可负担性问题和对印度炎症性肠病高级治疗的报销程序的需求。

IF 2.2 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Current Medical Research and Opinion Pub Date : 2025-06-01 Epub Date: 2025-07-25 DOI:10.1080/03007995.2025.2534471
Nagesh Kamat, Gaurav Patil, Ankit Dalal, Sanil Parekh, Amit Maydeo
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引用次数: 0

摘要

炎症性肠病(IBD)是一种侵袭性复发性疾病,可以在年轻时发展,并且具有很高的终身医疗费用风险。中度至重度克罗恩病或溃疡性结肠炎患者需要生物治疗来诱导和维持缓解。治疗这些疾病的费用已从住院和手术转移到生物制剂,这些费用部分得到报销。这篇综述发现,少数保险公司为生物注射提供日托保险,而在印度,注射只在24小时入院时得到报销。这因患者和保险公司而异。抗肿瘤坏死因子的生物仿制药可以节省成本,但不能节省总成本。通过免赔额、共付额和共同保险,病人不得不接受大量的费用。虽然保险部分覆盖了财务风险,但IBD的医疗保健仍然只有一些人负担得起。制造商需要了解付款人的观点,以提供最好的患者治疗结果。定价策略应该是特定指示/基于数量的定价。小分子药物的采用有可能通过将护理转向以药物为基础的模式,从而改变以输液为基础的报销政策,改善农村人口的可及性。有必要实施全民健康覆盖后,抵押模式可用于在IBD中分摊生物制剂的费用。在确定产品成本时,必须考虑付款人的观点,并将患者纳入医疗保健政策决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Affordability issues and the need for a reimbursement process of advanced therapy for inflammatory bowel diseases in India.

Inflammatory bowel disease (IBD) is an aggressive relapsing condition that can develop at a young age and carries a high lifetime risk of medical expenses. Patients with moderate-to-severe Crohn's disease or Ulcerative colitis need biologic therapy for induction and maintenance of remission. The cost of treating these has moved from hospitalization and surgery to biologics, which are partly reimbursed. This review identifies that a handful of insurance companies provide daycare coverage for the biologic infusion, while the injections get reimbursed only on 24-hour admission in India. This varies from patient to patient and from one insurance company to another. The biosimilars of anti-TNFs drive savings but not overall costs. Patients are made to accept substantial costs through deductibles, copayments, and coinsurance. While insurance partially covers the financial risk, healthcare in IBD remains affordable to only some. The manufacturers need to comprehend payers' perspectives to deliver the best possible patient outcomes. The pricing strategies should be indication-specific/volume-based pricing. Small molecules adoption has the potential to disrupt infusion-based reimbursement policies by shifting care to pharmacy-based models, improving access for rural populations. There is a need to implement universal health coverage post which the mortgage model can be used to spread the cost of biologics over time in IBD. The payers' perspective must be considered while determining the cost of the product and include patients in healthcare policy decision-making.

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来源期刊
Current Medical Research and Opinion
Current Medical Research and Opinion 医学-医学:内科
CiteScore
4.40
自引率
4.30%
发文量
247
审稿时长
3-8 weeks
期刊介绍: Current Medical Research and Opinion is a MEDLINE-indexed, peer-reviewed, international journal for the rapid publication of original research on new and existing drugs and therapies, Phase II-IV studies, and post-marketing investigations. Equivalence, safety and efficacy/effectiveness studies are especially encouraged. Preclinical, Phase I, pharmacoeconomic, outcomes and quality of life studies may also be considered if there is clear clinical relevance
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