[1]徐志浩,王 健,谭佳龙.医保决策中真实世界数据的应用实践与启示 ——以NICE药品准入评估中的决策调整因子为例[J].卫生经济研究,2026,43(06):34-38.
　XU Zhihao,WANG Jian,TAN Jialong.Practical Applications and Insights of Real-World Data in Health Insurance Decision-Making ——Taking Decision Modifiers of Drug Access Assessment in NICE as an Example[J].Journal Press of Health Economics Research,2026,43(06):34-38.
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医保决策中真实世界数据的应用实践与启示
——以NICE药品准入评估中的决策调整因子为例

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年06期
页码:
34-38
栏目:
卫生技术评估
出版日期:
2026-06-03

文章信息/Info

Title:
Practical Applications and Insights of Real-World Data in Health Insurance Decision-Making
——Taking Decision Modifiers of Drug Access Assessment in NICE as an Example
作者:
徐志浩1; 王 健1; 谭佳龙1
1.武汉大学董辅礽经济社会发展研究院，湖北 武汉 430072
Author(s):
XU Zhihao;  WANG Jian;  TAN Jialong
Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan Hubei 430072, China
关键词:
真实世界数据; 卫生技术评估; 决策调整因子; 国际经验
Keywords:
real-world data;  Health technology assessment;  decision modifiers;  international experience
分类号:
R19
文献标志码:
A
摘要:
英国国家卫生与临床优化研究所（NICE）将真实世界数据有效应用于卫生技术评估各环节，并在医保决策中创新性运用决策调整因子（如严重度调整因子、健康不平等、高度专业化技术等），弥补了单一QALY指标的局限性，实现了医保决策向多维度价值评估的转变。英国的经验表明，真实世界数据为提升医保决策科学化、精细化提供了关键支撑。对我国的启示是，建立药品真实世界价值评估机制、引入权重调整机制、降低新药上市和医保准入不确定性，为医保部门的药品准入与支付决策提供更全面、更公平的价值评估依据，推动医保定价和支付策略向以患者为中心的方向发展。
Abstract:
In the United Kingdom, National Institute for Health and Care Excellence (NICE) effectively applies real-world data (RWD) across all stages of health technology assessment (HTA), and innovatively employs decision modifiers (such as severity modifiers, health inequality considerations, and highly specialized technologies) in health insurance decision-making, which addresses the limitations of the single QALY metric and facilitates a shift toward multidimensional value assessment in health insurance decision-making. The UK experience demonstrates that RWD provides critical support for enhancing the scientific and refined management of health insurance decision-making. For China, it is recommended to establish a real-world value assessment mechanism for pharmaceuticals, introduce weighting adjustment mechanisms, and reduce uncertainty regarding new drug market entry and health insurance access. These measures aim to provide more comprehensive and equitable evidence to support drug access and reimbursement decisions in health insurance system in China, and promote the development of health insurance pricing and reimbursement strategies towards a patient-centered approach.

参考文献/References:

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更新日期/Last Update: 2026-06-03