【摘要】 目的:评估国家医保药品价格谈判对乳腺癌药品使用情况的影响，为提高我国乳腺癌患者用药可及性提供参考。方法:系统梳理2017-2021年成功通过国家医保药品价格谈判政策新增纳入医保药品目录的乳腺癌药品，并从中国药学会的全国医药信息网中提取相关药品的连续数据，对国家医保药品价格谈判前后的乳腺癌药品品种变化采用描述分析法，对采购金额、每日限定费用和用药频度的变化采用间断时间序列分析模型进行评估。结果:2017-2021年医保药品目录共新增纳入9个谈判成功的乳腺癌药品，对符合模型纳入条件的7种药品进行分析。国家医保药品价格谈判后，大部分乳腺癌药品的每日限定费用在谈判政策执行当月显著下降(P<0.05),除阿贝西利以外，其余乳腺癌药品每日限定费用的长期趋势无显著变化(P>0.05);大部分乳腺癌药品的用药频度和采购金额在谈判政策执行当月显著增加(P<0.05),国家医保药品价格谈判后长期呈现上升趋势(P<0.05)。结论:国家医保药品价格谈判降低了药品价格，显著提高了药品的利用率和可负担性，惠及到更多的乳腺癌患者。但药品采购金额增加的同时也给医保基金带来一定压力，需要政府部门监控药品的合理使用并探索新的支付模式，保证医保基金的可持续性。更多还原

【Abstract】 Objective: To evaluate the impact of national medical insurance drug price negotiations on the usage of breast cancer medications, and to provide a reference for improving the accessibility of medications for breast cancer patients in China. Methods: This study systematically reviewed breast cancer medications that were successfully added to the national medical insurance list through national medical insurance drug price negotiations from 2017 to 2021. Longitudinal data related to these medications were extracted from the National Pharmaceutical Information Network of the Chinese Pharmaceutical Association. Descriptive analysis was used to assess changes in the variety of breast cancer medications before and after the national medical insurance drug price negotiations. Interrupted time series analysis was employed to evaluate changes in procurement amount, defined daily cost, and frequency of medication use. Results: From 2017 to 2021, nine breast cancer medications were successfully added to the insurance list through national medical insurance drug price negotiations. Seven of these medications met the inclusion criteria for analysis. After national medical insurance drug price negotiations, the defined daily cost of most breast cancer medications significantly decreased in the month when the negotiation policy was implemented(P<0.05). Except for Abemaciclib, the long-term trend of defined daily cost for other breast cancer medications did not show significant changes(P>0.05). The frequency of medication use and procurement amount for most breast cancer medications significantly increased in the month the negotiation policy was implemented(P<0.05), with a long-term upward trend observed after national medical insurance drug price negotiations(P<0.05). Conclusion: The national medical insurance drug price negotiations have reduced drug prices, significantly improving the utilization and affordability of breast cancer medications and benefiting more patients, the increase in procurement amounts also poses certain pressure on the medical insurance fund. Government departments need to monitor the rational use of medications and explore new payment models to ensure the sustainability of the medical insurance fund.更多还原