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中国 肿瘤 药领域面面观

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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中国 肿瘤 药领域面面观

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  1. 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

  2. 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

  3. 近40年中国恶性肿瘤发病率态势

  4. 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)

  5. 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

  6. 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)

  7. Cancertherapies • Others Traditional medicaltherapy Immune therapy Gene therapy Surgicaltherapy Medical therapy Radiotherapy

  8. 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

  9. 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

  10. 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

  11. Drugs for Tumor in directory

  12. Drugs for Tumor in directory

  13. Drugs for Tumor in directory

  14. Drugs for Tumor in directory

  15. Drugs for Tumor in directory

  16. 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)

  17. 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)

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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)

  24. 赫赛汀援助项目

  25. 赫赛汀援助项目

  26. 中国药品收入占比

  27. 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

  28. 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>

  29. 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

  30. Thank You

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