湖北省两个不同经济类型地区肺结核患者经济负担调查  

Economic burdens of patients with tuberculosis in two areas of different economic status in Hubei province

作　　者：卢星星[1] 刘勋[1] 叶建君[1] 张梦娴 张玉[1] 杨成凤[1] 陈伟[2] 周丽平[1] LU Xingxing;LIU Xun;YE Jianjun;ZHANG Mengxian;ZHANG Yu;YANG Chengfeng;CHEN Wei;ZHOU Liping(Hubei Institute for Tuberculosis Control,Hubei Center for Disease Control and Prevention,Wuhan,Hubei 430030,China;不详)

机构地区：[1]湖北省疾病预防控制中心结核病防治所,湖北武汉430030 [2]中国疾病预防控制中心结核病控制中心

出　　处：《中国预防医学杂志》2023年第3期193-197,共5页Chinese Preventive Medicine

基　　金：国家科技重大专项项目(2017ZX10201302-007)。

摘　　要：目的 调查湖北省两个不同经济类型地区肺结核患者经济负担,并开展结核病防治工作的社会效果与成本效益分析,为进一步完善卫生资源投入与使用提供理论依据。方法 收集湖北省《十三五终期评估》的评估报告,对2020年湖北省石首市和巴东县结核病防治工作的成本-效益进行分析。采用现场调查方式调查患者的经济负担情况,并采用秩和检验进行资料分析。结果 巴东县和石首市肺结核患者总直接医疗费用中位数分别为13 624 (9 014~20 964)元和10 062 (5 639~17 975)元。巴东县肺结核患者开始正规抗结核治疗之前住院费用中位数为5 180 (1 658~12 173)元,住院费用占比97.37%,住院天数中位数8 (3~15) d;石首市肺结核患者开始正规抗结核治疗之前住院费用中位数为10 123 (7 308~13 889)元,住院费用占94.37%,住院天数中位数18 (12~23) d;巴东县总直接非医疗费用中位数为3 580 (2 391~5 255)元,远高于石首市总直接非医疗费用中位数为2 001 (1 056~3 360)元,其中患者及家属往返交通费、住宿费、其他费用经秩和检验,差异有统计学意义(P<0.05)。2020年巴东县和石首市因结核病防控工作避免新发患者减少的社会医疗费用分别为180.7万元和113.0万元,分别挽回8 840万元和10 096万元的间接社会效益;巴东县和石首市每投入1元结核病防治经费,可产生的社会经济效益分别为109.7元和129.6元。结论 巴东县和石首市肺结核患者总住院费用占总直接医疗费用的比例均较高,巴东县肺结核患者直接非医疗费用高于石首市,就医路径也更为复杂,建立长效的结核病保障和投入机制是持续降低结核病发病率、降低患者经济负担的重要保障。Objective To understand the economic burdens of patients with tuberculosis in two areas of different economic status in Hubei province and to analyze the social effect and cost-benefits,so as to provide the evidence for improving the input and use of health resources.Methods Field investigation was conducted in Shishou city and Badong county in Hubei province in 2020 to investigate the financial burden of tuberculosis patients and rank-sum test was employed for data analysis.The cost-effectiveness of TB control was analyzed by collecting the evaluation reports of the 13th Five-Year Final Evaluation in Hubei province.Results The overall median direct medical expenses of TB patients in Badong county and Shishou city were 13624(IQR:9014-20964)yuan and 10062(IQR:5639-17975)yuan,respectively.In Badong county,the median hospitalization expenses was 5180(IQR:1658-12173)yuan before the initiation of standardized anti-tuberculosis treatment,accounting for 97.37%of total cost,and the median length of hospital stay was 8(IQR:3-15)d.While in Shishou city,the me‐dian hospitalization expenses was 10123 yuan(IQR:7308-13889),accounting for 94.37%of total cost,and the median length of hospital stay was 18(IQR:12-23)d.The median total direct non-medical expenses including transportation,accommodation and other costs of patients and their family members in Badong county was 3580(IQR:2391-5255)yuan,which was much higher than that of 2001(IQR:1056-3360)yuan in Shishou City,the difference was statistically significant(P<0.05).In 2020,the total social medical cost in Badong county and Shishou city decreased by 1.81 million and 1.13 million simply by avoiding the appearance of newly infected TB cases,88.40 million and 100.96 million were saved in indirect social benefits,respectively.It was estimated that one yuan input on TB prevention could bring 109.7 yuan and 129.6 yuan of social and economic benefits in Ba‐dong county and Shishou city.Conclusions Both in Badong county and Shishou city,the ratios of total hospital‐ization expe

关 键 词：结核 经济负担 直接医疗费用 直接非医疗费用 成本-效益 

分 类 号：R183.3[医药卫生—流行病学]