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Abstract Potential saving from setting reimbursable rates of outpatient drugs for Civil Servant Medical Benefit Scheme in 2010

Chulaporn Limwattananon*, Noppakun Thammatacharee^†, Thananan Rattanachotphanit^‡, Pornpit Silkavute^§, Supon Limwattananon*, Samrit Srithamrongsawat^†

*Faculty of Pharmaceutical Sciences, Khon Kaen University, ^†Health Insurance System Research Office, ^‡Faculty of Pharmacy, Mahasarakham University, ^§Health Systems Research Institute

The medical expenditure for outpatients under the Civil Servant Medical Benefit Scheme’s direct billing system continued to be very high in 2009-2010 due to the use of drugs outside the National Lists of Essential Medicines. This study estimated potential cost-savings using the aggregate drug utilization data from 28 large public hospitals under two scenarios of reimbursement: 1) the lowest price of generic in each drug group, and 2) median price of each drug. If the reimbursement rate was set most restrictively based on the minimum price of the essential drug with an equivalent Anatomical, Therapeutic, and Chemical (ATC) code 1-3 (eg. the lowest price of simvastatin for antilipids), the expenditure for antilipids, antiosteoarthritis (non-steroidal anti-inflammatory drug (NSAID), cyclo-oxygenase (COX-2) inhibitor, and symptomatic slow-acting drugs for osteoarthritis (SYSADOA)), and antisecretory/antiulcers (histamine- 2 receptor antagonist (H-2RA) and proton pump inhibitor (PPI)) in 2010 would be reduced by 72.8, 85.7, and 86.5%, respectively. If each individual hospital was allowed the drug reimbursement as is but no higher than a ceiling determined as the median of price per prescription for the drug with the equivalent ATC 1-5, the expenditure for antilipids and antiosteoarthritis would be reduced by 13.4 and 13.3%, respectively. For 20 drug groups with relatively high expenditure, the reimbursement ceiling could reduce the expenditure by 14.0%. The least restrictive reimbursement condition using a fixed rate referent to the median price of drugs with equivalent ATC 1-5 from all hospitals could reduce the expenditure for the 20 drug groups by 2.9%. Therefore, to contain expenditure using a fixed rate of reference price based on drugs with an equivalent ATC 1-5 would be the least restrictive policy option.

Key words: Cost-saving, National Lists of Essential Medicines, Civil Servant Medical Benefit Scheme, reimbursement rate, reference pricing

‡

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162

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T52 S52

U52

V52

W52

H52

I52

J52 K52

L52

M52

N52

O52

P52

Q52

R52

A52 B52

C52 D52

E52

F52

G52

S53

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J53

K53 L53

M53

N53

O53

P53

Q53

R53

A53 B53

C53 D53

E53

F53

G53

50 55 60 65 70 75

Baht of non-essential drugs (%)

15 20 25 30 35 40 45

Scripts of non-essential drugs (%)

ป 2552 2553

รพ. กระทรวงกลาโหมและอื่นๆ รพ. กระทรวงสาธารณสุข รพ. มหาวิทยาลัย

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° “ √ √ â “ ß μ — « · ∫ ∫ ‡ æ ◊ Ë Õ ª √ – ¡ “ ≥ » — ° ¬ ¿ “ æ ¢ Õ ß ° “ √ ª√–À¬—¥§à“„™â®à“¬„π°“√»÷°…“π’È ‰¥â°”Àπ¥Õ—μ√“‡∫‘°®à“¬μ“¡

‡ß◊ËÕπ‰¢¢Õß√–¥—∫√“§“¬“ ¥—ßμàÕ‰ªπ’È (μ“√“ß∑’Ë Ò)

°√≥’∑’Ë Ò °”Àπ¥μ“¡¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘∑’ËÕ¬Ÿà„π

°≈ÿà¡‡¥’¬«°—π ´÷Ëß¡’√“§“μË”∑’Ë ÿ¥

¬“∑’ËÕ¬Ÿà„π°≈ÿà¡‡¥’¬«°—π„π°“√»÷°…“π’È À¡“¬∂÷ß¬“∑’Ë¡’√À—

Anatomical, Therapeutic, and Chemical (ATC)

¢ÕßÕß§å°“√Õπ“¡—¬‚≈°^(Ù) „π√–¥—∫∑’Ë Ò-Û ‡À¡◊Õπ°—π ‡™àπ Simvastatin, Atorvastatin, Rosuvastatin ·≈– Ezetimibe

¡’ ATC 1-3 §◊Õ C-10-A ®÷ß„™â√“§“¢Õß Simvastatin ´÷Ëß

‡ªìπ¬“∑’ËÕ¬Ÿà„π∫—≠™’¬“À≈—°·Ààß™“μ‘

°√≥’∑’Ë Ú °”Àπ¥„π≈—°…≥–¢Õß√“§“Õâ“ßÕ‘ß (reference pricing) ‰¥â·°à

(Ú.Ò) μ“¡√“§“®√‘ß∑’Ë·μà≈–‚√ßæ¬“∫“≈‡√’¬°‡°Á∫ ·μà

‰¡à‡°‘π‡æ¥“π∑’Ë°”Àπ¥®“°§à“¡—∏¬∞“π¢Õß¬“μ—«‡¥’¬«°—π®“°

∑ÿ°‚√ßæ¬“∫“≈

(Ú.Ú) μ“¡√“§“§ß∑’Ë ‚¥¬¡’Õ—μ√“‡∑à“°—∫§à“¡—∏¬∞“π

¢Õß¬“μ—«‡¥’¬«°—π®“°∑ÿ°‚√ßæ¬“∫“≈

∑—Èßπ’È ¬“μ—«‡¥’¬«°—π À¡“¬∂÷ß¬“´÷Ëß¡’™◊ËÕ “¡—≠ (generic name) ¢Õßμ—«¬“ ”§—≠∑’Ë‡À¡◊Õπ°—πμ“¡√À— ATC

