Exploring The Method Of Constructing The Clinical Path Of The Pharmacy Edition Under The Reform Of Drgs Payment Method

ObjectivesThe excessive and rapid growth of medical expenses has become a major problem and severe challenge in the world,and the level of drug costs has a great correlation with the level of medical and health costs.Our country has begun to implement a pilot reform of the payment method based on disease diagnosis-related groups(DRGs)in some hospitals,and the clinical pathway as a standardized clinical diagnosis and treatment standard is the basis for calculating the DRGs payment standard and the guarantee for the smooth implementation of the DRGs payment method reform.The current clinical pathway has not refined the specifications of drugs,and the economic considerations of drugs are not sufficient.After DRG data analysis and screening,this study finally took non-small cell lung cancer(NSCLC)as an example,through evidence-based pharmacy and pharmacoeconomic evaluation methods,the pharmacy clinical pathway of NSCLC was formulated to refine the medicine plan of clinical pathway and improve the quality of medical treatment.Methods1.Extracting data on the number of cases,hospitalization days,hospitalization fees,drug fees,antibacterial medicine expenses and other data of each disease group,and calculating the proportion of medicines,which are related to disease diagnosis grouping costs.Performing cost interval and composition analysis to find groups with high frequency of occurrence and large cost gaps.2.Evidence production for evidence-based guideline: Systematic retrieving the domestic or foreign NSCLC clinical practice guidelines,and then following the inclusion and exclusion criteria to screen the guidelines,and including the evidence-based clinical practice guidelines that meet the requirements.Using the guidelines research and evaluation tool(Appraisal of Guidelines for Research &Evaluation II,AGREE II)to evaluate the methodological quality of the included guidelines,taking the drug as the outline,merging the evidence-based guide information,then using the quality evaluation tool(The Grading of Recommendations Assessment,Development and Evaluation,GRADE)evaluated results,and comparing and summarizing the recommendations of drug treatment.3.Evidence production for Pharmacoeconomics research: The pharmacoeconomic evaluation literature of Chinese NSCLC treatment programs was searched systematically,and the literature was screened strictly according to the inclusion and exclusion criteria.The quality evaluation tool(Consolidated Health Economic Evaluation Reporting Standards,CHEERS)scale was used to evaluate the quality of the literature,extracting relevant data from the literature for analysis,and systematically evaluating the economic research results of different treatment options for NSCLC.Results1.Through the analysis of DRG data from a pilot hospital in Fujian Province,we extracted groups with high frequency of occurrence、large cost gaps and drug expense CV value—malignant tumor groups,and focused on NSCLC related clinical pathway.2.A total of 8 evidence-based clinical practice guidelines for NSCLC were included.After using the AGREEⅡtool,the recommended grades were all grade B.There are slight differences in the recommendations of therapeutic drugs in each guidelines.The difference group used GRADE to evaluate the quality of the original study and the grade of evidence.Through comprehensive analysis and integration,recommendations for the effectiveness of NSCLC treatment were formed.3.A total of 18 pharmacoeconomic evaluation studies were included,and different models were used to evaluate the economics of NSCLC treatment drugs from different perspectives.The drugs that have been studied the most are the TKIs.Among the EGFR-TKI drugs,first-line treatment with gefitinib is relatively economical.Crizotinib in ALK-TKI is relatively economical.Immunotherapy drugs are currently uneconomical to use in China.ConclusionsThe malignant tumor groups were screened out through the DRG data of a pilot hospital in Fujian Province,and the evidence-based guideline system evaluation and economic research system evaluation methods were used to explore the pharmic clinical pathway of NSCLC.At present,the treatment of NSCLC in our country mainly adopts TKI drugs,immunotherapy drugs and traditional chemotherapeutic drugs.It is necessary to improve the specific medication plan in the treatment pathway of NSCLC according to the specific conditions and needs of patients,combined with the cost and benefits of the treatment,so as to promote the better and more complete implementation of DRG.