“120万一针”的抗癌药可否能纳入医疗保险?公众最关心的是能把价格砍掉多少!
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正当<span style="color: black;">非常多</span>人在为“双十一”购物节疯狂添砖加瓦时,医药界的“双十一”落下帷幕,一场<span style="color: black;">相关</span>老<span style="color: black;">大众</span>看病用药的谈判登上了热搜榜。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">11月9日-11日,2021年国家<span style="color: black;">医疗保险</span>目录准入谈判在北京举行。早在今年7月,国家医疗<span style="color: black;">保证</span>局(以下简<span style="color: black;">叫作</span>“<span style="color: black;">医疗保险</span>局”)<span style="color: black;">颁布</span><span style="color: black;">关联</span>名单,共有271个<span style="color: black;">药物</span><span style="color: black;">经过</span>初步形式审查。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">值得关注的是,120万元/针的“天价抗癌药”<span style="color: black;">亦</span>进入了此前<span style="color: black;">颁布</span>的<span style="color: black;">药物</span>名单。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">据国家<span style="color: black;">医疗保险</span>局最新<span style="color: black;">信息</span>,价值120万元的阿基仑赛注射液<span style="color: black;">经过</span>了初步形式审查,但并未进入<span style="color: black;">医疗保险</span>目录谈判环节。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">天价“抗癌神药”,真的管用吗?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“花120万元打一针,能清零癌细胞!”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CAR-T治疗<span style="color: black;">是否</span>真的<span style="color: black;">那样</span>神?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“身价”<span style="color: black;">为何</span><span style="color: black;">那样</span>贵?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">能治<span style="color: black;">那些</span>癌症?有<span style="color: black;">无</span>副<span style="color: black;">功效</span>?</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">首先<span style="color: black;">咱们</span>得搞清楚这个药的“来头”是什么?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CAR-T细胞疗法是一种新兴的治疗方式,是国内<span style="color: black;">第1</span>款利用人<span style="color: black;">身体</span>的免疫细胞来治疗肿瘤的<span style="color: black;">办法</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">T细胞<span style="color: black;">亦</span>叫T淋巴细胞,是人体白细胞的一种,<span style="color: black;">源自</span>于骨髓造血干细胞,在胸腺中成熟,<span style="color: black;">而后</span>移居到人体血液、淋巴和<span style="color: black;">周边</span>组织器官,发挥免疫功能。其<span style="color: black;">功效</span>相当于人<span style="color: black;">身体</span>的“战士”,能够抵御和消灭“敌人”如感染、肿瘤、外来异物等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CAR-T技术<span style="color: black;">便是</span>把病人的免疫T细胞在实验室<span style="color: black;">经过</span>生物技术改造,将T细胞激活,并装上定位导航<span style="color: black;">安装</span>CAR(肿瘤嵌合抗原受体)再回输<span style="color: black;">身体</span>。<span style="color: black;">这般</span>T细胞这个普通“战士”变身为“超级战士”,即CAR-T细胞。利用其“定位导航<span style="color: black;">安装</span>”CAR,专门识别<span style="color: black;">身体</span>肿瘤细胞,并<span style="color: black;">经过</span>免疫<span style="color: black;">功效</span>释放<span style="color: black;">海量</span>的多种效应因子。它们能<span style="color: black;">有效</span>地杀灭肿瘤细胞,从而达到治疗恶性肿瘤的目的。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个药<span style="color: black;">为何</span>这么贵?</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">首要</span>,从CAR-T回输治疗中用到的肿瘤抗原特异性CD8阳性T细胞的分离,扩增,乃至肿瘤抗原特异性和免疫杀伤功能<span style="color: black;">得到</span>来讲,<span style="color: black;">过程</span>繁琐,且<span style="color: black;">触及</span>到<span style="color: black;">海量</span>流程和质控。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其次,<span style="color: black;">因为</span><span style="color: black;">病人</span>之间在免疫背景,病情<span style="color: black;">发展</span>,以及<span style="color: black;">自己</span>身体<span style="color: black;">前提</span>等方面的差异,肿瘤抗原特异性CD8阳性T细胞的制备<span style="color: black;">日前</span>只能<span style="color: black;">按照</span>每位<span style="color: black;">病人</span>的<span style="color: black;">状况</span>“量身定制”,<span style="color: black;">无</span>办法“批量生产”。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在血液肿瘤专家看来,CAR-T不是一种<span style="color: black;">一般</span><span style="color: black;">道理</span>上的药,是一种“个性化定制的<span style="color: black;">药品</span>”,更准确应<span style="color: black;">叫作</span>为“嵌合抗原受体T细胞疗法”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>,<span style="color: black;">因为</span><span style="color: black;">没</span>法规模化应用,<span style="color: black;">关联</span>临床和实验室人力成本在<span style="color: black;">短期</span>内很难降低。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CAR-T细胞,犹如带导航定位<span style="color: black;">安装</span>且威力强大的“装甲车”,这辆CAR-T“装甲车”犹如带着“金睛火眼”的“齐天大圣”,与“妖怪”(肿瘤细胞)一碰面,<span style="color: black;">马上</span>一变百,<span style="color: black;">乃至</span>变千,成对数级的扩增,对杀伤肿瘤细胞的<span style="color: black;">功效</span>陡升,发挥<span style="color: black;">精细</span>、定向、强力摧毁肿瘤细胞的效果。</p>
