类风湿关节炎在长沙地区的治疗方式与直接医疗费用:一项回顾性医保数据库研究  

Treatment Pattern and Direct Medical Cost of Rheumatoid Arthritis in Changsha: A Retrospective Analysis on Claimed Dataset

作　　者：孙兆泉 廖孝和[2] 杨安芳[3] Sun Zhaoquan Liao Xiaohe Yang Anfang(IHunan Medical, Injury, Maternity Insurance Management Service Bureau, Changsha, 410004 Xiangya Hospital Central South University, Changsha, 410008 The Second Xiangya Hospital of Central South University, Changsha, 410011)

机构地区：[1]湖南省医疗工伤生育保险管理服务局,长沙410004 [2]中南大学湘雅医院,长沙410008 [3]中南大学湘雅二医院,长沙410011

出　　处：《中国医疗保险》2017年第1期49-53,共5页China Health Insurance

摘　　要：目的 :评估国内类风湿关节炎的治疗模式与直接医疗费用,并提出提高卫生资源使用效率的建议。方法 :在湖南开展了一项基于医保数据库的描述性、回顾性研究,该数据库包括两家代表性三级医院5年的门诊数据和4年住院数据。研究共纳入994名住院患者和5522名门诊患者。对比分析本研究结果与国外文献数据,提出政策建议。结果 :传统DMARDs联合治疗是类风湿关节炎的主要治疗方式,生物制剂的使用率低(住院为12.5%,门诊不足1%),生物制剂治疗以肿瘤坏死因子拮抗剂英夫利西为主,生物制剂住院使用的比例为门诊的18倍。与发达国家生物制剂主要门诊使用和显著改善疗效、降低住院天数、手术次数的结果相反,该研究中生物制剂组的住院天数反而高于传统治疗组7天。生物制剂组的人均住院、门诊费用分别为44072元、34241元,传统治疗组的人均住院费用分别为16955元、4730元。结论 :我国生物制剂以住院使用为主的方式增加了生物制剂在中国的治疗成本,未来应探索通过门诊支付和按病种支付等形式鼓励生物制剂门诊使用,以节省有限的住院资源,提高医疗资源的使用效率。Objective： To evaluate the treatment pattern and direct medical cost in patients with Rheumatoid Arthritis（RA） and explore possible ways to optimize health resource utilization. Method： A retrospective analysis was conducted on the insurance data of Hunan province. The outpatient data of 5 years and inpatient data of 4 years in two tertiary hospitals were included. 994 inpatients and 5522 outpatients were selected. The results were further used to compare treatment patterns with those in developed countries, especially for the biologics agents use. Results： the treatment for RA was dominated by conventional DMARDs combinations, biologics agents use was uncommon（12.5% for inpatient setting, less than 1% for outpatient setting）, and most of the biologics use is infl iximab, a TNF-antagonist. The major administration setting for biologic agents use was in inpatient department（18times of that in outpatient department）. In contrast to developed countries where biologics are mainly administered in outpatient settings and are found to be strongly associated with increased effi cacy, decreased inpatient days and surgical procedures, the hospitalization days in the biologics group is associated with 7 days longer than those in conventional treatment group. The medical care costs associated with inpatient and outpatient use of biologics are 44072 and 34241 yuan, respectively, while the costs associated with the conventional treatment are 16955 and 4730 yuan in inpatient and outpatient settings, respectively. The research suggests that in China, the reimbursement policy should encourage biologics agents use in outpatient settings and explore the possibility of outpatient payment and disease-related payment, to avoid unnecessary hospitalizations and improve the effi ciency of health resource.

关 键 词：类风湿关节炎 治疗方式 直接医疗费用 肿瘤坏死因子拮抗剂 英夫利西单抗 

分 类 号：R593.22[医药卫生—内科学] R197.3[医药卫生—临床医学] F842.684[经济管理—保险]