分析我国肝移植受者移植后免疫抑制剂使用特征和药费情况。

回顾性分析2017年1月至2021年12月全国9个城市95家医疗机构的肝移植门诊处方数据，包括三级医院87家，二级医院7家，一级医院1家。纳入诊断含肝移植术后且含≥1种免疫抑制剂的门诊处方。样本抽取采用二阶段抽样方法。按门诊患者人次统计处方数据，若患者单次就诊处方数大于1张，计1人次；若同一患者就诊2次或以上，按就诊次数计算人次。提取肝移植免疫抑制剂处方中年龄、性别以及处方费用及人次等信息，分析免疫抑制剂使用特征和变化趋势。

共计调取肝移植门诊处方106 428人次，其中上海最多，占总人次37.90%(40 339)。2017至2021年肝移植受者各年份年龄分布情况基本一致，46～60岁患者占比最多；各年份性别构成也基本一致。共获得112 137人次的肝移植门诊报销数据。2017至2021年不同报销类型占比基本稳定不变，大部分为医保和自费，占比分别为58.21%(65 274/112 137)和24.60%(27 587/112 137)。2017至2021年期间肝移植门诊处方总人次呈上升趋势，2018至2020年免疫抑制剂次均药费逐年增长，免疫抑制剂药费在处方药费总额中的占比呈上升趋势。含有具体免疫抑制方案的肝移植门诊处方共53 084人次，以他克莫司为基础的免疫抑制方案药费占比较高，他克莫司联合霉酚酸类药费在所有免疫抑制方案中最高；在以环孢素为基础的免疫抑制方案中，环孢素联合霉酚酸类药费最高。在使用人次排序前5位的免疫抑制方案中，有4种免疫抑制方案以他克莫司为基础。他克莫司单药治疗最常使用，他克莫司联合霉酚酸类方案居第2位；在三联方案中，他克莫司联合霉酚酸类和糖皮质激素方案使用人次最多；以环孢素为基础的免疫抑制方案使用人数较少。

2017至2021年随着国内肝移植手术人数增加，免疫抑制剂的药费总额呈上升趋势。他克莫司单药以及联合霉酚酸类的免疫抑制方案为肝移植术后主要免疫抑制维持方案。

To analyze the characteristics of immunosuppressant usage and medication expenses among liver transplant recipients in China.

A retrospective analysis was conducted using prescription data from liver transplant outpatient departments in 95 hospitals across 9 cities in China from January 2017 to December 2021. The included institutions consisted of 87 tertiary hospitals, 7 secondary hospitals, and 1 primary hospital. Outpatient prescriptions were included if they involved patients who had undergone liver transplantation and were prescribed at least one type of immunosuppressant. A two-stage sampling method was used for sample selection. Prescription data were counted based on the number of outpatient visits. If a patient had multiple prescriptions during a single visit, it was counted as one visit. If the same patient had multiple visits, the total number of visits were counted. Information including age, sex, prescription costs and visit counts were extracted from the immunosuppressant prescriptions for liver transplant recipients to analyze the characteristics and trends of immunosuppressant usage.

A total of 106 428 outpatient visits for liver transplant prescriptions were retrieved, with Shanghai having the highest number of visits, accounting for 37.90% (40 339) of the total visits. The age distribution of liver transplant recipients remained consistent from 2017 to 2021, with the majority being between 46 and 60 years old. The sex composition also remained relatively consistent across the years. A total of 112 137 liver transplant outpatient reimbursement data were obtained. The proportion of different reimbursement types remained stable from 2017 to 2021, with the majority being partial health insurance and self-payment, accounting for 58.21% (65 274/112 137) and 24.60% (27 587/112 137), respectively. The total number of liver transplant outpatient visits showed an upward trend from 2017 to 2021. The average costs of immunosuppressant per visit increased annually from 2018 to 2020, and the proportion of immunosuppressant costs in the total prescription costs showed an increasing trend. Among the liver transplant prescriptions with specific immunosuppressive regimens (53 084 visits), regimens based on tacrolimus had a relatively high costs proportion. The combination of tacrolimus and mycophenolic acid had the highest cost among all immunosuppressive regimens. Among the regimens based on cyclosporine, the combination of cyclosporine and mycophenolic acid had the highest costs. Among the top 5 immunosuppressive regimens in terms of usage, 4 were based on tacrolimus. Monotherapy with tacrolimus was the most commonly used, followed by the combination of tacrolimus and mycophenolic acid. Among the triple regimens, the combination of tacrolimus, mycophenolic acid, and glucocorticoids had the highest usage, and regimens based on cyclosporine had a relatively lower number of users.

From 2017 to 2021, with the increase in the number of liver transplant surgeries in China, the total costs of immunosuppressants showed an upward trend. Tacrolimus monotherapy and the combination of tacrolimus and mycophenolic acid have become the main immunosuppressive maintenance regimens after liver transplantation.