医学-中国肿瘤药领域面面观

中国肿瘤药领域面面观

ProfessorDr.ZhaoPingCancerHospitalCAMSP.R.China20211116广州FormerPresidentofCancerInstitute&HospitalCAMSSecretary-in-ChiefofCancerFoundationofChinaDirectorofNationalCancerPreventionandControlOfficeFormerDirectorofNationalCancerRegistrationCenterDirectorialCommitteeMemberofChinaCancerHospitalAssociationGeneralsecretaryofAsianNationalCancerCenterAllianceFormerChiefEditorofChineseJournalofOncologyChiefEditorofChinaTumorClinicalYearBookRepresentativeofBeijingMunicipalPeoples’CongressRepresentativeofCPPCCPresentPost/10万人口发病率

年中国癌症发病率在今后30年还将继续上升人口老龄化是首要的因素生活方式的作用日显突出全球癌症发病率最高的国家是丹麦589/10万亚洲最高的国家是日本483/10万中国癌症发病率控制在400/10万是奋斗的目标也是可能实现的近40年中国恶性肿瘤发病率态势地区性别发病率

(1/105)中标率(1/105)世标率

(1/105)累积率0-74%全国合计男女合计285.91

146.87191.7222.08男性317.97165.92220.3325.68女性253.09129.49166.0418.64城市男女合计303.39

150.31195.7422.23男性330.19165.50219.8425.25女性276.15137.09175.0319.44农村男女合计249.98

139.68182.8821.76男性293.10166.94220.9426.65女性205.25113.07146.2416.83数据来源：(中国2021年肿瘤登记年报)中国癌症的发病率与死亡率死亡率

(1/105)构成比(%)中标率(1/105)世标率

(1/105)累积率0-74%184.67

84.36114.3212.89184.67228.14109.78149.9116.88228.14140.4860.6781.929.08140.48181.54

79.21107.7611.92181.54222.53102.17140.1315.47222.53139.9757.9278.508.56139.97196.34106.05141.6916.98196.34248.94141.40190.0022.74248.94142.3672.5096.5811.35142.36Chinaisthelargestmarketfor

thedrugsfortumorsintheworld1.3billionpopulation3millionnewpatients

withcancer/year25billionyuan/yearfordrugsfortumorsinChina城市农村肿瘤名称死亡率肿瘤名称死亡率肺癌48.76胃癌41.29肝癌23.81食管癌37.60胃癌22.64肺癌36.03结直肠癌16.44肝癌33.38食管癌10.51结直肠癌8.76胰腺癌8.09胰腺癌5.59乳腺癌5.77脑瘤4.31淋巴瘤4.24白血病3.46胆囊癌4.23乳腺癌3.23白血病4.14淋巴瘤2.89肿瘤合计181.54肿瘤合计196.34

城市农村发病率1/105

发病率1/1051肺癌58.81胃癌48.57

2结直肠癌35.78肺癌42.803胃癌30.20食管癌38.44

4肝癌26.63肝癌32.985乳腺癌25.94结直肠癌16.40

6食管癌14.21乳腺癌11.51

7甲状腺癌8.25子宫颈癌5.96

8淋巴瘤8.21脑瘤5.49

9胰腺癌8.19胰腺癌5.4110膀胱癌8.11白血病4.25

肿瘤合计303.39肿瘤合计294.98数据来源：(中国2021年肿瘤登记年报)中国常见恶性肿瘤发病率与死亡率Cancer

therapiesSurgicaltherapyMedicaltherapy

RadiotherapyOthersTraditionalmedicaltherapyImmunetherapyGenetherapy

紫杉醇(Paclitaxel)

-1999年上市

Indication一线化疗失败或屡次化疗失败的转移性卵巢癌(ovarycancer)和乳腺癌(breastcancer)及非小细胞肺癌的一线和二线治疗对于头颈癌、食管癌、精原细胞瘤、复发非霍奇金氏淋巴瘤有一定疗效