„π√–¥—∫∑’Ë Ò-ı ·≈–¡’√Ÿª·∫∫ (dosage form) ‡¥’¬«°—π ‡™àπ Simvastatin ¡’ ATC 1-5 §◊Õ C-10-A-A-01, Atorvastatin

§◊Õ C-10-A-A-05, ·≈– Ezetimibe §◊Õ C-10-A-X-09 ¥—ß π—Èπ „π°√≥’π’È ¬“∑—Èß “¡√“¬°“√®÷ß„™â√“§“Õâ“ßÕ‘ß∑’Ë·μ°μà“ß°—π πÕ°®“°π’È ¬—ß∑”°“√«‘‡§√“–Àå§«“¡‰«„π°√≥’‡¡◊ËÕ‡ª≈’Ë¬π‰ª„™â

§à“‡©≈’Ë¬¢Õß√“§“®“°∑ÿ°‚√ßæ¬“∫“≈·∑π§à“¡—∏¬∞“π

„π°“√»÷°…“π’È ‡π◊ËÕß®“°¢âÕ¡Ÿ≈∑’Ë„™â„π°“√«‘‡§√“–Àå

‰¡à„™à¢âÕ¡Ÿ≈√–¥—∫„∫ —Ëß¢Õß¬“·μà≈–√“¬°“√ ·μà¡’≈—°…≥–‡ªìπ

¬Õ¥√«¡®÷ß‰¡à “¡“√∂·®ßπ—∫ª√‘¡“≥¬“„π√Ÿª¢ÕßÀπà«¬

¡“μ√∞“π ‡™àπ ®”π«π«—πμ“¡¢π“¥„™â (daily dose) ´÷Ëß “¡“√∂π”¡“∫«°≈∫§Ÿ≥À“√¢â“¡§«“¡·√ß¢Õß¬“™π‘¥

‡¥’¬«°—π‰¥â ¥—ßπ—Èπ „π°“√«‘‡§√“–Àå ®÷ß„™â§√—Èß¢Õß°“√ —Ëß„™â À√◊Õ®”π«π„∫ —Ëß¬“‡ªìπÀπà«¬¢Õß¡“μ√«—¥ª√‘¡“≥ ·≈â«

§”π«≥Õ—μ√“°“√‡∫‘°®à“¬À√◊Õ√“§“μàÕÀπà«¬„ÀâÕ¬Ÿà„π√Ÿª¢Õß

∫“∑μàÕ„∫ —Ëß

º≈°“√»÷°…“

—¥ à«π¢Õß¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘·≈–¡Ÿ≈§à“μàÕ

„∫ —Ëß

„π Ò ‡¥◊Õπ·√°¢Õßªïß∫ª√–¡“≥ ÚııÛ ‚√ßæ¬“∫“≈

μ“√“ß∑’Ë Ò ‡ß◊ËÕπ‰¢√–¥—∫√“§“∑’Ë„™â„π°“√°”Àπ¥Õ—μ√“‡∫‘°®à“¬§à“¬“

≈—°…≥–¬“∑’Ë„™âÕâ“ßÕ‘ß

¢Õß°≈ÿà¡¬“‡¥’¬«°—π ¢Õßμ—«¬“‡¥’¬«°—π

(ATC level 1-3) (ATC level 1-5)

°. μ“¡√“§“¢Õß¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘∑’Ë‡ªìπ§à“μË” ÿ¥ °√≥’∑’Ë Ò --

¢. μ“¡Õ—μ√“∑’Ë √æ. ‡√’¬°‡°Á∫ ·μà‰¡à‡°‘π‡æ¥“π∑’Ë‡ªìπ§à“¡—∏¬∞“π* -- °√≥’∑’Ë Ú.Ò

§. Õ—μ√“§ß∑’Ë (‡∑à“°—π∑ÿ° √æ.) ‚¥¬„™â§à“¡—∏¬∞“π* -- °√≥’∑’Ë Ú.Ú

*„™â§à“‡©≈’Ë¬ ”À√—∫°√≥’°“√«‘‡§√“–Àå§«“¡‰«

(5)

164 Ú¯ ·Ààß ¡’§à“„™â®à“¬¥â“π¬“ ”À√—∫ºŸâªÉ«¬πÕ°„π√–∫∫°“√

®à“¬μ√ß¢Õß «— ¥‘°“√√—°…“æ¬“∫“≈¢â“√“™°“√§‘¥‡ªìπ¡Ÿ≈§à“

ÒÙ,ıÙÛ ≈â“π∫“∑ ®“°°“√ —Ëß„™â√«¡ ÒÙ,ıÒˆ ≈â“π§√—Èß °≈ÿà¡

¬“∑’Ë¡’¡Ÿ≈§à“°“√‡∫‘°®à“¬ Ÿß·≈–¡’¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘

À≈“¬√“¬°“√„Àâ‡≈◊Õ°„™â¬—ß§ß‡ªìπ¬“°≈ÿà¡‡¥’¬«°—∫„πªï ÚııÚ

‰¥â·°à ¬“≈¥°“√À≈—Ëß°√¥ ¬“ ACEI-ARB ¬“μâ“π¢âÕÕ—°‡ ∫

·≈–¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ‚¥¬¡’¬“πÕ°∫—≠™’¬“À≈—°·Ààß

™“μ‘„π —¥ à«π∑’Ë Ÿß¡“°‡™àπ°—π √Ÿª∑’Ë Ú · ¥ß§à“„™â®à“¬¢Õß

°≈ÿà¡¬“·≈– —¥ à«πμ“¡¡Ÿ≈§à“¢Õß¬“πÕ°∫—≠™’¬“À≈—°œ ®“°

‚√ßæ¬“∫“≈ ÚÛ ·Ààß∑’Ë¡’¢âÕ¡Ÿ≈∑—Èßªï ÚııÚ ·≈– ÚııÛ

√Ÿª∑’Ë Û-ı · ¥ß —¥ à«πμ“¡¡Ÿ≈§à“„πªï ÚııÚ (·∑àß∫π) ·≈– ÚııÛ (·∑àß≈à“ß) ”À√—∫¬“≈¥°“√À≈—Ëß°√¥

