罕见病用药医保准入标准偏好选择研究:基于医保专家视角OA

Objective To quantitatively elicit the preferences of Chinese health insurance experts regarding the reimbursement and access of rare disease drugs,and to provide empirical evidence for improving reimbursement evaluation criteria.Methods From July to November 2024,an online discrete choice experiment(DCE)survey was conducted among health insurance decision-making experts in China.Six attributes were analyzed using a conditional logit model to estimate their effects on reimbursement preferences,calculate relative importance(RI)and willingness-to-pay(WTP)for each attribute,and conduct scenario simulations.Results A total of 102 valid responses were collected.Except for the attribute"catastrophic expenditure",all others significantly influenced experts'preferences.Health benefit(RI=33.4%)was the most influential factor;experts were willing to accept an increase of 5.46 Yuan per person per year in insurance funding to raise the health benefit of reimbursed rare disease drugs from 0.01 to 4 QALYs.Increases in insurance funding(RI=18.9%),life expectancy without treatment(RI=18.6%),and whether similar drugs were already covered by insurance(RI=17.5%)also had substantial effects,while quality of life without treatment(RI=8.1%)had a relatively smaller impact.Conclusions Health insurance experts preferred drugs with greater health benefits,smaller increases in funding,targeting patients with shorter life expectancy without treatment and drugs not yet covered by insurance for the disease.The revealed preference structure provides empirical evidence to improve evaluation criteria for rare disease drug reimbursement,optimize negotiation strategies,and enhance policy transparency in China.