Effect非小细胞肺癌：紫杉醇联合顺铂治疗晚期非小细胞肺癌缓解率为21%-27%1年生存率31%-38.9%中位生存期个月Price进口泰素30mg/支1334.00元/支国产协和紫素30mg/支371.45元/支Chemicaltherapy托瑞米芬〔Toremifen)-2002年上市Indication绝经后雌激素受体阳性或不详的转移性乳腺癌Effect一线治疗绝经后晚期乳腺癌总有效率〔45%-54%)临床获益率74%-92%price法乐通60mg/片30片/盒377.00元/盒

Endo-HormoneEquilbriumModultors

Tormfen

FormestaneLetrozole

AnastozoleExemestane

Goserlin

吉非替尼Gefitinib

2007年我国上市Indication

非小细胞肺癌Effect

EGFR阳性者有效率

71.2%阴性者1.1%

Price

易瑞沙0.25g/片10片/盒

4695.00元/盒

TargetTherapyGefitinibCetuximabErlotinibBeacizumabSorafenibRitixizumabSunitinib

GemtuzumabImatinibTrastuzumabDrugsforTumorindirectory名称调价单位调前售价调后售价抑那通粉针(注射用醋酸亮丙瑞林微球)[3.75MG]支20871992.2达菲林粉针(注射用曲普瑞林)[3.75MG]支1890.21772.45法禄达(醋酸甲羟孕酮片)[500MG*30片]盒(30片)848847.98法禄达(醋酸甲羟孕酮片)[500MG*30片]盒(30片)847.98720科赛斯粉针(注射用醋酸卡泊芬净)[50MG]瓶19971792.42科赛斯粉针(注射用醋酸卡泊芬净)[50MG]瓶1792.421975.03科赛斯粉针(注射用醋酸卡泊芬净)[70MG]瓶25782292.08科赛斯粉针(注射用醋酸卡泊芬净)[70MG]瓶2292.082549.64威凡片(伏立康唑片)[200MG*10片]盒(10片)4659.993942.8威凡片(伏立康唑片)[200MG*10片]盒(10片)3942.84447.97斯皮仁诺注射液(伊曲康唑注射液)[250MG/25ML]支1096.991028.9斯皮仁诺注射液(伊曲康唑注射液)[250MG/25ML]支1028.9987威凡粉针(注射用伏立康唑){临时}[200MG]支14501278.5威凡粉针(注射用伏立康唑){临时}[200MG]支1278.51384.02诺雷德缓释植入剂(醋酸戈舍瑞林缓释植入剂)[3.6MG]支20951989.03注射用磷酸氟达拉滨{浙江海正}[50MG]瓶18401322.98泽菲粉针(注射用盐酸吉西他滨)[1GM]瓶12421033艾力粉针(注射用盐酸伊立替康)[100MG]瓶1646.91225艾力粉针(注射用盐酸伊立替康)[100MG]瓶12251322.5DrugsforTumorindirectory赛珍R粉针(注射用培美曲塞二钠)[200MG]支26801994赛珍R粉针(注射用培美曲塞二钠)[200MG]支19942206.85万珂粉针(注射用硼替佐米)[3.5MG]支1363512730万珂粉针(注射用硼替佐米)[3.5MG]支1273013635力比泰粉针(注射用培美曲塞二钠)[100MG]瓶3473.263394.44力比泰粉针(注射用培美曲塞二钠)[100MG]瓶3394.443817.35爱立汀粉针(注射用培美曲塞二钠)[500MG]瓶6750.044573爱立汀粉针(注射用培美曲塞二钠)[500MG]瓶45735172.7奥诺先粉针(注射用右丙亚胺)[250mg]支518.65529.23茵福粉针(注射用因卡膦酸二钠)[10mg]支2912.952310茵福粉针(注射用因卡膦酸二钠)[10mg]支23102570.25普来乐粉针(注射用培美曲塞二钠)[200mg]支3567.32003普来乐粉针(注射用培美曲塞二钠)[200mg]支20032217.2拉司太特软胶囊(依托泊苷软胶囊)[25MG*40粒]盒(40粒)943934格列卫胶囊(甲磺酸伊马替尼胶囊)[100MG*120粒]盒(120粒)2550023575格列卫胶囊(甲磺酸伊马替尼胶囊)[100MG*120粒]盒(120粒)2357525500艾去适胶囊(磷酸雌莫司汀胶囊)[140MG*40粒]盒(40粒)1152.661077.3艾去适胶囊(磷酸雌莫司汀胶囊)[140MG*40粒]盒(40粒)1077.31152.64蒂清胶囊(替莫唑胺胶囊)[50MG*7粒]盒(7粒)2565.632305.99蒂清胶囊(替莫唑胺胶囊)[50MG*7粒]盒(7粒)2305.992565.63DrugsforTumorindirectory维康达胶囊(替吉奥胶囊)[20MG*42粒]盒(42粒)2132.922045维康达胶囊(替吉奥胶囊)[20MG*42粒]盒(42粒)20452265.5索坦胶囊(苹果酸舒尼替尼胶囊)[12.5MG*28粒]盒(28粒)1310011734索坦胶囊(苹果酸舒尼替尼胶囊)[12.5MG*28粒]盒(28粒)1173413100泰道胶囊(替莫唑胺胶囊)[20MG*5粒]瓶(5粒)12801175.8泰道胶囊(替莫唑胺胶囊)[20MG*5粒]瓶(5粒)1175.81265.92泰道胶囊(替莫唑胺胶囊)[100MG*5粒]瓶(5粒)53004633泰道胶囊(替莫唑胺胶囊)[100MG*5粒]瓶(5粒)46335241.7爱斯万胶囊(替吉奥胶囊)[20MG*140粒]盒(140粒)9950.00018333.5爱斯万胶囊(替吉奥胶囊)[20MG*140粒]盒(140粒)8333.59497.27易瑞沙R片(吉非替尼片)[250MG*10片]盒(10片)55004695瑞宁得片(阿那曲唑片)[1MG*14片]盒(14片)673633.59