¬“μâ“π¢âÕÕ—°‡ ∫ ·≈–¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ μ“¡≈”¥—∫

¢Õß‚√ßæ¬“∫“≈·μà≈–·Ààß „π ÚÛ ·Ààß ∑’Ë¡’¢âÕ¡Ÿ≈¢Õß∑—Èß Õßªï

‚¥¬·®°·®ß ”À√—∫¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘·μà≈–√“¬°“√

∑’Ë¡’§«“¡ ”§—≠·≈–‡ªìπ‡ªÑ“À¡“¬„π°“√§«∫§ÿ¡§à“„™â®à“¬ ‚¥¬

‡ª√’¬∫‡∑’¬∫°—∫√“¬°“√¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘

·∫∫·ºπ§à“„™â®à“¬¢Õß°“√„™â¬“·μà≈–°≈ÿà¡√–À«à“ßªï ÚııÚ ·≈– ÚııÛ ¢Õß‚√ßæ¬“∫“≈ à«π„À≠à‰¡à·μ°μà“ß°—π

¡“° ‚¥¬¬“≈¥°“√À≈—Ëß°√¥ª√–‡¿∑ PPI ∑’ËÕ¬ŸàπÕ°∫—≠™’¬“

À≈—°·Ààß™“μ‘ ‰¥â·°à Esomeprazole, Lansoparzole, Pantoprazole ·≈– Rabeprazole ´÷Ëß¡’ à«π·∫àß¢Õß§à“„™â

®à“¬§àÕπ¢â“ß Ÿß (√Ÿª∑’Ë Û) ¡’√“§“·æß¡“° ‡¡◊ËÕ«‘‡§√“–Àå‚¥¬„™â

§à“¡—∏¬∞“π¢ÕßÕ—μ√“‡∫‘°®à“¬μàÕ„∫ —Ëß®“°¢âÕ¡Ÿ≈¢Õß‚√ßæ¬“∫“≈

Ú¯ ·Ààß æ∫«à“ ¡Ÿ≈§à“μàÕ„∫ —Ëß„πªï ÚııÛ ¢Õß¬“πÕ°∫—≠™’

¬“À≈—°œ ‡À≈à“π’È‡∑à“°—∫ Ú,ı˘Ú-Ú,¯Ùˆ ∫“∑ „π¢≥–∑’Ë¡Ÿ≈§à“

μàÕ„∫ —Ëß¢Õß¬“„π∫—≠™’¬“À≈—°·Ààß™“μ‘ §◊Õ Ranitidine ·≈–

Omeprazole „πªï‡¥’¬«°—π Õ¬Ÿà∑’Ë‡æ’¬ß ˆı ·≈– ˘Û ∫“∑

μ“¡≈”¥—∫

”À√—∫¬“μâ“π¢âÕÕ—°‡ ∫ (√Ÿª∑’Ë Ù) ¡Ÿ≈§à“°“√„™â¬“

πÕ°∫—≠™’¬“À≈—°œ ∑’Ë‡ªìπ COX-2 inhibitors (Celecoxib ·≈–

E t o r i c o x i b ) · ≈ – S Y S A D O A ( G l u c o s a m i n e , Glucosamine+Chondroitin ·≈– Diacerein) ¡’ —¥ à«π∑’Ë Ÿß¡“° ‚¥¬„πªï ÚııÛ ¡—∏¬∞“π¢Õß¡Ÿ≈§à“μàÕ„∫ —Ëß¢Õß

√Ÿª∑’Ë Ú °≈ÿà¡¬“∑’Ë¡’§à“„™â®à“¬ Ÿß·≈– —¥ à«π¬“πÕ°∫—≠™’¬“À≈—°œ ªï ÚııÚ ·≈– ÚııÛ „π‚√ßæ¬“∫“≈ ÚÛ ·Ààß

0 100 200 300 400 500 600 700 800 900 1,000

Expenditure (million Baht)

Antiulcer ACEI-ARB Antiosteoarthritis Antilipid

2552 2553 2552 2553 2552 2553 2552 2553

Non-essential drug Essential drug

93.6% 92.7% 87.8% 85.3% 97.2% 98.0% 86.4% 85.9%

มูลคา (ลานบาท)และสัดสวนยานอกบัญชียาหลักแหงชาติ ยานอกบัญชียาหลักฯ ยาในบัญชียาหลักฯ

(6)

14173 13758 11496 11492 11484 11482 11481

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

0 10 20 30 40 50 60 70 80 90 100

11472 10745 10715 10679 10677 10676 10672 10670 10669 10666 10661

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

RNTD OMPZ

ESMPZ LSPZ PTPZ RBPZ

0 10 20 30 40 50 60 70 80 90 100

13781 13779 13778 13777 13756

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

U1

U2

U3

U4

U5

R1 R2 R3 R4 R5 R6 R7

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11

À¡“¬‡Àμÿ ¬“„π∫—≠™’¬“À≈—°œ ‰¥â·°à RNTD=Ranitidine ·≈– OMPZ=Omeprazole; ¬“πÕ°∫—≠™’¬“À≈—°œ PPI ‰¥â·°à ESMPZ=Esomeprazole, LSPZ=Lansoprazole, PTPZ=Pantoprazole ·≈– RBPZ=Rabeprazole

U1-U5 ‚√ßæ¬“∫“≈¡À“«‘∑¬“≈—¬ ı ·Ààß; R1-R7 ‚√ßæ¬“∫“≈ —ß°—¥Õ◊Ëπ ˜ ·Ààß; P1-P11 ‚√ßæ¬“∫“≈°√–∑√«ß “∏“√≥ ÿ¢ ÒÒ ·Ààß

