云南省部分地区艾滋病免费抗病毒治疗相关直接医疗费用分析  

An analysis of direct medical expenditures related with free ARV treatment for AIDS patients in part of Yunnan province

作　　者：周枫[1] 李永 王建生[3] 郭志伟[4] 许元武 杨海清 李继萍 章银娣 段兴钧 李品银 丁雨生 徐海波 段松[8] 李波[2] 邵国荣 田树明 曹韵贞[9] 

机构地区：[1]中国医学科学院病原生物学研究所,北京100730 [2]云南省德宏州卫生局,潞西678400 [3]中国疾病预防控制中心公共卫生监测与信息服务中心卫生统计室,北京100050 [4]中国医学科学院医学信息研究所,北京100730 [5]云南省陇川县人民医院,陇川678700 [6]云南省德宏州医疗集团,潞西678400 [7]云南瑞丽民族医院,瑞丽678600 [8]云南省德宏州疾病预防控制中心,潞西678400 [9]中国医学科学院 病原生物学研究所,北京100730

出　　处：《中国艾滋病性病》2008年第5期450-453,共4页Chinese Journal of Aids & STD

基　　金：中国医学科学院病原生物学研究所基本科研业务费项目(2007IPB06);第四轮中国全球基金艾滋病项目应用性研究项目(R036)

摘　　要：目的研究国家免费抗病毒治疗相关医疗费用分布情况,为制定针对艾滋病治疗的相关政策提供参考信息。方法系统收集德宏州年龄>18岁、治疗随访资料相对完整的艾滋病病人,进入国家免费抗病毒治疗阶段后的全部相关直接医疗费用资料进行系统分析。结果176例艾滋病病人的人均抗病毒药物费用分别是:AZT+ 3TC+NVP 17932元。D4T+3TC+EFV19290元,D4T+3TC+NVP14337元,DDI+3TC+NVP15976元;人均CD4细胞计数检测费用第一年1000元,常规随访临床检验费用为人均514元/年;药物不良反应中肝损伤发生率最高。其次是药物过敏性皮疹和消化道症状,对应的治疗费用分别为人均1637元/年、1070元/年、1341元/年;不同CD_4水平药物不良反应的费用差异有统计学意义(P<0.05);抗病毒治疗后发生的机会性感染主要有呼吸道感染、卡氏肺孢子虫肺炎(PCP)、腹泻等,巨细胞病毒(CMV)感染的治疗费用最高,其次是HIV合并结核(TB),分别为10107元/年和3078元/年。结论抗病毒药物的费用是国家免费抗病毒治疗的主要构成部分,抗病毒治疗费用控制的重点应该放在药物不良反应和机会性感染的随访和治疗,需要开展长期的队列研究,对不同免疫状态下治疗费用的差别进行成本效益分析。Objective To explore the distribution of expenditures of national free antiretroviral （ARV） treatment for AIDS, and provide information for the development of policy related to AIDS treatment. Method The direct expenditure of ARV treatment included ARV medicines, hospital admission, routine clinical tests, treatment of side effects and opportunistic infection. All data of the direct expenditure related to free ARV treatment among AIDS patients over 18 years were collected from their medical records and analyzed systematically. Results One hundred and seventy six patients were enrolled into the study from Dehong prefecture in Yunnan province.The expenditures on ARV regimens were 17 932 Yuan （CNY） for AZT＋ 3TC ＋ NVP, 19 290 Yuan for D4T ＋ 3TC ＋ EFV, 14 337 Yuan for D4T ＋ 3TC ＋ NVP and 15 976 Yuan for DDI ＋ NVP ＋ 3TC, respectively. The expenditure for testing CD4/CD8 cell count was 1000 Yuan per person in the first year. The annual expenditure for follow-up clinical laboratory test was 514 Yuan per person. The abnormal liver function was listed as a most prevalent ARV side effect, which was followed by skin rash and gastrointestinal disorders, and the corresponding expenditure of their treatment were 1637 Yuan, 1070 Yuan and 1341 Yuan, respectively. The expenditures of treating drug related adverse events （P 〈 0.05） were significantly different in patients with different levls of CD4 cell count, as analyzed by chi-squared test. Opportunistic infections after initiating ARV treatment were respiratory infections, PCP, diarrhea, and others. The highest expenditure occurred for the treatment of CMV infection, with 10107 Yuan per year; the next was for the treatment of HIV/TB co-infection,with 3078 Yuan per year. Conclusion The cost of ARVs medicineswas the main component of the expenditures for national free antiretroviral treatment. Expenditure control should be focused on the treatment and follow up of ARV related side effects and OI. It is necessary to conduct long term prospective cohor

关 键 词：艾滋病 高效抗病毒治疗 费用分析 

分 类 号：R512.91[医药卫生—内科学]