泡沫硬化剂与传统手术治疗下肢大隐静脉曲张的卫生经济学比较  

Health economics of sclerotherapy with foam hardener versus traditional surgery in treating varicosis of great saphenous vein of lower extremities

作　　者：杨锦 陈云玲[2] 郭伟昌[2] 黄智勇[2] 李昭辉[2] YANG Jin;CHEN Yunling;GUO Weichang;HUANG Zhiyong;LI Zhaohui(North Sichuan Medical College,Nanchong,Sichuan Province 637000;Department of Vascular Surgery,Yibin Municipal First People’s Hospital,Yibin,Sichuan Province 644000,China)

机构地区：[1]川北医学院,四川南充637000 [2]四川宜宾市第一人民医院血管外科

出　　处：《介入放射学杂志》2020年第12期1235-1239,共5页Journal of Interventional Radiology

摘　　要：目的通过卫生经济学评价方法比较泡沫硬化剂疗法和大隐静脉高位结扎结合点式抽剥术治疗下肢大隐静脉曲张的成本和效果。方法回顾性分析2017年1月至2018年10月宜宾市第一人民医院收治的120例大隐静脉曲张患者临床资料。根据治疗方式的不同分为泡沫硬化剂组(n=80)和传统手术组(n=40)。对比分析两组临床疗效、直接医疗成本、直接非医疗成本、间接成本和总成本及二次干预费用。结果泡沫硬化剂组术中出血量、手术时间、术后住院时间、总住院时间及术后并发症均低于传统手术组(P<0.05)。泡沫硬化剂组直接医疗成本比例主要为手术费[(30.30±6.40)%]和药品费[(29.95±8.13)%],手术费显著高于传统手术组[(1 012.66±58.15)元对(823.59±342.43)元](P<0.001),但药品费[(1 132.22±754.89)元对(3 530.60±2 124.67)元]、材料费[(259.93±200.56)元对(1 575.73±507.95)元]、检查检验费[(704.19±212.60)元对(964.39±350.53)元]及治疗费[(460.28±330.45)元对(1 572.10±639.74)元]均显著低于传统手术组(P<0.001);传统手术组直接医疗成本以药品费为主,其比例显著高于泡沫硬化剂组[(38.80±12.18)%对(29.95±8.13)%](P<0.001)。泡沫硬化剂组直接医疗成本、直接非医疗成本、间接成本和总成本均显著低于传统手术组[(3 569.28±1 312.19)元对(8 466.41±2 911.25)元,(226.00±206.93)元对(521.75±219.31)元,(406.06±364.42)元对(914.24±375.16)元,(4 201.34±1 789.95)元对(9 902.40±3 368.38)元](P<0.001)。泡沫硬化剂组术后1年复发率(7.5%)高于传统手术(5%)(P>0.05),但再次干预平均成本显著低于传统手术组[(3 980.80±202.32)元对(11 434.28±481.77)元](P<0.001)。结论泡沫硬化剂治疗大隐静脉曲张与传统手术相比,可明显降低患者成本,有助于在有限资源下提高社会效益和经济效益,是一种对医院和患者均有很大经济学价值的治疗方式。Objective By using health economics evaluation method to compare the medical cost and curative effect between sclerotherapy with foam hardener and traditional surgery(high ligation of great saphenous vein together with point exfoliation) in treating varicosis of great saphenous vein of lower extremities. Methods The clinical data of 120 patients with varicosis of great saphenous vein of lower extremities, who were admitted to the Yibin Municipal First People’s Hospital of China during the period from January 2017 to October 2018,were retrospectively analyzed. According to the different treatment methods, the patients were divided into foam sclerotherapy group(n=80) and traditional surgery group(n=40). The clinical efficacy, direct medical cost, direct non-medical cost, indirect cost, total cost and secondary intervention cost were compared between the two groups. Results The amount of intraoperative blood loss, time spent for operation, postoperative hospitalization days, total hospitalization time and postoperative complications in the foam sclerotherapy group were lower than those in the traditional surgery group(P<0.05). The direct medical expenses in the foam sclerotherapy group was mainly operation fee and medication cost, accounting for(30.30±6.40)% and(29.95±8.13)% of total medical expense respectively. In the foam sclerotherapy group, the specific operation fee was(1012.66±58.15) Chinese yuan, which was higher than(823.59±342.43) Chinese yuan in the traditional surgery group(P<0.01). The medication cost, medical materials cost, examination cost and treatment cost in the foam sclerotherapy group were(1 132.22±754.89),(259.93±200.56),(704.19±212.60) and(460.28±330.45) Chinese yuan respectively,all of which were significantly lower than(3 530.60±2 124.67),(1 575.73±507.95),(964.39±350.53) and(1 572.10±639.74) Chinese yuan respectively in the traditional surgery group(P<0.01). The direct medical expenses in the traditional surgery group was mainly medication cost, accounting for(38.80±12.18)% o

关 键 词：下肢大隐静脉曲张 泡沫硬化疗法 大隐静脉高位结扎剥脱术 卫生经济学 

分 类 号：R622.4[医药卫生—整形外科]