目的 分析昆明醫(yī)科大學(xué)第一附屬醫(yī)院藥品零加成實施前后口服降糖藥的使用變化，評價藥品零加成實施后糖尿病患者的受益情況。方法 采用限定日劑量（DDD）法對藥品零加成實施前后昆明醫(yī)科大學(xué)第一附屬醫(yī)院口服降糖藥的銷售金額、用藥頻度（DDDs）、限定日費用（DDC）以及藥品排序比（B/A）進行統(tǒng)計分析。結(jié)果 藥品零加成實施后，5類口服降糖藥的銷售金額均明顯下降，阿卡波糖、二甲雙胍、格列美脲、瑞格列奈、格列齊特在零加成前后的銷售金額均穩(wěn)居前5位，所有口服降糖藥的DDDs均減少，但阿卡波糖的DDDs接近于二甲雙胍的DDDs，格列齊特的DDDs排序甚至超過了格列美脲；口服降糖藥的DDC均呈不同幅度的減小，但其排序保持不變；且B/A基本穩(wěn)定不變，二甲雙胍的B/A最大，為2.00。結(jié)論 取消藥品加成對口服降糖藥的使用情況影響較大，明顯減小了糖尿病患者的經(jīng)濟負擔(dān)，但需關(guān)注醫(yī)院部分口服降糖藥后續(xù)的臨床應(yīng)用是否合理。

Objective To analyze the changes in the use of oral hypoglycemic agents before and after the "zero additional cost of drugs" in the First Affiliated Hospital of Kunming Medical University, and to evaluate the benefits of diabetes patients after the "zero additional cost of drugs". Methods Consumption sum, defined daily doses (DDDs), defined daily cost (DDC), and drug sequence ratio of oral hypoglycemic agents before and after the "zero additional cost of drugs" in the First Affiliated Hospital of Kunming Medical University were analyzed statistically by the Limited Daily Dose (DDD) method. Results After the "zero additional cost of drugs", consumption sum of five kinds of oral hypoglycemic agents all significantly decreased, and consumption sum of acarbose, metformin, glimepiride, repaglinide, and gliclazide ranked the top five. DDDs of all oral hypoglycemic agents were decreased, but DDDs of acarbose was near to DDDs of metformin. While the DDDs sequence of gliclazide exceeded that of glimepiride. DDC of oral hypoglycemic agents all showed different degrees of decrease, but the sequence of DDC was stable. And B/A of oral hypoglycemic agents was basically stable. B/A of metformin was the biggest (2.00).Conclusion The abolishment of drug price addition has a greater impact on the usage of oral hypoglycemic agents, which significantly reduces the economic burden of diabetic patients, but it is necessary to pay attention to whether the clinical application of some oral hypoglycemic drugs is reasonable in the hospital in the future.

云南省衛(wèi)生科技計劃項目（2017NS075）