目的 分析昆明医科大学第一附属医院药品零加成实施前后口服降糖药的使用变化，评价药品零加成实施后糖尿病患者的受益情况。方法 采用限定日剂量（DDD）法对药品零加成实施前后昆明医科大学第一附属医院口服降糖药的销售金额、用药频度（DDDs）、限定日费用（DDC）以及药品排序比（B/A）进行统计分析。结果 药品零加成实施后，5类口服降糖药的销售金额均明显下降，阿卡波糖、二甲双胍、格列美脲、瑞格列奈、格列齐特在零加成前后的销售金额均稳居前5位，所有口服降糖药的DDDs均减少，但阿卡波糖的DDDs接近于二甲双胍的DDDs，格列齐特的DDDs排序甚至超过了格列美脲；口服降糖药的DDC均呈不同幅度的减小，但其排序保持不变；且B/A基本稳定不变，二甲双胍的B/A最大，为2.00。结论 取消药品加成对口服降糖药的使用情况影响较大，明显减小了糖尿病患者的经济负担，但需关注医院部分口服降糖药后续的临床应用是否合理。

Objective To analyze the changes in the use of oral hypoglycemic agents before and after the "zero additional cost of drugs" in the First Affiliated Hospital of Kunming Medical University, and to evaluate the benefits of diabetes patients after the "zero additional cost of drugs". Methods Consumption sum, defined daily doses (DDDs), defined daily cost (DDC), and drug sequence ratio of oral hypoglycemic agents before and after the "zero additional cost of drugs" in the First Affiliated Hospital of Kunming Medical University were analyzed statistically by the Limited Daily Dose (DDD) method. Results After the "zero additional cost of drugs", consumption sum of five kinds of oral hypoglycemic agents all significantly decreased, and consumption sum of acarbose, metformin, glimepiride, repaglinide, and gliclazide ranked the top five. DDDs of all oral hypoglycemic agents were decreased, but DDDs of acarbose was near to DDDs of metformin. While the DDDs sequence of gliclazide exceeded that of glimepiride. DDC of oral hypoglycemic agents all showed different degrees of decrease, but the sequence of DDC was stable. And B/A of oral hypoglycemic agents was basically stable. B/A of metformin was the biggest (2.00).Conclusion The abolishment of drug price addition has a greater impact on the usage of oral hypoglycemic agents, which significantly reduces the economic burden of diabetic patients, but it is necessary to pay attention to whether the clinical application of some oral hypoglycemic drugs is reasonable in the hospital in the future.

云南省卫生科技计划项目（2017NS075）