14173 13758 11496 11492 11484 11482 11481

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

0 10 20 30 40 50 60 70 80 90 100

11472 10745 10715 10679 10677 10676 10672 10670 10669 10666 10661

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

DCFN IBPF NAPX PRXC MLXC CLCX ETCX GCSM DACR

0 10 20 30 40 50 60 70 80 90 100

13781 13779 13778 13777 13756

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

U1

U2

U3

U4

U5

R1 R2 R3 R4 R5 R6 R7

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11

À¡“¬‡Àμÿ ¬“„π∫—≠™’¬“À≈—°œ ‰¥â·°à DCFN=Diclofenac, IBPF=Ibuprofen, NAPX=Naproxen ·≈– PRXC=Piroxicam; ¬“πÕ°∫—≠™’¬“À≈—°œ NSAID

·≈– COX-2 inhibitor ‰¥â·°à MLXC=Meloxicam, CLCX=Celecoxib ·≈– ETCX=Etoricoxib; ¬“πÕ°∫—≠™’¬“À≈—°œ SYSADOA ‰¥â·°à GCSM=Glucosamine, Glucosamine+Chondroitin ·≈– DACR=Diacerein

U1-U5 ‚√ßæ¬“∫“≈¡À“«‘∑¬“≈—¬ ı ·Ààß; R1-R7 ‚√ßæ¬“∫“≈ —ß°—¥Õ◊Ëπ ˜ ·Ààß; P1-P11 ‚√ßæ¬“∫“≈°√–∑√«ß “∏“√≥ ÿ¢ ÒÒ ·Ààß

√Ÿª∑’Ë Û √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“≈¥°“√À≈—Ëß°√¥·μà≈–√“¬°“√ ªï ÚııÚ ·≈– ÚııÛ

√Ÿª∑’Ë Ù √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“μâ“π¢âÕÕ—°‡ ∫·μà≈–√“¬°“√ ªï ÚııÚ ·≈– ÚııÛ

(7)

166 Celecoxib ·≈– Etoricoxib ‡∑à“°—∫ Ò,Ú˜ ·≈– Ò,ÒÛÛ

∫“∑ ·≈–¢Õß SYSADOA Õ¬Ÿà∑’Ë Ò,ÙıÒ-Û,ÛÚ˘ ∫“∑

”À√—∫¡Ÿ≈§à“°“√„™â¬“„π∫—≠™’¬“À≈—°œ ‰¥â·°à Diclofenac, Ibuprofen, Naproxen ·≈– Piroxicam ¡’ —¥ à«π∑’ËμË”¡“°

„π‚√ßæ¬“∫“≈‡°◊Õ∫∑ÿ°·Ààß ‚¥¬¡’¡—∏¬∞“π¢Õß¡Ÿ≈§à“μàÕ„∫ —Ëß

„πªï‡¥’¬«°—πÕ¬Ÿà∑’Ë Ú¯-ÒÛ˘ ∫“∑ ‡∑à“π—Èπ

”À√—∫¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ (√Ÿª∑’Ë ı) æ∫«à“ „πªï ÚııÛ ‚√ßæ¬“∫“≈‡°◊Õ∫∑—ÈßÀ¡¥¡’¡Ÿ≈§à“°“√„™â Atorvastatin

‡ªìπ —¥ à«π Ÿß∑’Ë ÿ¥ √Õß≈ß¡“§◊Õ Rosuvastatin ·≈–

Ezetimibe ´÷Ëß∑—ÈßÀ¡¥‡ªìπ¬“πÕ°∫—≠™’¬“À≈—°œ ∑’Ë¡’√“§“·æß

„π¢≥–∑’Ë¡Ÿ≈§à“¢Õß Simvastatin ´÷Ëß‡ªìπ¬“„π∫—≠™’¬“À≈—°œ

¡’ —¥ à«π∑’Ë§àÕπ¢â“ßμË” ·∫∫·ºπ¥—ß°≈à“«§≈â“¬§≈÷ß°—∫ªï ÚııÚ

‚¥¬¡—∏¬∞“π¢Õß¡Ÿ≈§à“¬“μàÕ„∫ —Ëß¢Õß Simvastatin §‘¥‡ªìπ

ª√–¡“≥√âÕ¬≈– ı ¢Õß Atorvastatin ·≈– Rosuvastatin

»—°¬¿“æ„π°“√ª√–À¬—¥§à“„™â®à“¬¥â“π¬“¥â«¬°“√

°”Àπ¥Õ—μ√“‡∫‘°®à“¬

Ò. Õ—μ√“°“√‡∫‘°®à“¬μ“¡√“§“¢Õß¬“„π∫—≠™’¬“À≈—°·Ààß

™“μ‘

À“°°”Àπ¥‡ß◊ËÕπ‰¢°“√‡∫‘°®à“¬∑’Ë§àÕπ¢â“ß‡¢â¡ß«¥ §◊Õ

°“√„Àâ‡∫‘°§à“¬“„πÕ—μ√“μàÕ„∫ —Ëß∑’ËÕâ“ßÕ‘ß°—∫√“§“μË” ÿ¥¢Õß¬“

„π∫—≠™’¬“À≈—°œ ∑’ËÕ¬Ÿà°≈ÿà¡‡¥’¬«°—π §◊Õ¡’√À— ATC 1-3 ∑’Ë

‡À¡◊Õπ°—π (‡™àπ „™â√“§“¬“ “¡—≠¢Õß simvastatin ”À√—∫

¬“°≈ÿà¡§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥∑ÿ°μ—«) æ∫«à“ ®– “¡“√∂≈¥§à“

„™â®à“¬„πªï ÚııÛ ¢Õß°≈ÿà¡¬“‡ªÑ“À¡“¬ ”§—≠ Û °≈ÿà¡ ‰¥â·°à

¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥ ¬“μâ“π¢âÕÕ—°‡ ∫ ·≈–¬“≈¥°“√À≈—Ëß

