英夫利西单抗治疗类风湿关节炎的健康结果与卫生资源使用  

Health Outcomes and Health Resources Utilization of Infliximab Treatment for Rheumatoid Arthritis: A Prospective Cohort Study

作　　者：李敬扬[1] 文振华[1] 罗筱雯 邓丽[1] 陈文东 

机构地区：[1]中南大学湘雅医学院附属株洲医院风湿免疫科,株洲412007 [2]长沙诺民医疗科技有限公司,长沙410008

出　　处：《中国医疗保险》2016年第8期53-56,共4页China Health Insurance

摘　　要：在中等城市株洲开展了一项前瞻性队列研究,比较英夫利西单抗和常规改善病情抗类风湿药物(conventional disease modified anti-rheumatic drugs,cDMARDs)治疗类风湿关节炎30周后的疾病活动度、患者生活质量、卫生资源使用和直接医疗费用。疾病活动度采用DAS28评分方法,生活质量评估方法包括EQ-5D和SF-12量表,卫生资源使用评估包括治疗期间的住院次数和住院天数,直接医疗费用包括药品费用和诊疗费。30周治疗后的临床结果比较发现,英夫利西单抗相对于cDMARDs能够显著降低疾病程度(DAS28评分校正后相关系数-2.718,p<0.001)和改善患者生活质量(EQ-5D评分校正后的相关系数0.453,p<0.001)。然而,英夫利西单抗对临床结果的显著改善没有转化成卫生资源使用的减少,英夫利西单抗治疗组的住院时间显著高于cDMARDs组(30.2天vs 14.0天,p=0.012)。本研究对象为住院患者和次均住院费用,未来应进一步评估类风湿关节炎的按病种付费或门诊特殊病管理对降低卫生资源使用的作用。A prospective cohort study was conducted in a medium-sized city Zhuzhou to compare the effect of 30-week treatment by Infl iximab and by conventional disease modifi ed anti-rheumatic drugs（c DMARDs）, which included disease activity measured by DAS 28 score, quality of life measured by EQ-5D and SF-12, health resources utilization measured by hospital admissions and length of stay, and direct medical costs measured by medication costs and medical service costs for patients with rheumatoid arthritis. After 30-week follow-up, infl iximab treatment signifi cantly reduced diseases severity（DAS 28 score adjusted correlation coeffi cient being-2.718, p0.001） andimproved patients＇ quality of life（EQ-5D adjusted correlation coefficient being 0.453, p0.001） when comparedto c DMARDs. However, the signifi cantly improved clinical effectiveness was not refl ected by resource utilization. The patients treated by Infl iximab have signifi cantly longer length of stay in hospital than those treated by cD MARDs（30.2 days vs. 14.0 days,p=0.012）. As the mode of per-admission reimbursement is not adjusted as a confounding factor in the analysis, future research should explore the possible effect of costs saving by DRG and outpatient reimbursement mode for rheumatoid arthritis treatment.

关 键 词：英夫利西单抗 类风湿关节炎 卫生资源 直接医疗费用 

分 类 号：R593.22[医药卫生—内科学]