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題名 製藥產業創新核價模式
Innovative Pricing Model in Pharmaceutical Industry
作者 王宥人
貢獻者 李仁芳
王宥人
關鍵詞 創新核價模式
風險分攤
價量協議
結果導向給付方案成
效為基礎給付模式
製藥產業
日期 2011
上傳時間 1-九月-2016 23:40:55 (UTC+8)
摘要 由於醫療科技的進步以及人口老化造成各國政府對於健康支出越來越高，導致財務上的壓力；很多創新的藥品因為研發成本高或是病人族群太少所以價格高昂。醫療保險也因為財務衝擊過大而無法給付，最後演變成醫療的需要無法被完全滿足。

因此藥品公司採用創新核價模式，透過分擔財務上風險來降低交易成本，近年來更有藥品公司與保險公司或政府簽訂契約，以分擔治療結果上的風險來降低市場進入障礙。

本篇論文嘗試以新制度經濟學交易成本理論，初探製藥產業為了降低市場進入障礙採用創新核價模式的可行性。透過文獻整理、外在環境與兩個個案分析發現，創新核價/給付模式提供政府與藥品公司足夠的誘因，讓雙方願意坐下來協商雙方都可接受的可能性。

因此，創新核價/給付模式確實能有效降低市場進入障礙，提高新藥的可近性。適合採用創新核價模式的產品通常有以下三個共同特點：交易頻率相對較低，單價高或財務衝擊大，有明確的審查依據並能取得客觀可靠的資訊。台灣目前已有產品部份採用創新核價/給付模式。

不確定性是影響交易成本的主要因素，事實上台灣也有越來越多的創新核價/給付模式用來增加市場可近性，除了個案所提的價量協議合約以外，事實上健保局早就將以成效為基礎給付的創新核價/給付模式隱身在給付規定中。未來，創新核價/給付模式除了財務上的風險分攤以外，依實證發展給付（coverage with evidence development, CED）模式或許會成為下一個發展的重點。
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43. Sullivan SD, Garrison LP, Carlson JJ, et al. Performance-Based Risk-Sharing Reimbursement Agreements for New Medical Products (Executive Summary). In: ISPOR 11th Annual European Congress: Risk-sharing agreements panel. Athens: Pharmaceutical Outcomes Research and Policy Program, University of Washington; 2008.

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48. Philip J. Rosenfeld et al. for the MARINA Study Group. Ranibizumab for Neovascular Age-Related Macular Degeneration. N Engl J Med 2006;355:1419-31.

49. David M. Brown et al. for the ANCHOR Study Group. Ranibizumab versus Verteporfin for Neovascular Age-Related Macular Degeneration. N Engl J Med 2006;355:1432-44.

50. National Institute for Health and Clinical Excellence, NICE technology appraisal guidance 155. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. Aug 2008. http://www.nice.org.uk/nicemedia/live/12057/41719/41719.pdf

51. National Institute for Health and Clinical Excellence, Audit Support. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. Sep 2008. http://www.nice.org.uk/nicemedia/live/12057/41926/41926.doc

52. Department of Health and Ageing. About Pharmaceutical Benefits Scheme http://www.pbs.gov.au/info/about-the-pbs

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54. Canadian Agency for Drugs and Technologies in Health. CEDAC Final Recommendation and Reasons for Recommendation, Ranibizumab. Mar, 2008 http://www.cadth.ca/media/cdr/complete/cdr_complete_Lucentis_March-27-2008.pdf

55. Saskatchewan Health, Appendix A of Exception Drug Status (EDS) Program. http://formulary.drugplan.health.gov.sk.ca/publications/APPENDIX%20A.pdf

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57. 全民健康保險藥事小組第8屆第9次會議紀錄http://www.nhi.gov.tw/Resource/webdata/Attach_14890_2_全民健康保險藥事小組第8屆第9次會議記錄0990111.pdf

58. 全民健康保險藥事小組第8屆第13次會議紀錄http://www.nhi.gov.tw/Resource/webdata/Attach_15476_2_全民健康保險藥事小組第8屆第13次會議紀錄.pdf

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70. Black DM, Delmas PD, Eastell R, et al. Once-yearly Zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007:356:1809-22.

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72. 國民健康局2007年台灣中老年身心社會生活狀況長期追蹤(第六次）調查

73. Black DM, Delmas PD, Eastell R, et al. Once-yearly Zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007:356:1809-22.

74. 游慧光(2004)，OECD國家與台灣醫療保健支出成長因素之探討，逢甲大學會計與財稅研究所碩士論文。

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76. Frank R.G.,“Government Commitment and Regulation of Prescription Drugs” Health Affairs 2003;22(3):46-48.