°√¥≈ß‰¥â∂÷ß √âÕ¬≈– ˜Ú.¯, ¯ı.˜ ·≈– ¯ˆ.ı μ“¡≈”¥—∫

0 10 20 30 40 50 60 70 80 90 100

13781 13779 13778 13777 13756

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

14173 13758 11496 11492 11484 11482 11481

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

0 10 20 30 40 50 60 70 80 90 100

11472 10745 10715 10679 10677 10676 10672 10670 10669 10666 10661

2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552 2553 2552

SMVS ATVS ROSV PRVS FLVS PTVS EZTM ACPM FNFB U1

U2

U3

U4

U5

R1 R2 R3 R4 R5 R6 R7

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11

À¡“¬‡Àμÿ ¬“„π∫—≠™’¬“À≈—°œ Statins §◊Õ SMVS=Simvastatin; ¬“πÕ°∫—≠™’¬“À≈—°œ Statins ‰¥â·°à ATVS=Atorvastatiin, ROSV=

Rosuvastatin, PRVS=Pravastatin, FLVS=Fluvastatin, ·≈– PTVS=Pitavastatin; ·≈–¬“πÕ°∫—≠™’¬“À≈—°œ Õ◊ËπÊ ‰¥â·°à EZTM=Ezetimibe, ACPM=Acipimox, ·≈–¬“„π∫—≠™’¬“À≈—°œ Õ◊ËπÊ §◊Õ FNFB=Fenofibrate

U1-U5 ‚√ßæ¬“∫“≈¡À“«‘∑¬“≈—¬ ı ·Ààß; R1-R7 ‚√ßæ¬“∫“≈ —ß°—¥Õ◊Ëπ ˜ ·Ààß; P1-P11 ‚√ßæ¬“∫“≈°√–∑√«ß “∏“√≥ ÿ¢ ÒÒ

·Ààß

√Ÿª∑’Ë ı √âÕ¬≈–¢Õß¡Ÿ≈§à“¬“§«∫§ÿ¡‰¢¡—π„π‡≈◊Õ¥·μà≈–√“¬°“√ ªï ÚııÚ ·≈– ÚııÛ

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Ú. Õ—μ√“‡∫‘°®à“¬μ“¡√“§“Õâ“ßÕ‘ß

°“√»÷°…“π’È‡≈◊Õ°¬“ Ú °≈ÿà¡∑’Ë¡’§à“„™â®à“¬ Ÿß‰¡àμË”°«à“

°≈ÿà¡≈– ı ≈â“π∫“∑ ¬“∑—Èß Ú °≈ÿà¡§‘¥‡ªìπ√âÕ¬≈– ˆˆ.Ú

¢Õß¡’¡Ÿ≈§à“∑’Ë‡∫‘°®à“¬∑—ÈßÀ¡¥ æ∫«à“ §«“¡º—π·ª√¢Õßª√‘¡“≥¬“

‡™àπ ®”π«π‡¡Á¥μàÕ„∫ —Ëß∑’Ë√“¬ß“π‚¥¬‚√ßæ¬“∫“≈ Ú¯ ·Ààß

¡’§à“ —¡ª√– ‘∑∏‘Ï§«“¡·ª√ª√«π (coefficient of variation, CV) ‡∑à“°—∫ √âÕ¬≈– ıı.Û ‚¥¬‡©≈’Ë¬ ‚¥¬¡’√“¬°“√¬“∑’Ë¡’§à“

CV Ÿß°«à“ √âÕ¬≈– Ò „π —¥ à«π‡æ’¬ß√âÕ¬≈– ÒÒ.Ò ¢Õß

®”π«π√«¡∑—Èß ‘Èπ ÛÚÛ √“¬°“√ ¥—ßπ—Èπ °“√„™â¡Ÿ≈§à“¬“μàÕ

„∫ —Ëß‡ªìπ√“§“Õâ“ßÕ‘ß®÷ß‰¡àπà“®–∑”„Àâº≈°“√§“¥ª√–¡“≥

»—°¬¿“æ„π°“√ª√–À¬—¥§à“„™â®à“¬º—π·ª√¡“°π—°

Ú°. √“§“‰¡à‡°‘π‡æ¥“πÕ—μ√“‡∫‘°®à“¬

À“°°√¡∫—≠™’°≈“ß°”Àπ¥Õ—μ√“‡∫‘°®à“¬§à“¬“μ“¡∑’Ë‚√ß æ¬“∫“≈·μà≈–·Ààß„™â„πªí®®ÿ∫—π ·μà‰¡à‡°‘π‡æ¥“π∑’ËÕâ“ßÕ‘ß®“°

§à“¡—∏¬∞“π¢Õß√“§“®“°‚√ßæ¬“∫“≈∑ÿ°·Ààß æ∫«à“ ®–

“¡“√∂≈¥§à“„™â®à“¬¢Õß¬“ Ú °≈ÿà¡≈ß‰¥â§‘¥‡ªìπ¡Ÿ≈§à“

Ò,ÛÙ˜,¯ÛÚ,ˆ¯ı ∫“∑ À√◊Õ√âÕ¬≈– ÒÙ. ¢Õß§à“„™â®à“¬

√«¡ ”À√—∫¬“∑—Èß Ú °≈ÿà¡

‡¡◊ËÕ®”·π°μ“¡°≈ÿà¡¬“ (√Ÿª∑’Ë ˆ°) æ∫«à“ ¬“§«∫§ÿ¡

‰¢¡—π„π‡≈◊Õ¥ “¡“√∂≈¥‰¥â¡“°∑’Ë ÿ¥ §◊Õ Ò˘ˆ,ÚÛ˜,ıÚÛ ∫“∑

(√âÕ¬≈– ÒÛ.Ù) √Õß≈ß¡“ §◊Õ ¬“μâ“π¢âÕÕ—°‡ ∫™π‘¥√—∫ª√–∑“π

‡∑à“°—∫ ÒÚÛ,Ù¯˜,ÒıÙ ∫“∑ (√âÕ¬≈– ÒÛ.Û) ®–‡ÀÁπ«à“ °“√

°”Àπ¥‡æ¥“πÕ—μ√“‡∫‘°®à“¬∑’ËÕ‘ß°—∫¬“μ—«‡¥’¬«°—ππ’È¡’

