中国12个地区乙型肝炎相关疾病住院患者经济负担调查  

Survey of economic burden of hepatitis B-related diseases in 12 areas in China

作　　者：马起山[1,3] 梁森[1] 肖和卫[1,4] 张顺祥[1] 庄贵华[2] 邹宇华[3] 谭红专[4] 刘近春[5] 张毓洪[6] 徐爱强[7] 张丽[7] 冯向先[8] 胡东生[9] 王富珍[10] 崔富强[10] 梁晓峰[10] 

机构地区：[1]深圳市疾病预防控制中心m518055 [2]西安交通大学,710061 [3]广东药科大学,广州510006 [4]中南大学,长沙410008 [5]山西医科大学第一医院,太原030001 [6]宁夏医科大学,银川750004 [7]山东省疾病预防控制中心,济南250014 [8]长治医学院,046000 [9]深圳大学,518060 [10]中国疾病预防控制中心,北京100050

出　　处：《中华流行病学杂志》2017年第7期868-876,共9页Chinese Journal of Epidemiology

基　　金：深圳市国家科技重大专项配套项目（GJHS20120628150832769）;国家科技重大专项（2008ZX10002-001）负责完成各地区调查的还有：西安交通大学张敏,山东省CDC吕静静、亓文婷、颜丙玉,宁夏医科大学李小强、许红霞,山西医科大学李俊华,山西长治医学院郭崇政、史武杰

摘　　要：目的中国缺少全国性乙型肝炎（乙肝）相关疾病经济负担研究，本病的社会经济危害未能阐明，乙肝防治经济学评价缺乏关键参数；本研究旨在获得我国不同地区乙肝相关疾病患者住院期间及年均直接、间接和无形费用。方法选取中国12个地区的传染病专科医院和综合性医院，采用时间阶段连续病例整群抽样法，对住院治疗的乙肝相关疾病患者进行调查。直接费用包括直接医疗和直接非医疗费用；间接费用采用人力资本法，分地区按城镇和农村人口计算患者和陪护人误工费；无形费用采用支付意愿法。多元线性逐步回归分析直接和间接费用的影响因素。结果全国12个地区共调查医院27所，有效调查样本4718例，总应答率为77．7％。按住院期间计算，平均住院29．2（27～34）d，例均费用16832．80元，药费（10365．10元）占比（61．2％）最高；直接和间接费用分别为18336．10元和4759．60元，二者之比3．85：1，直接和间接费用高低与乙肝严重程度相一致。直接医疗费用为17434．70元，高于直接非医疗费用（901．40元）；直接医疗费用中，住院费高于门诊费和自购药费；直接非医疗费用中，旅费最高。间接费用中，患者误工费（3832．50元）高于陪护人误工费（927．20元）。直接和间接费用合计高低依次为肝移植、重型乙肝、原发性肝癌和失代偿期肝硬化，而急性乙肝、代偿期肝硬化和慢性乙肝（CHB）较低。直接和间接费用共同影响因素为医院级别高、乙肝相关疾病严重、城市户籍、使用抗病毒治疗、住院天数多、家庭收入高。按1年计算，年均门诊和住院3．74次和1．51次，年均直接、间接和无形费用分别为30135．30元、6253．80元和44729．90元，合计总费用为81119．00元；直接、间接和无形费用的构成比分别为37．3％、7．7％和55．0％。年均直接费用�Objective Less surveys on the economic burden of hepatitis B （HB）-related diseases have been conducted in China, so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking. This study aimed to analyze the direct, indirect and intangible expenditures of hospitalized patients with liB-related diseases during hospitalization and during a year in different areas of China. Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study. All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases. The direct expenditure included direct medical cost and direct non-medical cost. The indirect expenditure, including work loss of patients and caregivers, were calculated by using human capital method for urban and rural populations in 12 areas. The intangible expenditure were reflected by willing to pay and stochastic tournament. The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis. Results A total of 27 hospitals in 12 areas were included in the survey. A total of 4 718 cases were surveyed, the overall response rate was 77.7%. The average hospital stay was 29.2 days （27-34） and the hospitalization expenditure was averagely 16 832.80 yuan （RMB） per case, in which the highest proportion （61.2%） was medicine fees [ 10 365.10 yuan （RMB）]. The average direct expenditure and indirect expenditure were consistent with the severity of illness, which were 18 336.10 yuan （RMB） and 4 759.60 yuan （RMB） respectively, with the ratio of 3.85 ： 1. The direct medical expenditure El7 434.70 yuan （RMB）I were substantially higher than the direct non-medical expenditure ~901.40 yuan （RMB）~. It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medi

关 键 词：乙型肝炎 乙型肝炎相关疾病 住院患者 直接费用 间接费用 无形费用 

分 类 号：R512.62[医药卫生—内科学]