基于潜在类别模型的乙肝相关疾病患者治疗模式及住院费用研究  

Studying on The Treatment Patterns and Hospitalization Expenses of Patients with Hepatitis B Related Diseases Based on Latent Class Model

作　　者：李观海 贾卫东[2] 陈舸 李粤平 杨朔 梁颖芳 周舒冬 宫晓 杨翌 郜艳晖 Li Guanhai(School of Public Health,Guangdong Pharmaceutical University,Guangzhou,P.R.China)

机构地区：[1]广东药科大学公共卫生学院,广东广州510310 [2]广州市第八人民医院

出　　处：《中国卫生事业管理》2020年第6期434-437,466,共5页Chinese Health Service Management

基　　金：国家自然科学基金“慢乙肝患者治疗队列医疗费用及群体异质性的混合模型研究”(71573059);广东省医学科研基金“基于潜变量模型的慢性病多共病患者共病特征及健康行为研究”(A2017036)。

摘　　要：目的:研究广州市乙肝相关疾病患者治疗模式的异质性,及不同治疗模式特征人群的住院费用,为精准估计费用、制定控费政策、合理配置医疗资源提供参考依据。方法:从广州市第八人民医院医院信息系统(Hospital Information System,HIS)中提取2015年乙肝相关疾病(慢乙肝、肝硬化和肝癌)住院患者信息,采用潜在类别分析(latent class analysis,LCA)对9种治疗方案进行聚类,描述不同治疗模式的人群特征、住院费用及费用构成。结果:乙肝相关疾病患者(2903人次)的治疗模式分成3类:模式1(占19.53%)为保肝药治疗为主,合并部分干扰素治疗(Interferon,IFN);模式2(占20.67%)为保肝药基础上加核苷(酸)类似物(Nucleotide analogue,NAs)治疗为主;模式3(占59.80%)为除干扰素外,其他治疗方案使用均较高。模式1到模式3的慢乙肝患者比例减少、肝硬化和肝癌患者比例增加;住院天数和住院费用也相应地增加;住院费用及其构成的差异比不同病程患者间的差异更大,而同一治疗模式下的不同病程患者住院费用和各成分费用的比例更为接近。结论:按治疗模式聚类能有效区分乙肝相关疾病患者的异质性,更精确地估计同质性亚组患者的医疗费用及各类费用构成。Objective To explore the heterogeneity of treatment patterns among patients with hepatitis B related diseases in Guangzhou and the hospitalization expenses of patients with different treatment patterns,provide references for accurately estimating hospitalization expenses,establishing expense control policy and rationally allocating medical resources.Methods The hospitalization data of patients with hepatitis B related diseases(chronic hepatitis B,cirrhosis and liver cancer)was collected from one hospital in 2015,and analyzed with Latent class analysis(LCA).Results The treatment patterns of patients with hepatitis B-related diseases(2,903 person-times)were divided into three categories.Mode 1 was hepatoprotective combined with interferon(IFN).Mode 2 was hepatoprotective combined with Nucleotide analogue(NAs).Mode 3 was all treatments high-frequency using except IFN.The proportion of patients with chronic hepatitis B decreased,and the proportion of patients with liver cirrhosis and liver cancer increased.The hospitalization duration and hospitalization expenses increased correspondingly.The difference in hospitalization costs and composition was greater than that among patients with different disease course.In the same treatment pattern,the hospitalization expenses and proportion were closer among patients with different disease course.Conclusion Clustering by treatment patterns can effectively distinguish the heterogeneity of patients with hepatitis B related diseases,and more accurately estimate the medical expenses and various cost components of homogenous subgroups.

关 键 词：乙肝相关疾病 潜在类别分析 治疗模式 住院费用 

分 类 号：R19[医药卫生—卫生事业管理]