The original US medical insurance DRG system is difficult to cope with current drug-resistant infections
The infections caused by current resistant bacteria have caused serious threats to public health. The US health care system uses the “Diagnosis-Related Group” (DRG) for payment. Medicare and hospitals are more willing to use cheaper antibiotics to reduce costs. These antibiotics are basically generic drugs and are difficult to cope with. Infection caused by the drug bacteria.
“The original medical insurance payment system + antibiotic use” makes the development of new antibiotics difficult
After the development and marketing of new antibiotics, although the curative effect is small and the side effects are small, it is likely to be neglected by the medical insurance hospital due to the high cost and heavy burden, resulting in the company not being able to obtain the expected sales revenue and social and patient benefits.
Achaogen is a good example. Although it successfully developed a new generation of aminoglycoside antibiotic ZEMDRI, it also received hundreds of millions of dollars in research and development subsidies from the government, but the so-called “reasonable use” that was conservative before the existing US medical insurance payment system and antibiotics. Under the dual pressure, its commercial promotion was difficult and ultimately led to the company’s unsustainable application for bankruptcy. It should be noted that in order to encourage new drug development and clinical use, and to make patients more beneficial, the US government introduced a new technology called “New Technology Add-on Payment” (NTAP) in 2001. The preferential policy, but this policy does not solve the dilemma faced by the development and use of new antibiotics, because on the one hand, the NTAP subsidy is only valid for 3 years, and such a short period of time obviously cannot adapt to the relatively slow pace of clinical promotion of new antibiotics. More importantly, the new drugs must have a “substantial clinical benefit” (SCB), and new antibiotics were rejected because of the “non-inferiority” clinical trial design. Even if a small number of antibiotics can be selected, medical institutions will lose interest because the amount of medical insurance reimbursement is too small and the application process is complicated. As a result, new antibiotics do not benefit more from society and patients.
The latest American theory subverts the traditional misconception and proposes the use of new antibiotics to effectively reduce the production of resistant bacteria.
The 2020 medical insurance IPPS implementation plan timely compensated for the shortcomings of the previous policies, and the support for antibiotic new drug reimbursement has increased significantly, especially those new antibiotics that have obtained QIDP certification, and will be implemented on October 1, 2019. The new version of the program no longer requires QIDP antibiotics to meet the “significant clinical advantage” to enjoy NTAP subsidies, and increase the subsidy amount from the previous 50% to 75%.
Due to the cancellation of the “major clinical advantage” requirement in the United States, the antibiotic-resistant antibiotic-resistant strains that have obtained QIDP certification can enter the US NTAP. The increase in the number of medical insurance and the increase in the amount of reimbursement will inevitably lead the major hospitals to pay attention to new antibiotics. The rational use of daily treatment truly benefits society and patients, and promotes major commercial insurance companies to develop a more favorable payment policy for such antibiotics. In addition, in order to solve the shortcomings of the NTAP subsidy policy with only three years, the new US medical insurance IPPS system also sets a new diagnostic code (ICD-10) for multiple types of drug-resistant infections, namely patient medical bills. As long as one of the diagnostic codes is included, it can be attributed to a serious “complication or comorbidity” (CC) disease level, resulting in an additional benefit. Because this updated diagnostic code is effective for a long time, it can gradually improve the enthusiasm of clinicians to rationally use new antibiotics, thus effectively controlling drug-resistant infections.
The latest American theory on the clinical use of antibiotics in China
The latest concept of the United States is to subvert the original misconception: first rational use of new antibiotics to reduce the resistance of drug-resistant bacteria, that is, to use new better antibiotics as soon as possible to treat bacterial infections, especially resistance Drug antibiotics, not the previous (British-style conservative treatment concept: first use the old cheap and poorly effective side effects and more antibiotics with less resistant antibiotics, it is not good to use new antibiotic resistant bacteria but high price Some new antibiotics …), this is actually wrong: first, delay / delay the condition. Second, missed the time window of effective treatment, endangering the patient’s life safety. Third, many resistant bacteria have been cultivated… (Infections caused by pathogenic bacteria for a long time are actually the most troublesome and superior medium for cultivating resistant bacteria!). Fourth, it increases the healing time and treatment costs (on the surface, old antibiotics are cheaper, but actually expensive!). Recently, the United States has subverted the traditional misconception based on the actual development of modern clinical drug-resistant bacteria. It is very correct to propose the use of new antibiotics to effectively reduce the production of drug-resistant bacteria. It is worthy of clinical practice in Chinese government and medical circles and hospitals. Promote the use of: 1 to cure bacterial infections faster within the effective time window. 2, reduce the risk of life caused by delay in effective treatment time … 3 relative side effects are small and less, less sequelae. 4, the relative healing time is short, relative to the overall comprehensive cure for medical expenses and other expenses (hospital, lost work, rehabilitation, side effects …). 5, especially since the source has effectively reduced and reduced the possibility of the emergence and spread of drug-resistant bacteria…
For example: if penicillin is used, it has no effect until 9.6 million units, and finally uses about 16 million units. The side effects are large, penicillin cerebral edema, long curing time, large patient sequelae, life-threatening, and the actual effect is poor. If you use the national first class new drug with ceftriaxone sodium sodium sulbactam sodium and cefotaxime sodium sulbactam sodium and piperacillin sodium sulbactam sodium, it will speed up the cure, reduce side effects and shorten the course of treatment. Effectively reduce the total cost of the patient!
Overall, the reform of the antibiotics medical insurance reimbursement system fully reflects the US government’s emphasis on the infection of drug-resistant bacteria. It is believed that it will further stimulate the enthusiasm of drug companies to develop new antibiotics, which will greatly promote human health. The follow-up CMS will also collect feedback from various pharmaceutical companies, hospitals and scientific research institutions, and gradually establish a mature drug-resistance infection treatment reimbursement system to ensure timely and reasonable treatment of such patients. Looking at the country, the increasingly serious drug-resistant infection is also a major public health risk that China is facing now. The lack of new anti-drug resistant drugs in China is also obvious to all. Therefore, this article also takes this opportunity to appeal to all government departments and pharmaceutical counterparts. Experts and scholars and government officials can discuss and exchange ideas, try to design more reasonable incentives from the medical reimbursement system, increase the support and clinical use of new drug development against drug-resistant bacteria, to avoid further deterioration of bacterial resistance, and let society and disease Patients get more and more benefits.