最优跨期治疗性药品支出：法国丙型肝炎案例

中文摘要

我们研究卫生当局在考虑使用创新性治疗药物控制流行病时所面临的跨期权衡。我们构建了一个动态控制的易感—感染—康复（SIR）模型，其中患者可能无症状，并分析了卫生当局在药物创新过程之初所决定的治疗支出序列的最优性条件。我们表明，解析结论因依赖于参数取值而并不明确。作为应用，我们聚焦于丙型肝炎的案例研究，其治疗在 2014 年治疗性药物引入时经历了重大变革。我们使用法国数据校准受控 SIR 模型并模拟最优政策。我们表明，最优政策需要对跨期预算进行一定程度的提前投入。该分析展示了跨期预算相对于非前瞻性的固定预算分配可以带来多大益处。

Abstract

We study intertemporal tradeoffs that health authorities face when considering the control of an epidemic using innovative curative medical treatments. We set up a dynamically controlled susceptible–infected–recovered (SIR) model for an epidemic in which patients can be asymptomatic, and we analyze the optimality conditions of the sequence of cure expenses decided by health authorities at the onset of the drug innovation process. We show that analytical conclusions are ambiguous because of their dependence on parameter values. As an application, we focus on the case study of hepatitis C, the treatment for which underwent a major upheaval when curative drugs were introduced in 2014. We calibrate our controlled SIR model using French data and simulate optimal policies. We show that the optimal policy entails some front loading of the intertemporal budget. The analysis demonstrates how beneficial intertemporal budgeting can be compared to non-forward-looking constant budget allocation.