广西医学

目的基于真实世界数据分析在疾病诊断相关分组（DRG）付费改革背景下，使用集中带量采购冠状动脉支架（集采支架）行经皮冠状动脉介入（PCI）治疗的有效性、安全性和经济性。方法纳入DRG为FM1组（经皮冠状动脉支架植入）的5 301例患者，其中单纯使用集采支架共3 357例（集采组），单纯使用非集采支架共1 944例（非集采组）。通过倾向匹配得分法对两组患者进行1∶1的基线特征匹配。比较两组行PCI治疗的有效性、安全性和经济性指标。结果通过1∶1匹配后最终筛选出3 888例患者，每组1 944例。集采组住院天数少于非集采组（P<0.05），而两组的好转率差异无统计学意义（P>0.05）。两组疼痛数字评定量表评分≤3分的比例差异无统计学意义（P>0.05），两组患者均未发生并发症。与非集采组相比，集采组的总住院费用、医保统筹支付费用、药品费、手术治疗费、总材料费以及材料费中的支架费用、导管费用均减少，检查化验费、材料费中的球囊和附件费用及DRG权重增加（P<0.05）。结论冠状动脉支架集中带量采购后，行经皮冠状动脉支架植入的患者总住院费用显著下降，手术有效性、安全性未受影响，但医疗服务价格调整和补偿机制滞后。应通过强化“三医联动”，推动医用耗材领域改革和创新发展，实现患者、医保、医疗、医药四方共赢。

Objective To analyze the effectiveness, safety and economy of employing centralized volume⁃based procurement coronary stent (centralized⁃procurement stent) for percutaneous coronary intervention (PCI) therapy under the background of diagnosis related groups (DRG) payment reform based on real⁃world data. Methods A total of 5301 patients whose DRG were in the FM1 group (percutaneous coronary stent implantation) were enrolled, therein there were 3357 cases (centralized⁃procurement group) using centralized⁃procurement stent alone, and 1944 cases (non⁃centralized procurement group) using non⁃centralized procurement stent alone. Patients of the two groups were matched with 1:1 baseline features by propensity matching score method. The indices of effectiveness, safety and economy of PCI therapy were compared between the two groups. Results After 1:1 matching, 3888 patients were finally screened out, with 1944 cases in each group. Length of hospital stay in the centralized⁃procurement group was less than that in the non⁃centralized procurement group (P<0.05), whereas there was no statistically significant difference in the improvement rate between the two groups (P>0.05). There was no statistically significant difference in the proportion of Numeric Rating Scale score for pain≤3 between the two groups (P>0.05). No complication in patients of the two groups occurred. Compared with the non⁃centralized procurement group, the centralized procurement group exhibited decreased total hospital expenses, medical insurance payment expenses, drug expenses, surgical treatment expenses, total material expenses, and decreased stent expenses and catheter expenses of material expenses, whereas increased examination and medical laboratory expenses, and increased balloon and accessory expenses of material expenses, as well as increased DRG weight (P<0.05). Conclusion After coronary stent centralized volume⁃based procurement, the total hospital expenses of patients undergoing percutaneous coronary stent implantation decreased significantly, and the effectiveness and safety of surgery are not affected, but medical service price adjustment and compensation mechanism lag behind. It is necessary to promote the reform and innovative development of medical consumables field, so as to achieve a win⁃win situation for patients, medical insurance, medical service and medicine by strengthening the “3Ms”, namely, the joint reform of medical service system, medical insurance system and medicine system.

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