康士得片(比卡鲁胺片)[50MG*28片]盒(28片)14051357.4弗隆片(来曲唑片)[2.5MG*30片]盒(30片)15061393.56阿诺新片(依西美坦片)[25MG*30片]盒(30片)16511616.7福至尔片(氟他胺片)[250MG*100片]瓶(100片)14691367.72多吉美R片(甲苯磺酸索拉非尼片)[0.2GM*60片]盒(60片)2519224267特罗凯R片(盐酸厄洛替尼片)[150mg*7片]盒(7片)42154600艾朗粉针(注射用唑来膦酸)[4MG]瓶16041067.2择泰粉针(注射用唑来膦酸)[4MG]支29442539DrugsforTumorindirectory天晴依泰注射液(唑来磷酸注射液)[4MG/5ML]支17941181.05楷莱脂质体注射液(盐酸多柔比星脂质体注射液)[10ML:20MG]支8823.957528.4楷莱脂质体注射液(盐酸多柔比星脂质体注射液)[10ML:20MG]支7528.48571.41乐沙定粉针(注射用奥沙利铂)[50MG]支26932635中人氟安(植入用缓释氟尿嘧啶)[100MG]瓶761.95675.5福达华粉针(注射用磷酸氟达拉滨)[50MG]支2438.62356.14健择粉针(注射用盐酸吉西他滨)[1.0GM]支20651982.48健择粉针(注射用盐酸吉西他滨)[200MG]支506500.94泰素注射液(紫杉醇注射液)[30MG/5ML]支13161334安素泰注射液(紫杉醇注射液)[30MG/5ML]支1294.81292.88泰索帝注射液(多西他赛注射液)[20MG/0.5ML]支19801919.75力比泰粉针(注射用培美曲塞二钠)[500MG]瓶1339712011力比泰粉针(注射用培美曲塞二钠)[500MG]瓶1201113397业立宁粉针(注射用盐酸博安霉素)[10MG]支943822.08业立宁粉针(注射用盐酸博安霉素)[10MG]支822.08859.14业立宁粉针(注射用盐酸博安霉素)[10MG]支859.14822.08美罗华注射液(利妥昔单抗注射液)[50ml:500mg]支1995017486美罗华注射液(利妥昔单抗注射液)[50ml:500mg]支1748619950美罗华注射液(利妥昔单抗注射液)[10ml:100mg]支4312.53712美罗华注射液(利妥昔单抗注射液)[10ml:100mg]支37124182.55DrugsforTumorindirectory美罗华注射液(利妥昔单抗注射液)[10ml:100mg]支37124182.55赫赛汀粉针(注射用曲妥珠单抗)[440MG]支2562421688赫赛汀粉针(注射用曲妥珠单抗)[440MG]支2168824854.95赫赛汀粉针(注射用曲妥珠单抗)[440MG]支24854.9524500开普拓注射液(盐酸伊立替康注射液)[40MG/2ML]支1646.521465.58开普拓注射液(盐酸伊立替康注射液)[40MG/2ML]支1465.581599.16艾力粉针(注射用盐酸伊立替康)[40MG]支860.89770.25艾力粉针(注射用盐酸伊立替康)[40MG]支770.25799.53恩度注射液(重组人血管内皮抑制素注射液)[15MG/3ML]支1125.85992恩度注射液(重组人血管内皮抑制素注射液)[15MG/3ML]支9921054.55开普拓注射液(盐酸伊立替康注射液)[5ML:0.1GM]支27372440.64开普拓注射液(盐酸伊立替康注射液)[5ML:0.1GM]支2440.642720.48震达粉针(注射用唑来膦酸)[4MG]支1610747.6震达粉针(注射用唑来膦酸)[4MG]支747.6773.49尼妥珠单抗注射液(泰欣生){临时}[10ML:50MG]支36803419尼妥珠单抗注射液(泰欣生){临时}[10ML:50MG]支34193680爱必妥注射液(西妥昔单抗注射液)[20ml:100mg]支46984303爱必妥注射液(西妥昔单抗注射液)[20ml:100mg]支43034698亿迈林注射液(盐酸伊立替康注射液)[2ml:40mg]支750776.25艾思美(异氟烷)[100ML]瓶(100ML)653.88629.32活宁液体(异氟烷)[100ML]瓶(100ML)667.03645DecisionmakingNewdruguseapprovaltoenterthehospitalaftertheclinicaltrial(phaseIII)andapprovedbyCFDANewdrugusedintheclinicdecidedbythehospitalpharmacycommitteeClinicaluseofdrugsfortumoraccordingtothepatient’condition〔Individualtherapy〕China’sdrugpolicyDrugtariffs〔15%〕toraisethemedicalmedicineDrugpriceformingmechanismTheNationalDevelopmentandReformpricedepartmentorlocalpricedepartmentaccountingproducesthehighestretailprice〔ceilingprice〕Unitedcentralizedbidevaluationexpertsprovinceshavepricedin各省统一集中招标专家评定产生〔purchaseprice中标价〕Thehospitaldrugsbonuspolicy〔hospitalretailprice零售价〕Cost-effect-PayTooexpensivecomparingwiththeincomeWorldaveragemonthsalary9327yuanChinaaveragemonthsalary4134yuan易瑞莎0.25g/片10片/盒4695元/盒

