江苏省启东市HBV感染相关疾病的医疗费用及其影响因素分析  

Medical expenditure of hepatitis B virus infection and its impact factors analysis in Qidong,Jiangsu Province

作　　者：王宇婷[1] 黄慧瑶[2] 秦海松 姚红玉[4] 陈松[4] 郁冬梅[4] 代敏[2] 陈陶阳[5] 曲春枫[1,6] 石菊芳[2] WANG Yuting HUANG Huiyao QIN Haisong et al(Department of Immunology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院免疫学研究室,北京100021 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院城市癌症早诊早治项目办公室,北京100021 [3]启东市传染病医院,江苏启东226200 [4]启东市人民医院启东肝癌防治研究所科研科,江苏启东226200 [5]启东市人民医院启东肝癌防治研究所病因室,江苏启东226200 [6]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021

出　　处：《临床肝胆病杂志》2017年第1期61-66,共6页Journal of Clinical Hepatology

基　　金：“十二五”传染病国家科技重大专项(2012ZX10002008-001,003);江苏省科技支撑计划(BE2013657)

摘　　要：目的量化江苏省启东市HBV感染相关疾病的例均医疗费用,并分析其构成及影响因素。方法基于启东市人民医院与启东市传染病医院,采用时间阶段连续病例整群抽样法,选取2012年HBV感染相关原发性肝癌(n=217)、乙型肝炎肝硬化(n=234)、慢性乙型肝炎(CHB,n=136)住院患者,收集2010年1月-2012年12月住院及门诊费用合计(例均医疗费用)及相关基本和临床信息。采用专家咨询法,调查急性乙型肝炎、HBs Ag无症状携带者和HBV隐匿感染者的例均医疗费用。不同年份的费用采用2014年医疗保健消费价格指数进行转换。计量资料组间比较采用独立样本t检验,多组间比较采用方差分析,组内进一步两两比较采用SNK-q检验;采用多重线性回归分析(逐步回归法)进行例均医疗费用的影响因素探讨。结果 HBV感染相关原发性肝癌、乙型肝炎肝硬化、CHB患者2010-2012年的例均医疗费用分别为30 183元、22 066元和15 703元,住院费用分别为29 058元、21 383元和15 394元,占例均医疗费用的比例分别为96.3%、96.9%、98.0%;药品费用分别占例均住院费用的55.0%、73.4%和78.2%;3种疾病患者的住院次数(F值分别为89.1、67.7、11.5,P值均<0.001)、治疗方案(F=21.8、t=-2.1、t=-3.7,P值分别为<0.001、0.039、<0.001)、医保类型(t值分别为3.1、2.6、2.7,P值分别为0.002、0.011、0.012)是例均医疗费用的影响因素,临床分期仅为CHB患者例均医疗费用的影响因素(分为轻、中和重度,多因素分析:β=1.238,F=5.9,P=0.021)。急性乙型肝炎患者例均医疗费用为5950元,HBs Ag无症状携带者或HBV隐匿感染者的年均医疗费用为770~1540元。结论 HBV感染相关疾病的医疗费用随着病情加重逐步递增,该数据将为后期疫苗或筛查干预的经济学效果评价提供基线信息。riance was used for comparison between multiple groups,and the SNK -q test was used for comparison within each group.Multiple linear re-gression analysis （stepwise regression）was used to investigate the influencing factors for medical costs per case.Results The medical costs per case of patients with HBV related primary liver cancer,patients with HBV related cirrhosis,and CHB patients from 2010 to 2012 were 30183 RMB,22066 RMB,and 15703 RMB,respectively,and the inpatient costs were 29058 RMB,21383 RMB,and 15394 RMB,re-spectively,which accounted for 96.3%,96.9%,and 98.0% of the medical costs per case.Drug costs of these three groups accounted for 55.0%,73.4%,and 78.2% of the medical costs per case,respectively.The number of times of hospitalization （F =89.1,67.7,and 11.5,all P 〈0.001）,treatment regimen （F =21.8,t =-2.1,and t =-3.7,P 〈0.001,P =0.039,and P 〈0.001）,and type of medical insurance （t =3.1,2.6,and 2.7,P =0.002,0.011,and 0.012）were influencing factors for medical costs per case,while clini-cal stage was an influencing factor for medical costs per case only in CHB patients （a multivariate analysis for patients mild,moderate,and severe CHB：β=1.238,F =5.9,P =0.021）.The medical costs per case for patients with acute hepatitis B were 5950 RMB,and the an-nual medical costs for HBsAg asymptomatic carriers and patients with occult HBV infection ranged from 770 RMB to 1540 RMB.Conclusion The medical costs of HBV related is increasing as the illness progresses.Our results will provide baseline information for the following eco-nomic evaluation of vaccination or screening interrention.

关 键 词：肝炎病毒 乙型 医疗费用 经济负担 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]