

Surgicaltherapy

Medical therapy

Radiotherapy

paclitaxel 1999
紫杉醇(Paclitaxel)- 1999年上市

Chemical therapy

Indication

一线化疗失败或多次化疗失败的转移性卵巢癌(ovary cancer)和乳 腺癌(breast cancer)及非小细胞肺癌的一线和二线治疗

对于头颈癌、食管癌、精原细胞瘤、复发非霍奇金氏淋巴瘤有一定疗效

Effect

非小细胞肺癌:紫杉醇联合顺铂治疗晚期非小细 胞肺癌缓解率为21%-27% 1年生存率31%-38.9%中位生存期 7.8-9.9个月

Price

进口 泰素 30mg/支 1334.00元/支

国产 协和紫素 30mg/支 371.45元/支

t oremifen 2002
托瑞米芬(Toremifen)- 2002年上市

Endo-Hormone EquilbriumModultors

TormfenFormestaneLetrozole

AnastozoleExemestaneGoserlin

Indication

绝经后雌激素受体阳性或不详的转移

性乳腺癌

Effect

一线治疗绝经后晚期乳腺癌总有效率

(45%-54%)临床获益率74%-92%

price

法乐通 60mg/片 30片/盒

377.00元/盒

gefitinib 2007
吉非替尼Gefitinib 2007年我国上市

Target Therapy

GefitinibCetuximabErlotinibBeacizumabSorafenibRitixizumabSunitinibGemtuzumabImatinibTrastuzumab

Indication非小细胞肺癌

EffectEGFR阳性者有效率

71.2% 阴性者1.1%

Price易瑞沙

0.25g/片 10片/盒

4695.00元/盒

decision making
Decision making
  • New drug use approval to enter the hospital after the clinical trial(phase III) and approved by CFDA
  • New drug used in the clinic decided by the hospital pharmacy committee
  • Clinical use of drugs for tumor according to the patient’ condition(Individual therapy)
china s drug policy
China’s drug policy
  • Drug tariffs(15%)to raise the medical medicine
  • Drug price forming mechanism
  • The National Development and Reform price department or local price department accounting produces the highest retail price (ceiling price)United centralized bid evaluation experts provinces have priced in 各省统一集中招标 专家评定产生(purchase price中标价)

The hospital drugs bonus policy

(hospital retail price 零售价)

cost effect pay
Cost-effect-Pay
  • Too expensive comparing with the income
  • World average month salary 9327yuan
  • China average month salary 4134 yuan
  • 易瑞莎 0.25g/片 10片/盒 4695元/盒

法乐通 60mg/片 30片/盒 377元/盒

international experiences
International experiences
  • Germany:Patients get medicine pharmacy paid by medical insurance
  • France:Full reimbursement drugs government pricing medicine
  • Japan:15 thousand drugs government pricing medicine
  • USA:According to the market independent pricing government rarely intervention medicine
  • Canada:Drugs prices government control
  • UK:Drugs price standard system control capital return rate
  • India:74 basic drugs government pricing medicine
china s medical health system reform
China’s Medical Health System reform
  • Target

Everyone have the right to basic health care

1.3 billion people have health insurance and new rural cooperative medical(low level and unversal coverage)

Challenge

Medical price vsmedical technology progress

Who pay for the patients How much they can pay up

the reform of the system of drugs
The reform of the system of drugs
  • Cancel the affordance of drugs
  • Bisic drugs in the directory (371) full reimbursement
  • Drugs in the directory of the medical insurance 90% reimbursement for the urban residents
  • Drugs in the directory of new rural cooperation medical system 80% reimbursement for the peasants
  • Drugs w. patent(Target drugs )no reimbursemen
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中国药品捐赠项目

回顾性研究

药品捐赠

索坦项目

临床试验捐赠

患者关怀

slide23
索坦捐赠发药情况

35660

1. 药品发放特征

自08年开始,患者领药数量逐年激增

仅2011年一年发药量就占总发药量的47%

预计2012年全年发药量将达到5.4万瓶,折合人民币7亿多

21280

9980

1477

备注:2008年数据时间段2008.7.1-2008.12.31

2012年时间段为2012.1.1-2012.4.10

2008

2009

2010

2011

2012

每年发药情况(瓶)

slide27
中国医院药品收入
  • 2002 03 04 05 06 07 08 09 10 11年

----------------------------------------------------------

药品 1616万元 1733 2045 2383 2599 3127 3924 4846 5825 6817

2011年 全国综合医院平均收入与支出

药品销售收入 6817万元 支出 6384万元 利润 433万元

医疗服务收入 8519万元 支出9290万元 亏损 771万元

slide28
治理医药领域商业贿赂
  • 刑法163条 公司 企业 非国家工作人员
  • 医疗机构中国家工作人员 在药品 医疗器械 医用卫生材料等医药产品采购活动中个利用职务便利 索取销售方财务 或者非法收受销售方财务 为销售方财谋取利益 构成犯罪的 依照刑法385条规定 以受贿罪处罚
  • 医疗机构中医务人员 利用开处方的职务便利 以各种名义非法收受药品 医疗器械 医用卫生材料等医药产品销售方财务 为医药产品销售方谋取利益 数额较大的 依照刑法136条的规定 以非国家工作人员受贿罪处罚
  • 2006年 卫生部 、中医局<卫生部/国家中医药管理局关于开展治理医药购销领域商业贿赂专项工作的实施意见>
slide29
结束语
  • 医疗与药品是分不开的
  • 医与药的矛盾是历史政策的必然
  • 药品价格随质量和效果的提高必然攀高
  • 药品销售领域的促销违背医疗道德
  • 药品价格的控制是低水平广覆盖的必然