法乐通60mg/片30片/盒377元/盒InternationalexperiencesGermany：PatientsgetmedicinepharmacypaidbymedicalinsuranceFrance：FullreimbursementdrugsgovernmentpricingmedicineJapan：15thousanddrugsgovernmentpricingmedicineUSA：AccordingtothemarketindependentpricinggovernmentrarelyinterventionmedicineCanada：DrugspricesgovernmentcontrolUK：DrugspricestandardsystemcontrolcapitalreturnrateIndia：74basicdrugsgovernmentpricingmedicineChina’sMedicalHealthSystemreformTarget

Everyonehavetherighttobasichealthcare

1.3billionpeoplehavehealthinsuranceandnewruralcooperativemedical(lowlevelandunversalcoverage)

ChallengeMedicalpricevsmedicaltechnologyprogress

WhopayforthepatientsHowmuchtheycanpayupThereformofthesystemofdrugsCanceltheaffordanceofdrugsBisicdrugsinthedirectory(371)fullreimbursementDrugsinthedirectoryofthemedicalinsurance90%reimbursementfortheurbanresidentsDrugsinthedirectoryofnewruralcooperationmedicalsystem80%reimbursementforthepeasantsDrugsw.patent〔Targetdrugs〕noreimbursemen索坦工程临床试验捐赠患者关心药品捐赠回忆性研究