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医療保険財源提案 - 全国保険医団体連合会
ISSN 0288-5093 2012 年 3 月 5 日（毎月 1 回 1 日）発行・通巻 1087 号・昭和 47 年 6 月 15 日第三種郵便物認可 明日の医療を考える 臨時増刊号 No.1087 2012 薬価の国際比較調査にもとづく 医療保険財源提案 ●報告掲載 薬価の国際比較 ─2010年薬価の比較調査報告書 2011年12月22日 「日本の薬価問題プロジェクト2011」 1 4 2 8.4 5 6 2 ߣߎࠈ߇⮎ޔዪ⺞ಽߩ⮎⾌ࠍ߫ ޔᐕߦ߅ߡ߽ ߦߢߔޔ㧑㧔 ళ㧕ߦߥࠆߎߣ߇್ߒ ߇ࠇߎޔᐕߢߪ 㧑㧔ක⑼ಽ㧕 ޔᱤ⑼ක≮ࠍࠆ ߣ 㧑ߣߥߞߡࠆ㧔ߚߛߒ &2% ߥߤ൮ක≮ߦଥࠆㇱಽࠍ㒰ߊ㧕 ޕ ৻ᣇ⮎ߩࡄ࠶ࡠ࡛ޔଔߪᦨ⚳ᖚ⠪ଔᩰߢ␜ߐࠇߡ߅ࠅߩߎޔਛߦߪᣣᧄߩ⺞ᛛ ⴚᢱߦ⋧ᒰߔࠆ⮎ዪࡑࠫࡦ߇߹ࠇߡࠆޔߡߞ߇ߚߒޕᣣᧄߣᄖ࿖ߩ⮎⾌ࠍᐔ ߦᲧセߔࠆߚߦߪ⺞ޔᛛⴚᢱ߽ߡ▚ቯߔࠆᣇᴺ߇ㆡಾߢࠆ⺞ޕ⮎ዪߩᛛⴚ ᢱ㧔ᐕߢళ㧕ࠍട߃ࠆߣళ㧔✚ක≮⾌ߩ⚂㧑㧕ߦ㆐ߔࠆޕ వ⊒ຠߦଐሽߒߚᣣᧄߩ㜞⮎⾌᭴ㅧߪ⛯ߡࠆ ⮎ଔタຠ⋡ߩ⩄㗵ࠪࠚࠕ㧔ᐕ㧕ߦࠃࠆߣ⮎ޔଔタ㌏ᨩߢߪోߩ 㧑 ߩޟᓟ⊒ຠߩߥవ⊒ຠޠ 㧔ᣂ⮎⟲㧕ߪ⮎✚ޔ⾌ߩ 㧑ࠍ߽භߡࠆ㧔ࠬࠗ࠼ 㧢㧕 ৻ޕᣇޔ㐳ᦼタຠ㧔ᓟ⊒ຠߩࠆవ⊒ຠ㧕ߪ㌏ᨩࠪࠚࠕߢ 㧑ߦኻߒߡ㊄㗵ࠪ ࠚࠕߢߪ 㧑ߣ߁ታ❣ ߢޔᓟ⊒ຠ߇⊒ᄁߐࠇߡ߽ᒁ߈⛯߈వ⊒ຠߩᄁߪ⛽ᜬߐ ࠇߡࠆ߽ࠇߎޕ᰷☨ߩ⁁ᴫߣᲧセߒߡ㓙┙ߞߡࠆޕ ٖ ߎ߁ߒߚߎߣ߆ࠄ ޔᐕ ޔᐕߦ⺞ᩏߒߚᤨߣห᭽ޔᣣᧄߩ⮎ଔߪᣂ⮎ࠍవ ⊒ຠࠍਛᔃߦ⻉ߦߛ߹ޔᄖ࿖ߦᲧߒ⪺ߒߊ㜞ߩߢߪߥ߆߇ߣߎߩߘߚ߹ޔක≮ 㒾⽷ࠍㄼߒߡࠆߩߢߪߥ߆ߣ⠨߃ߚޔߢߎߘޕએ೨ߩᚻᴺߦḰߓߡᡷߡ⮎ଔ ߩ࿖㓙Ყセࠍታᣉߔࠆߎߣߣߒޔએਅߩ⚿ᨐࠍᓧߚޕ 㧞ޔ࿁⺞ᩏ⚿ᨐߩⷐ ⮎ଔߩ࿖㓙Ყセ⺞ᩏ⚿ᨐ ᐕߩᏒ႐ⷙᮨ㧔ࡔࠞ⩄㗵㧕 ߹ߢߩ⮎ߢ☨ޔ࿖ࡈޔ࠷ࠗ࠼ޔ ࡦࠬ⧷ޔ࿖ߩ߁ߜ㧟߆࿖એߩ࿖ߢ⮎ଔ߇್ߒߚ⮎ ຠ⋡ࠍኻ⽎ߣߒߚޕฦ࿖ ߩ⮎ଔߪᦨᣂߩ⮎ଔߦ߽ߣߠ߈⮎ޔዪ⾼ଔᩰ㧔ᣣᧄߩ⮎ዪ⾼ଔᩰߪ㧞⒳㘃ߢផ ቯ㧕ߣ⚳ᦨޔᖚ⠪ଔᩰߩ㧟⒳㘃ࠍߦ឵▚ߒޔᶏᄖߩ⮎ଔߦኻߔࠆᣣᧄߩ⋧ኻ⮎ଔࠍ᳞ ߩߘޔᐔဋ୯ߣߒߡਥߦᐞᐔဋ୯ߢᲧセߒߚޕ ߘߩ⚿ᨐޔᣣᧄߩ⮎ଔߪ⧷ޔ࿖ߣࠬࡦࡈޔᲧセߒߡ⚂㧞ߣ࠷ࠗ࠼ޔᲧセߒߡ⚂ ߢࠅޔᏒ႐ⷙᮨߩᄢ߈⮎ߢߪޔ㨪 ߣ⋧ኻ⮎ଔ㧔₸㧕߇ࠃࠅᄢ߈ ߆ߞߚޕᏒ႐ⷙᮨ߇ 㨪 ߢߞߡ߽⧷࿖ ߩࠬࡦࡈޔߦ࠷ࠗ࠼ޔኻߒ ߡ߽ ߣ߿߿㜞߆ߞߚޕ ☨࿖ߦ߅ߌࠆ⮎ዪ⾼ଔᩰߩታᘒߩਇ⏕ߐࠍ⠨ᘦߒߚߣߒߡ߽ޔ࿁ߩ⺞ᩏ⚿ᨐ 㧔ኻ☨⋧ኻ⮎ଔ 㧕߆ࠄ☨ޔ࿖ߩ⮎ଔߩᣇ߇ᣣᧄࠃࠅ㜞ߣផኤߐࠇߚޕ ᐕ㧥⺞ᩏ㧔 ᐕ ᣣޔਛකද⮎ଔኾ㐷ㇱળ㧕 ⧷$0(㧦$TKVKUJ0CVKQPCN(QTOWNCT[ 8K&#. ⁛4QVG.KUVG ☨4GF$QQM2JCTOCE[U (WPFCOGPVCN4GHGTGPEG 㧟㧼⸓ᱜේⓂ FH 3 9 4 5 14 6 18 7 8 2-5-5 03-3375-5121 9 03-3375-1862 ⮎ଔ䈱࿖㓙Ყセ⺞ᩏ䈮䉅䈫䈨䈒 ක≮㒾⽷Ḯឭ᩺ 2012ᐕ1222ᣣ ో࿖㒾ක࿅ㅪวળ 䇸ᣣᧄ䈱⮎ଔ㗴䊒䊨䉳䉢䉪䊃2011䇹 1 ᕤ̖ોܭắểỆᕤ̖ỊࡽẨɦậỤủềẟỦ ᡷቯᐕ タຠ⋡ ᢙ ᡷቯ₸ ⮎ଔ䊔䊷䉴 ක≮⾌䊔䊷 䉴 ⠨ 2000ᐕ 11,287 䂥䋷.0䋦 䂥䋱.6䋦 ⺞ᢛ䋲䋦 2002ᐕ 11,191 䂥䋶.3䋦 䂥䋱.3䋦 ⺞ᢛ䋲䋦 వ⊒ຠ䈱৻ቯ₸ᒁਅ䈕 2004ᐕ 11,993 䂥䋴.2䋦 䂥䋰.9䋦 ⺞ᢛ䋲䋦 వ⊒ຠ䈱৻ቯ₸ᒁਅ䈕 2006ᐕ 13,311 䂥䋶.7䋦 䂥䋱.6䋦 ⺞ᢛ䋲䋦 