Access to and price trends of antidiabetic, antihypertensive, and antilipidemic drugs in outpatient settings of the Universal Coverage Scheme in Thailand

Under the Universal Coverage Scheme (UCS) with payment per capita for outpatient (OP) services, hospitals’ financial risks will rise if access to essential drugs increases. This study examined trends in access to and price of essential drugs for noncommunicable diseases (NCDs) and an overall purchasing price index (PPI) for an OP drug basket from public hospitals. To examine drug access, OP prescription data from 2010–2012 were obtained from the UCS. Access to thirteen drugs for diabetes, hypertension, and dyslipidemia was examined for trend using a time-series analysis. To calculate the PPI, drugs in the same dataset in 2010 that each contributed at least 0.2% of the total OP drug expenditure (N = 118 items) were selected together with drugs expected for near future growth (N = 48 items). The PPI was constructed from purchasing prices in 16 hospitals using a standard method developed by the International Labour Organization. Based on 166 drug items accounting for 75% of OP drug expenditures, the overall PPI continually declined by 6.8% from 2010 to 2012. Access to the 13 selected NCD drugs, accounting for 22% of the total OP drug expenditure increased from 22 to 30 per 1,000 population for antidiabetics, 27 to 47 for antihypertensive agents, and 32 to 53 for antilipidemics from 2010–2012. Growth in the study drug recipients was relatively higher than that in the population and diagnosed patients. Due to generic market competition, metformin, glipizide, amlodipine, losartan, simvastatin, atorvastatin, and fenofibrate prices decreased by 6–22%. Antiretrovirals and risperidone prices decreased by more than 10% due to price negotiation by the UCS. Access to essential drugs for diabetes, hypertension and dyslipidemia has increased. A decline in the PPI could contain essential drug expenditure when the demand for the drugs increased. Generic market competition and price negotiation by the UCS led to price reduction.

在按人头付费的全民医保计划（Universal Coverage Scheme, UCS）门诊（outpatient, OP）服务框架下，若基本药物可及性提升，医院将面临更高财务风险。本研究聚焦公立医院非传染性疾病（noncommunicable diseases, NCDs）基本药物的可及性与价格趋势，以及门诊药物篮子整体采购价格指数（purchasing price index, PPI）的变化情况。为评估药物可及性，本研究从UCS调取了2010-2012年的门诊处方数据，采用时间序列分析方法，考察糖尿病、高血压及血脂异常领域共13种药物的可及性变化趋势。在采购价格指数构建环节，本研究选取2010年同数据集内、单药占门诊药物总支出比例不低于0.2%的药物（共118种），以及预计近期具有市场增长潜力的药物（共48种）。采购价格指数参照国际劳工组织制定的标准方法，基于16家医院的采购价格完成构建。基于覆盖门诊药物总支出75%的166种药物样本，整体采购价格指数在2010至2012年间持续下行6.8%。针对13种入选非传染性疾病药物（占门诊药物总支出的22%）的可及性分析显示，降糖药每千人用药人次从22升至30，降压药从27升至47，调脂药从32升至53。本研究纳入的用药人群增速显著高于总人口与确诊患者增速。价格层面，受仿制药市场竞争影响，二甲双胍、格列吡嗪、氨氯地平、氯沙坦、辛伐他汀、阿托伐他汀及非诺贝特的价格下降6%至22%；得益于UCS开展的价格谈判，抗逆转录病毒药物与利培酮的价格降幅超过10%。本研究结论表明：糖尿病、高血压及血脂异常相关基本药物的可及性有所提升；在药物需求增长的背景下，采购价格指数下行可有效控制基本药物支出规模；仿制药市场竞争与UCS的价格谈判共同推动了药物价格下降。