»—°¬¿“æ„π°“√ª√–À¬—¥§à“„™â®à“¬¢Õß°≈ÿà¡¬“§«∫§ÿ¡‰¢¡—π„π

‡≈◊Õ¥·≈–¬“μâ“π¢âÕÕ—°‡ ∫‰¥âμË”°«à“°√≥’∑’ËÕ‘ß°—∫√“§“¬“„π

∫—≠™’¬“À≈—°œ ∂÷ß ı-ˆ ‡∑à“μ—«

”À√—∫ ¬“≈¥°“√À≈—Ëß°√¥ ¬“‚√§°√–¥Ÿ°æ√ÿπ ¬“≈¥

§«“¡¥—π‚≈À‘μ°≈ÿà¡ ARB ·≈–¬“‡∫“À«“π™π‘¥√—∫ª√–∑“π ¡’

—¥ à«π§à“„™â®à“¬∑’Ë “¡“√∂≈¥≈ß‰¥â„°≈â‡§’¬ß°—π §◊Õ √âÕ¬≈–

ÒÒ.ˆ, ÒÚ.Ù, ÒÚ.ˆ ·≈– ÒÚ.ˆ μ“¡≈”¥—∫ (√Ÿª∑’Ë ˆ°)

0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 ORL

ORL INJ ORL INJ INJ ORL ORL OTH INJ ORL INJ ORL INJ ORL ORL ORL OTH INJ INH ORL INJ ORL ORL ORL INJ ORL INJ INJ ORL ORL INJ INJ ORL OTH M.relaxant ORL Gonadotropic Insulin ACEI DMARD Antipsychotic Immuno.suppr.

Hormo.chemo.

Antineuro.pain Antiasthma

Antiplatelet

Oral antiDM Anti-HBV ARB Antiulcer

Antiosteoporosis

Hypo/hemo/renal anemia

NSAID/Antiosteoarthritis Cytotoxic Antilipid

ลานบ มูลคายารวม

มูลคายาที่ประหยัดได

(รอยละของมูลคารวม)

มูลคาของกลุมยา

นอย

มาก

20.4%

67.9%

15.9%

22.6%

18.6%

15.0%

12.5%

9.9%

10.5%

15.1%

48.8%

11.9%

18.3%

10.3%

9.0%

21.2%

12.4%

8.0%

1.4%

21.5%

12.6%

20.2%

11.8%

12.6%

63.5%

11.6%

7.2%

9.5%

12.4%

29.8%

16.5%

9.2%

13.3%

8.9%

13.8%

13.4%

√Ÿª∑’Ë ˆ° °“√≈¥§à“„™â®à“¬¢Õß¬“ Ú °≈ÿà¡ À“°„Àâ‡∫‘°®à“¬μ“¡®√‘ß‰¡à‡°‘π‡æ¥“π§à“¡—∏¬∞“πμàÕ„∫ —Ëß Ú¯ ‚√ßæ¬“∫“≈ ªï ÚııÛ À¡“¬‡Àμÿ ORL = Oral form, INJ = Injection form, OTH = other form

≈â“π∫“∑

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168

·∑π§à“¡—∏¬∞“π æ∫«à“ ®– “¡“√∂ª√–À¬—¥§à“„™â®à“¬¢Õß¬“∑—Èß Ú °≈ÿà¡¥—ß°≈à“«≈ß‰¥â„°≈â‡§’¬ß°—∫°“√„™â§à“¡—∏¬∞“π §◊Õ Ò,ÛÛ,ˆ˘Û,ÙÒı ∫“∑ À√◊Õ§‘¥‡ªìπ√âÕ¬≈– ÒÛ.¯

Ú¢. Õ—μ√“‡∫‘°®à“¬§ß∑’Ë

À“°°”Àπ¥Õ—μ√“°“√‡∫‘°®à“¬ ”À√—∫∑ÿ°‚√ßæ¬“∫“≈„Àâ

§ß∑’Ë‡∑à“°—∫§à“¡—∏¬∞“π¢Õß√“§“®“°‚√ßæ¬“∫“≈ Ú¯ ·Ààß æ∫

«à“ “¡“√∂ª√–À¬—¥§à“„™â®à“¬¢Õß¬“∑—Èß Ú °≈ÿà¡‰¥â‡æ’¬ß Ú˜˜,Û˜ı,˘Ù˜ ∫“∑ À√◊Õ§‘¥‡ªìπ√âÕ¬≈– Ú.˘ ¢Õß¡Ÿ≈§à“¬“

Ú °≈ÿà¡ (√Ÿª∑’Ë ˆ¢)