వ⊒ຠ䈱৻ቯ₸ᒁਅ䈕 2008ᐕ 14,359 䂥䋵.2䋦 䂥䋱.1䋦 ⺞ᢛ䋲䋦 వ⊒ຠ䈱৻ቯ₸ᒁਅ䈕 2010ᐕ 15,455 䂥䋵.75䋦 䂥䋱.23䋦 ⺞ᢛ䋲䋦 వ⊒ຠ䈱৻ቯ₸ᒁਅ䈕 2 10 㧝㧜㧼⸓ᱜේⓂ FH 2005 32.4 28.7 2006 32.4 28.6 2007 33.4 29.3 2008 34.1 29.0 2009 35.3 33.2 2010 36.6 33.0 8.0 6.7 55.8 6.9 5.2 57.2 59.1 8.4 5.75 54.1 60.7 63.1 3 4 11 5 6 12 13 8 14,193 3,715 26.1 9,973 1,317 13.6 9,539 1,150 12.1 7,689 1,052 13.7 4,095 766 18.7 45,489 8,000 7.6 9 14 2560 2010 1 4,193 5,785 3,175 7,347 304 259 3,715 26.2 40.8 1 3,037 4,628 2,560 19.6 46 10 • 1992 • 2002 2007 2010 • 600 2009 11 11 , 11 15 12 2.5 344.4 1,033.2 A 25mg 1,033.2 25mg 1,084.9 100mg 38.5 1,084.9 1,084.9 25mg 112.7 13 16 14 • • 15 17 • • • 16 17 18 • 15 • 148 138 51 337 277 257 90 624 18 • . . . • . • . 19 19 . . . . . . . 20 5mg 1178.9 1178.9 0.0 1032.3 1032.3 0.0 15309.0 15309.0 0.0 2286.0 2286.0 0.0 22.5 22.3 0.5mg B 25mg 300 1mg 0 20 2 0.9 21 4mg ARB 5mg 80mg 3000 5mg Ca 83.3 77.3 7.2 72.5 67.1 7.4 1216.4 1042.6 14.3 4034.0 3099.0 23.2 52.9 41.8 21.0 22 50mg 168.0 11 234.1 66.1 11 21 ARB 2008 72 1998 8 5 600 23 234.1 887.5 11 9 484 24 • • • 25 22 n 135 E U 131 109 0 6.2 97.0 80.7 n=128 n=112 118 22 7.9 15.2 87.4 16.3 n=115 n=100 63 46.7 1 0.7 41.5 n=60 13.3 n=53 2011.12 26 • • • • 27 23 • • • 28 • 29 24 25 26 27 28 29 30 31 32 33 34 2010 2010 100 77 67 1.48 2.05 b a 1.97 0.71 7 63.1 23.8 2.25 1.97 1.34 0.75 2011 2 1993 4.1 1 36 1.5 4.2 2010 2011.12.19 1990 1980 10 30 40 [1] 1994 [1-3] 1990 1990 [4a,b] EBM Evidence- Based Medicine [4b] 1990 21 WHO [4b,c] ARB 1800 5000 2005 1.1 ARB 2005 1995 27 2.7 1990 4700 2 2.3 3000 9400 1999 [5a,b] ARB 1999 16 2008 [6] 7.3 1999 20 1 37 19.6 6.1 2003 [6] [6] 20 30.7 2005 1999 