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<h2 style="color: black; text-align: left; margin-bottom: 10px;">广东已完成首例CAR-T治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>一位辗转难治的弥漫性大B细胞淋巴瘤<span style="color: black;">病人</span>,在中山大学肿瘤防治中心接受CAR-T治疗1个月后成功<span style="color: black;">得到</span>了完全缓解。这<span style="color: black;">亦</span>是华南首例接受CAR-T治疗的<span style="color: black;">病人</span>。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这是一位50多岁的弥漫大B细胞淋巴瘤(DLBCL,non-GCB型)<span style="color: black;">病人</span>,他的治疗难度非常大,从最初的标准一线治疗,到后面<span style="color: black;">运用</span>二线、三线<span style="color: black;">方法</span>进行治疗后,疗效都欠佳,<span style="color: black;">疾患</span><span style="color: black;">火速</span><span style="color: black;">发展</span>,现有的治疗<span style="color: black;">办法</span><span style="color: black;">已然</span><span style="color: black;">没</span>法取得好的疗效,<span style="color: black;">病人</span>的预后非常令人担忧。幸运的是,中国首个CAR-T<span style="color: black;">药物</span><span style="color: black;">获准</span>上市带来了新的治疗<span style="color: black;">选取</span>和<span style="color: black;">期盼</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗的过程中存在几个难点:</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">首要</span>是年龄<span style="color: black;">很强</span>、既往接受<span style="color: black;">太多</span>线化疗和放疗。CAR-T治疗的原理是要采集<span style="color: black;">身体</span>有免疫活性的T细胞,<span style="color: black;">而后</span><span style="color: black;">经过</span>基因工程<span style="color: black;">办法</span>生产出具备清除肿瘤能力的CAR-T细胞。但<span style="color: black;">针对</span>本例<span style="color: black;">病人</span>,既往多种治疗可能会对T细胞产生不良影响,<span style="color: black;">倘若</span>采集到的细胞质量相对较差,<span style="color: black;">那样</span>生产出来的CAR-T细胞治疗<span style="color: black;">亦</span>会受到影响。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>,该<span style="color: black;">病人</span>体重<span style="color: black;">很强</span>(超过90<span style="color: black;">千克</span>),<span style="color: black;">据说</span>是国内<span style="color: black;">日前</span>接受CAR-T治疗的<span style="color: black;">病人</span>中体重最大的,这对单采循环量、采集的细胞数量和质量以及回输时的液体把控都<span style="color: black;">增多</span>了难度。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽管预料到种种困难,中山大学肿瘤防治中心黄慧强教授、高岩博士、白冰博士及团队的其他医护人员经过仔细<span style="color: black;">评定</span>,仍确定这<span style="color: black;">便是</span>该<span style="color: black;">病人</span>的最佳<span style="color: black;">选取</span>。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">经与<span style="color: black;">病人</span>的细致沟通,黄慧强教授及其团队<span style="color: black;">起始</span>为该<span style="color: black;">病人</span>制定CAR-T细胞疗法的<span style="color: black;">方法</span>,并与<span style="color: black;">病人</span>及CAR-T<span style="color: black;">公司</span><span style="color: black;">一块</span>齐心协力<span style="color: black;">起步</span>治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">幸运的是,该<span style="color: black;">病人</span>单采血非常顺利,在工厂里经过严谨的生产和质控质检等<span style="color: black;">繁杂</span>流程,一袋成品CAR-T细胞保质保量出厂,回输到<span style="color: black;">病人</span><span style="color: black;">身体</span>快速<span style="color: black;">生效</span>,临床疗效和安全性都令人满意。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">黄慧强教授说:“<span style="color: black;">针对</span>如此难治的<span style="color: black;">病人</span>,该<span style="color: black;">药物</span>能够达到<span style="color: black;">这般</span>的效果,<span style="color: black;">咱们</span>相当满意。<span style="color: black;">另一</span>,<span style="color: black;">咱们</span><span style="color: black;">日前</span>还有2~3例<span style="color: black;">病人</span><span style="color: black;">亦</span>在接受该<span style="color: black;">药物</span>的治疗,期待能<span style="color: black;">得到</span><span style="color: black;">一样</span>好的疗效。尽管CAR-T治疗效果好,但后续有<span style="color: black;">非常多</span><span style="color: black;">必须</span><span style="color: black;">重视</span>的事项。<span style="color: black;">例如</span><span style="color: black;">定时</span>复查,<span style="color: black;">即时</span><span style="color: black;">发掘</span><span style="color: black;">关联</span>毒性、<span style="color: black;">关联</span>指标变化等。既往数据<span style="color: black;">表示</span>,50%的<span style="color: black;">病人</span><span style="color: black;">能够</span><span style="color: black;">经过</span>CAR-T治愈<span style="color: black;">疾患</span>,<span style="color: black;">因此</span><span style="color: black;">咱们</span><span style="color: black;">期盼</span>随着<span style="color: black;">商场</span>化CAR-T治疗的<span style="color: black;">面世</span>,<span style="color: black;">更加多</span>的<span style="color: black;">病人</span>能<span style="color: black;">得到</span>治愈的机会。”</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其实,天价“抗癌神药”进入<span style="color: black;">医疗保险</span>谈判,这本身<span style="color: black;">便是</span>一次成功。在今后的日子里,双方都会为下一步的谈判取得<span style="color: black;">发展</span><span style="color: black;">持续</span>地做准备。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">期盼</span><span style="color: black;">医疗保险</span>集采谈判的路越走越广,能把<span style="color: black;">更加多</span>“天价神药”拉下“神坛”、推向“人间”,造福<span style="color: black;">更加多</span>平民<span style="color: black;">大众</span>,尽可能地减轻<span style="color: black;">她们</span>的病痛<span style="color: black;">包袱</span>,大庇天下<span style="color: black;">病人</span>俱欢颜。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">注:本文<span style="color: black;">照片</span><span style="color: black;">源自</span>于网络</p>
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