‡ªìπ∑’Ëπà“ —ß‡°μ«à“ ¡’¬“À≈“¬°≈ÿà¡∑’Ë°“√°”Àπ¥Õ—μ√“‡∫‘°

®à“¬·∫∫§ß∑’Ë∑”„Àâ§à“„™â®à“¬ ÿ∑∏‘°≈—∫‡æ‘Ë¡ Ÿß¢÷Èπ®“°∑’Ë‡ªìπÕ¬Ÿà

„πªí®®ÿ∫—π ‡π◊ËÕß®“°‚√ßæ¬“∫“≈À≈“¬·Ààß´÷Ëß‡§¬‡∫‘°®à“¬μ“¡

√“§“®√‘ß (∑’ËμË”°«à“√“§“Õâ“ßÕ‘ß À√◊Õ§à“¡—∏¬∞“π) “¡“√∂‡∫‘°

„π√“§“∑’Ë Ÿß¢÷Èπ ®πÕ“®¡’¡Ÿ≈§à“¡“°°«à“§à“„™â®à“¬∑’Ë≈¥≈ß®“°

À√◊Õ√âÕ¬≈– ı¯.¯) ¬“„™â„π hypoplastic, hemolytic ·≈–

renal anemia (‡æ‘Ë¡¢÷Èπ ÒÚÙ,ˆ˜Ú,ÛıÙ ∫“∑ À√◊Õ√âÕ¬≈–

Ò˘.Ú) ‡ªìπμâπ

æ∫«à“ §à“„™â®à“¬√«¡¢Õß¬“ Ú °≈ÿà¡∑’Ë “¡“√∂ª√–À¬—¥‰¥â®–

≈¥≈ß‡À≈◊Õ‡æ’¬ß Ûı,ı˘ı,ı˘Û ∫“∑ À√◊Õ√âÕ¬≈– .Ù ´÷Ëß

‡ªìπ —¥ à«π∑’ËπâÕ¬¡“°®πÕ“®‰¡à§ÿâ¡§à“°—∫°“√„™â¡“μ√°“√¥—ß

°≈à“«

√Ÿª∑’Ë ˆ¢ °“√≈¥§à“„™â®à“¬¢Õß¬“ Ú °≈ÿà¡ À“°„Àâ‡∫‘°®à“¬‡∑à“°—∫§à“¡—∏¬∞“πμàÕ„∫ —Ëß Ú¯ ‚√ßæ¬“∫“≈ ªï ÚııÛ

-150 -50 50 150 250 350 450 550 650 750 850 950 1,050 1,150 1,250 1,350 1,450 ORL

ORL INJ ORL INJ INJ ORL ORL OTH INJ ORL INJ ORL INJ ORL ORL ORL OTH INJ INH ORL INJ ORL ORL ORL INJ ORL INJ INJ ORL ORL INJ INJ ORL OTH M.relaxant ORL Gonadotropic

Insulin ACEI DMARD Antipsychotic Immuno.suppr.

Hormo.chemo.

Antineuro.pain Antiasthma

Antiplatelet

Oral antiDM Anti-HBV ARB Antiulcer

Antiosteoporosis

Hypo/hemo/renal anemia

NSAID/Antiosteoarthritis Cytotoxic Antilipid

มูลคาของกลุมยา

นอย

มาก

10.3%

58.8%

-26.3%

14.8%

1.6%

8.6%

6.6%

0.9%

-7.1%

8.5%

7.4%

7.8%

12.2%

2.3%

0.8%

13.9%

5.6%

-22.3%

-0.6%

1.3%

2.4%

13.6%

3.3%

6.8%

60.5%

4.3%

2.7%

-1.0%

6.2%

28.3%

-19.2%

-58.8%

3.0%

-10.3%

8.1%

6.8%

มูลคายารวม มูลคายาที่ประหยัดได

(รอยละของมูลคารวม)

ลานบาท

À¡“¬‡Àμÿ ORL = Oral form, INJ = Injection form, OTH = other form

(10)

«‘®“√≥å·≈–¢âÕ¬ÿμ‘

À“°√—∞∫“≈μ—¥ ‘π„®„™â¡“μ√°“√§«∫§ÿ¡§à“„™â®à“¬ ”À√—∫

¬“ Ú °≈ÿà¡∑’Ë¡’¡Ÿ≈§à“°“√‡∫‘°®à“¬‰¡àμË”°«à“°≈ÿà¡≈– ı ≈â“π

∫“∑ ¥â«¬°“√°”Àπ¥Õ—μ√“‡∫‘°®à“¬‚¥¬Õ“»—¬√“§“Õâ“ßÕ‘ß ”À√—∫¬“∑’Ë¡’√À— ATC 1-5 ·≈–¡’√Ÿª·∫∫‡¥’¬«°—π ª√–¡“≥

°“√‰¥â«à“ À“°°”Àπ¥‡æ¥“π„Àâ‰¡à‡°‘π§à“¡—∏¬∞“π¢Õß√“§“μàÕ

„∫ —Ëß®“°∑ÿ°‚√ßæ¬“∫“≈ ®–¡’»—°¬¿“æ„π°“√≈¥§à“„™â®à“¬

®“°„πªí®®ÿ∫—π≈ß‰¥â√âÕ¬≈– ÒÙ ·μà∂â“„Àâ‚√ßæ¬“∫“≈∑ÿ°·Ààß

‡∫‘°‰¥â„πÕ—μ√“∑’Ë‡∑à“°—∫√“§“¡—∏¬∞“π ®–≈¥§à“„™â®à“¬‰¥â‡æ’¬ß

√âÕ¬≈– Ú.˘

„πªï ÚııÙ-Úııı Õÿμ “À°√√¡¬“®–¡’ ‘∑∏‘∫—μ√¬“

®”π«π¡“°À¡¥Õ“¬ÿ≈ß À≈“¬√“¬°“√‡ªìπ¬“∑’ËÕ¬Ÿà„π°≈ÿà¡∑’Ë

»÷°…“π’È ‡™àπ Clopidogrel; Atorvastatin, Rosuvastatin;

Losartan, Valsartan, Irbesartan; Pioglitazone, Rosiglitazone; Budesonide+Formoterol, Salmeterol+

Fluticasone, Montelukast; Zoledronic; Anastrozole, Letrozole; Olanzapine, ·≈– Quetiapine ‡ªìπμâπ „π ª√–‡∑» À√—∞Õ‡¡√‘°“ √“§“‡©≈’Ë¬¢Õß¬“„π∑âÕßμ≈“¥∑’Ë‡§¬¡’