77. 行政院衛生署中央健康保險局, 全民健康保險藥品給付規定http://www.nhi.gov.tw/Resource/webdata/15321_1_藥品給付規定條文.doc
描述 碩士
國立政治大學
科技管理研究所
94359030
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0094359030
資料類型 thesis
dc.contributor.advisor 李仁芳zh_TW
dc.contributor.author (作者) 王宥人zh_TW
dc.creator (作者) 王宥人zh_TW
dc.date (日期) 2011en_US
dc.date.accessioned 1-九月-2016 23:40:55 (UTC+8)-
dc.date.available 1-九月-2016 23:40:55 (UTC+8)-
dc.date.issued (上傳時間) 1-九月-2016 23:40:55 (UTC+8)-
dc.identifier (其他 識別碼) G0094359030en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/101065-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 科技管理研究所zh_TW
dc.description (描述) 94359030zh_TW
dc.description.abstract (摘要) 由於醫療科技的進步以及人口老化造成各國政府對於健康支出越來越高，導致財務上的壓力；很多創新的藥品因為研發成本高或是病人族群太少所以價格高昂。醫療保險也因為財務衝擊過大而無法給付，最後演變成醫療的需要無法被完全滿足。

因此藥品公司採用創新核價模式，透過分擔財務上風險來降低交易成本，近年來更有藥品公司與保險公司或政府簽訂契約，以分擔治療結果上的風險來降低市場進入障礙。

本篇論文嘗試以新制度經濟學交易成本理論，初探製藥產業為了降低市場進入障礙採用創新核價模式的可行性。透過文獻整理、外在環境與兩個個案分析發現，創新核價/給付模式提供政府與藥品公司足夠的誘因，讓雙方願意坐下來協商雙方都可接受的可能性。

因此，創新核價/給付模式確實能有效降低市場進入障礙，提高新藥的可近性。適合採用創新核價模式的產品通常有以下三個共同特點：交易頻率相對較低，單價高或財務衝擊大，有明確的審查依據並能取得客觀可靠的資訊。台灣目前已有產品部份採用創新核價/給付模式。

不確定性是影響交易成本的主要因素，事實上台灣也有越來越多的創新核價/給付模式用來增加市場可近性，除了個案所提的價量協議合約以外，事實上健保局早就將以成效為基礎給付的創新核價/給付模式隱身在給付規定中。未來，創新核價/給付模式除了財務上的風險分攤以外，依實證發展給付（coverage with evidence development, CED）模式或許會成為下一個發展的重點。		zh_TW
dc.description.tableofcontents 第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題 4
第二章 文獻探討 5
第一節 交易成本理論 8
壹、 交易的概念 8
貳、 何謂交易成本 8
參、 交易成本分析 11
肆、 小結 13
第二節 契約理論 14
壹、 契約理論的要素 14
貳、 契約理論的類型 15
參、 小結 20
第三節 創新核價/給付模式 21
壹、 創新核價/給付模式的類型 21
貳、 以成效為基礎給付的創新核價/給付模式類型 24
參、 藥品公司整理的創新核價/給付模式的範疇與型態 32
第三章 研究方法 38
第一節 研究流程 38
第二節 研究架構 39
壹、 影響不確定性的因素 39
貳、 影響交易頻率的因素 40
參、 影響資產專屬性的因素 40
第三節 研究設計與資料收集方式 42
壹、 研究方法 42
貳、 資料收集方法 42
參、 研究對象 43
第四節 研究限制 45
第四章 個案研究 46
第一節 Lucentis 46
壹、 個案背景介紹 46
貳、 各國創新核價/給付模式 49
參、 個案分析 62
第二節 Aclasta 66
壹、 個案背景介紹 66
貳、 各國創新核價/給付模型 69
參、 個案分析 74
第五章 研究發現與討論 78
第一節 研究發現 78
壹、 創新核價模式能提高新藥的可近性 78
貳、 採用創新核價模式的產品共同特點 78
參、 台灣部份採用創新核價/給付模式 81
第二節 討論 82
壹、 創新核價/給付模式是未來的核價給付趨勢 82
貳、 不確定性是影響交易成本的主要因素 82
參、 台灣也有越來越多的創新核價/給付模式 87
附錄一. NICE Guidance for Ranibizumab 92
附錄二. 德國合約 93
附錄三. NICE Audit Support for Lucentis 101
第六章 參考文獻 105		zh_TW
dc.format.extent 3628794 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0094359030en_US
dc.subject (關鍵詞) 創新核價模式zh_TW
dc.subject (關鍵詞) 風險分攤zh_TW
dc.subject (關鍵詞) 價量協議zh_TW
dc.subject (關鍵詞) 結果導向給付方案成zh_TW
dc.subject (關鍵詞) 效為基礎給付模式zh_TW
dc.subject (關鍵詞) 製藥產業zh_TW
dc.title (題名) 製藥產業創新核價模式zh_TW
dc.title (題名) Innovative Pricing Model in Pharmaceutical Industryen_US
dc.type (資料類型) thesisen_US
dc.relation.reference (參考文獻) 1. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision. http://esa.un.org/unpp, Saturday, September 25, 2010.

2. Bill Mitchell, The US should have universal public health care. http://bilbo.economicoutlook.net/blog/?p=8909 Sunday, Oct 3,2010.

3. WHO (May 2009). "World Health Statistics 2009" http://www.who.int/whosis/whostat/2009/en/index.html, Sunday, Oct 3, 2010

4. Institute for research and information in health economics. OECD Health Data 2010 – Frequently Requested Data. http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls, Monday, Oct 4, 2010.

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