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Personalized Medicine의 보험급여 현황과 쟁점

Reimbursement Status and Challenges with Personalized Medicine

유수연|권준성|양봉민|문유정
한국보건경제정책학회 (The Korean Association of Health Economics and Policy)|2013.03|보건경제와 정책연구 (The Korean Journal of Health Economics and Policy)|제19권 제1호|pp. 23-39

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참고문헌

키워드

Reimbursement보험급여Personalized Medicines표적치료제Targeted Therapies
주제분류사회과학일반

초록

최근 Personalized Medicine (PM)은 바이오마커 진단을 통해 환자를 선별하여 치료하는 맞춤의료법으로 주목을 받고 있다. PM의 종류는 사용 목적에 따라 치료 효과를 높이기 위한 것과 부작용을 줄이기 위한 것으로 구분할 수 있고, 질병군별로 분류하면 암, 심혈관계 질환, 에이즈, 레트로바이러스 치료제로 나눌 수 있다. PM은 선별된 그룹에게 치료 반응률이 높기 때문에 효과적인 치료를 가능하게 하고 부작용은 줄이는 강점을 가지고 있다. PM의 이러한 장점 때문에 의약품 시장에서 PM의 개발은 점차 두드러지고 있고 앞으로 더 많은 PM 의약품이 개발될 것으로 예상된다. 그러나 PM은 새로운 기회를 맞이하는 동시에 새로운 도전에 직면하고 있다. 보다 높은 질의 보건의료 서비스를 원하는 환자의 수요를 바탕으로 PM을 개발하여 그 가치를 인정받고자 하는 제약사의 입장과 PM의 경제적 가치의 불확실성 때문에 보험급여를 꺼리는 보험자의 입장 사이에 갈등이 일어날 가능성이 생긴 것이다. 따라서 앞으로 PM의 특성을 잘 파악하여 그 특성에 맞는 보험급여 평가 방법에 대해 논의할 필요가 있을 것이다.

Abstract

Customized medical therapy, Personalized Medicine (PM) which selects the patients based on genetic variation is now spotlighted. If the type of PM is divided by the usage, its usage can be divided into increasing its therapeutic effects and reducing the side effects. Type of PM can also be divided into treatment groups such as anticancer drug, cardiovascular agents, and AIDS antiretroviral drugs. The strengths of PM are increasing therapeutic effects and reducing side effects. These advantages of PM provide sufficient incentives for pharmaceutical companies to develop more PM. However, there are both opportunities and challenges for healthcare reimbursement policy and emerging market. Even with the recognition of certain clinical advantages of PM, payers may be reluctant to invest in PM because of embedded uncertainty on resource savings. It will therefore be necessary to develop reimbursement schemes which reflect the characteristics of PM at the system level. This review is a first step, hopefully, toward such a development.

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