2000 10.1 8.0 33.1 26.1 30.5 7.8 26.3 5 (4700 ) 2.4 ( ARB [5a,b] (88 ) 2.1 6 ) 1994 2010 100 100 10 2010 (2011 100 7 30 ) [7] 100 ( ) British National Formulary BNF 2011 VIDAL2011 Rote Liste2010 Book2010 2 38 3 Red BNF VIDAL Rote Liste [12-15] a) a [8] a b) b 8.4 2011 (8.4 ) 8.4 [9] b 3 39 2009 c) 2010 736.1 (72.6 ) 277.3 1013.5 27.4 [16] 2010 63.1 23.8% [17] 1.238 0.85 63.1×27.4 1) 100 63.1 /100 1.238 : 2) 3) (g) 4) 4 40 7 F http://www.stat.go.jp/data/getujidb/index.htm [9] 87.16 114.91 134.57 (a) b) 25 100 4 64 13 77 76 74 10 1) 2) 3) 4) 5) 6) 7) 8) 8) 10) 19 (33 ) ) (35 58 60 62 69 73 88 UFT:100 23 5 41 75 5 14 22 29 ( ) 30 18 96 74 ( ) ( 57 72 41 B12 B12 a 3-a a 75 25 1-a 1.97 2.05 1.48 0.71 25 1.08 75 1.97 2.25 2.87 2.05 75 25 1.54 2.25 25 2.58 1.97 75 1.44 1995 1994 2011 2010 0.81 3-b 75 0.71 25 1-b 6 42 8.4% c) 3-c 1-c 63.1 23.8 10.5 1.94 0.78 2.25 a 0.72 a 4- b 2- 4-b,c 2-ab 4-ab 20 2.14 2-b,c 2.21 1.72 1.7 1. a -a -b -b 2.0 1991 15 0.7 1996 20 1.1 2.1 2.1 14 19 10 13 7 43 91 96 1.9 ( ) 2.56 SSRI 1.83 2.02 ARB( 1.81 1.68 1.66 1.64 ARB ( ) 10 3910 0.96 1.9 2.7 ARB 4.5 2.3 3.5 55 1.4 3.3 1.03 0.33 0.77 0.13 2010 1.5 81 1.7 2.2 2.3 100 1.1 10.5 40 2.5 8 44 0.88 2010 88 12 2.3 1 134.57 5200 1 2800 9.4 4 1993 4.2 [1] 2 1995 1) 94 106 (58 ) [1,3] 62 42 44 95 ) 18 106 18 2) 7 1995 1994 1995 8 ab 1991 ab 1996 1997 1991 ( 96 8 ) (27 ) 2000 (9 ) (37 ) (10 1997 12 1995 16 8 1991 9 45 2000 ) (20 2000 ) 1995 1) Red Book AWP average wholesale price 15 0.85 AWP [11] AWP single source 70 ASP(average sale price) [11] 2010 2005 [10,11] AWP 74 multiple source 72 single source source 74 multiple 66 AWP 32 [10,11] AWP ASP AMP average manufacture EAC(Estimated acquisition cost: ) WAC(Whole sale price acquisition cost) Best Price FCP (Federal ceiling price) Part D PartB [11] 2) 0.66 0.21 0.13 1.59 3) 10 46 1.12 4.71 0.52 4.16 AWP 70 1995 8 [11,19] 1) 1993 1995 1995 4.2 (4.1 ) 2005 [20a,b] 81 100 211 99 2 Danzon ( 8) 71 20 2) 1995 4 0.70 2.05 11 47 1.50 2.11 3) BNF VIDAL Rote [12-15] Liste a b 4) Danzon [20a,b] Danzon [21] IMS 2005 [20a] [20b] Public price Price Index median 2004 2008 [21] Danzon 100 8 2008 a Danzon 2005 100 2008 00 99 8 [20b] 111 1 211 99 81 12 48 90% Danzon 1999 350 9 [20c] 250 Price Index median 2 1.4 1.9 2.3 1.9 1993 1994 [22,23] ACE 100 [22,23] 20 ARB 5053 [24] 972 100 [25] 2783 [26.27] TIP 10 [28-31] 2011 [32,33] 479 SSRI [34-37] 2010 84 2009 [38,39] 2000 WHO 760 2005 8 [40,41] 13 49 2009 2011 [42] 2009/10 2009AH1N1 12 [43] [1] 1995 2010 100 77 1.5 2.2 2.3 81 100 1.7 1.1 0.71 2010 4.2 4.1 14 50 1993 HTA 2011 1) 1996 2) a) TIP 10 1 1-7 1995 b) 1975 1995 No330 8 3) a) TIP 10 12 116-119 TIP 1995 b) (2) 1994 27(1) 121-122 1996 c) (3) 1 1 53-54 1996 d) 55(3) 240-244 1996 4) a) ISDB (International Society of Drug Bulletin). 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Purchasing Power Parities for GDP and related indicators. http://stats.oecd.org/Index.aspx?DataSetCode=PPPGDP 46) http://dcp.seesaa.net/article/160256793.html 18 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 1 70 2 71 3 72 4 73 昭和四十七年六月十五日第三種郵便物認可 定 価 〒共一、 〇〇〇円︵本号に限り︶ 郵便振替 〇〇一六〇 〇 - 一 - 四〇三四六 TEL 03(3375)5121（代） 発行人 住江 憲勇 全国保険医団体連合会 〒 151-0053 東京都渋谷区代々木 2-5-5 新宿農協会館 発行所 二〇一二年三月五日︵毎月一回一日︶発行 月刊保団連臨時増刊号 No. 1087