º≈‘μ¿—≥±åμâπ·∫∫∑’Ë∑√ß ‘∑∏‘∫—μ√®–≈¥≈ßÕ¬à“ß¡“° ¿“¬„π‡«≈“

Ò ªïÀ≈—ß°“√À¡¥Õ“¬ÿ ‘∑∏‘∫—μ√ ‡π◊ËÕß®“°°“√·¢àß¢—π¢Õß º≈‘μ¿—≥±å∑’Ë‡ªìπ¬“™◊ËÕ “¡—≠^(ı) ¥—ßπ—Èπ §“¥«à“√“§“Õâ“ßÕ‘ß¢Õß

¬“À≈“¬μ—«∑’Ë¡’ºŸâ®”Àπà“¬À≈“¬√“¬πà“®–≈¥μË”≈ß°«à“√“§“∑’Ë„™â

«‘‡§√“–Àå„π°“√»÷°…“π’È ∑”„Àâ»—°¬¿“æ¢Õß°“√ª√–À¬—¥§à“„™â

®à“¬®“°°“√„™â√“§“Õâ“ßÕ‘ß‡æ‘Ë¡¢÷Èπ √—∞‚¥¬°√¡∫—≠™’°≈“ß§«√

„Àâ§«“¡ ”§—≠°—∫°“√„™â¡“μ√°“√√“§“Õâ“ßÕ‘ß ”À√—∫§«∫§ÿ¡

°“√„™â¬“∑’Ë¡’§à“„™â®à“¬ Ÿß¢Õß‚√ßæ¬“∫“≈ ‚¥¬¡’∑“ß‡≈◊Õ°¢Õß

√–¥—∫√“§“Õâ“ßÕ‘ß√–À«à“ß‡ß◊ËÕπ‰¢∑’Ë‡¢â¡ß«¥∑’Ë ÿ¥ §◊Õ ¬“„π

∫—≠™’¬“À≈—°·Ààß™“μ‘∑’Ë¡’√À— ATC code 1-3 ‡À¡◊Õπ°—π °—∫

‡ß◊ËÕπ‰¢∑’Ë‡¢â¡ß«¥πâÕ¬∑’Ë ÿ¥ §◊Õ ¬“∑’Ë¡’√À— ATC code 1-5

‡À¡◊Õπ°—π ·≈–Õ¬Ÿà„π√Ÿª·∫∫‡¥’¬«°—π

°‘μμ‘°√√¡ª√–°“»

ºŸâπ‘æπ∏å¢Õ¢Õ∫§ÿ≥ °√¡∫—≠™’°≈“ß„π°“√ª√– “πß“π°—∫

‚√ßæ¬“∫“≈·≈–„Àâ¢âÕ¡Ÿ≈∑’Ë‡ªìπª√–‚¬™πåμàÕ°“√«‘®—¬ ¢Õ

¢Õ∫§ÿ≥ ∂“∫—π«‘®—¬√–∫∫ “∏“√≥ ÿ¢„π°“√„Àâ§«“¡√à«¡¡◊Õ π—∫ πÿπ¢âÕ¡Ÿ≈ß“π«‘®—¬∑’Ë‡°’Ë¬«¢âÕß ·≈–¢Õ¢Õ∫§ÿ≥‚√ß æ¬“∫“≈π”√àÕß∑’Ë„Àâ¢âÕ¡Ÿ≈‡æ◊ËÕ„™â„π°“√»÷°…“§√—Èßπ’È

‡Õ° “√Õâ“ßÕ‘ß

Ò. ”π—°ß“π°≈“ß “√ π‡∑»∫√‘°“√ ÿ¢¿“æ ( ° .) √ÿª°“√‡∫‘°®à“¬§à“

√—°…“æ¬“∫“≈ºŸâªÉ«¬„π·≈–ºŸâªÉ«¬πÕ°∑’Ë¥”‡π‘π°“√„πªïß∫ª√–¡“≥

ÚııÚ ·≈–º≈°“√«‘‡§√“–Àå √«¡∑—Èß¢âÕ‡ πÕ·π–„π°“√¥”‡π‘π°“√

μàÕ‰ª ‡Õ° “√“¬ß“π °√ÿß‡∑æ¡À“π§√ ° . ÚııÛ.

Ú. ”π—°ß“π«‘®—¬‡æ◊ËÕ°“√æ—≤π“À≈—°ª√–°—π ÿ¢¿“æ‰∑¬ ( «ª°.) °“√„™â¬“

º≈°√–∑∫μàÕ§à“„™â®à“¬ ·≈–¡“μ√°“√§«∫§ÿ¡°“√„™â¬“¢Õß‚√ß æ¬“∫“≈π”√àÕß °√≥’ºŸâªÉ«¬πÕ° „π√–∫∫®à“¬μ√ß «— ¥‘°“√√—°…“

æ¬“∫“≈¢â“√“™°“√ ªïß∫ª√–¡“≥ ÚııÚ √“¬ß“π ππ∑∫ÿ√’ «ª°.

ÚııÛ.

Û. ®ÿÃ“¿√≥å ≈‘¡«—≤π“ππ∑å, ÿæ≈ ≈‘¡«—≤π“ππ∑å, Õ“√’«√√≥

‡™’Ë¬«™“≠«—≤π“, πæ§ÿ≥ ∏√√¡∏—™Õ“√’, æ—™π’ ∏√√¡«√√≥“, —¡ƒ∑∏‘Ï

»√’∏”√ß «— ¥‘Ï. §à“„™â®à“¬¢Õß «— ¥‘°“√√—°…“æ¬“∫“≈¢â“√“™°“√°—∫

°“√„™â¬“πÕ°∫—≠™’¬“À≈—°·Ààß™“μ‘. «“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢

ÚııÙ.

Ù. WHO Collaborating Centre for Drug Statistics Methodology. Guide- lines for ATC classification and DDD assignment 2010 (13th edition). Oslo, 2009.

ı. Berndt E, Joseph N. Pricing and reimbursement in U.S. Pharma- ceutical Market. HKS Faculty Research Working Paper Series RWP10-039. Harvard University 2010.