2017—2021年我院儿童肝移植术后经济负担研究  

Financial burden after pediatric liver transplantation in a hospital from 2017 to 2021

作　　者：刘冉佳 徐计德[3] 李丹丹[1] 徐烨 孙丽莹[4] 崔向丽 朱志军[4] Ran-Jia LIU;Ji-De XU;Dan-Dan LI;Ye XU;Li-Ying SUN;Xiang-Li CUI;Zhi-Jun ZHU(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069,China;Department of Statistics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Liver Transplantation Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院药学部,北京100050 [2]首都医科大学药学院,北京100069 [3]首都医科大学附属北京友谊医院统计室,北京100050 [4]首都医科大学附属北京友谊医院肝移植中心,北京100050

出　　处：《药物流行病学杂志》2023年第10期1089-1096,共8页Chinese Journal of Pharmacoepidemiology

基　　金：国家自然科学基金面上项目(81970562);北京友谊医院科研启动基金项目(yygdktgl2021-3);北京市通州区科技计划项目(KJ2022CX039)。

摘　　要：目的 分析儿童肝移植术后经济负担,为开展相关卫生经济评估提供数据支持,为优化我国器官移植医疗资源配置提供依据。方法 回顾性收集2017—2021年首都医科大学附属北京友谊医院儿童肝移植受者的基本信息和缴费数据分析直接医疗成本,并采用便利抽样法对门诊及住院随访的儿童肝移植受者的监护人进行问卷调查,通过问卷获得的信息和人力资本法计算直接非医疗成本和间接成本,同时调查患儿家庭主观经济负担感受。分析2017—2021年直接医疗成本变化趋势、构成及相关影响因素。结果 共纳入683例患儿,问卷调查部分共收到有效问卷234份。2017—2021年儿童肝移植术后直接医疗成本呈先增高后降低的趋势,其中药费占比最高,门诊患者药费占比45.27%~57.33%。2021年人均疾病经济负担17 870.12元(95%CI:16 370.87~19 369.37),其中直接医疗成本13 321.65元(95%CI:11 818.46~14 824.85),直接非医疗成本2 248.05元(95%CI:2 169.86~2 326.24),间接成本2 300.42元(95%CI:2 253.43~2 347.40)。疾病经济负担与移植术后时长呈负相关。从全社会的角度分析,特病医保患儿较其他保险类型支出更多(P <0.05)。结论儿童肝移植术后家庭和社会的经济负担较重,药费是重要组成部分。期待国家持续优化医保资源配置,通过免疫抑制药物集中采购等政策减轻儿童肝移植受者的疾病经济负担。Objective To analyze financial burden after pediatric liver transplantation(PLT).By providing data,it will contribute to health economic evaluations and optimization of the allocation of medical resources for organ transplantation in China.Methods The basic information and payment data of PLT cases from 2017 to 2021 in Beijing Friendship Hospital,Capital Medical University were retrospectively collected to analyze the direct medical cost.Convenience sampling method was used to select guardians of PLT case in outpatient and inpatient follow up for a questionnaire-based survey.Direct non-medical costs and indirect costs were obtained by questionnaire survey and human capital method.The subjective feelings of the patients’families about the financial burden were investigated.The changing trend,composition and influencing factors of financial burden in the 5 years were analyzed.Results A total of 683 children were included,234 valid questionnaires were collected.In the 5 years,the direct medical costs of follow-up patients after PLT exhibited a trend first increasing and then decreasing.And the drug costs accounted for the highest proportion,accounting for 45.27%-57.33%of outpatients.In 2021,the per capita financial burden of pediatrics after PLT was 17870.12 yuan(95%CI 16370.87 to 19369.37),of which the direct medical cost was 13321.65 yuan(95%CI 11818.46 to 14824.85),the direct non-medical cost was 2248.05 yuan(95%CI 2169.86 to 2326.24),and the indirect cost was 2300.42 yuan(95%CI 2253.43 to 2347.40).The economic burden was inversely correlated with the duration of follow-up after transplantation(P<0.05).From the whole society view,the financial burden of pediatric patients with special medical insurance was heavier than other types of medical insurance(P<0.05).Conclusion PTL brings a heavy financial burden for families and society.The cost of medicine is the major factor.It is expected that the government will continue to optimize the allocation of medical insurance resources and pharmaceutical centralized purch

关 键 词：儿童肝移植 疾病经济负担 直接医疗成本 间接成本 免疫抑制药 随诊 长期生存 

分 类 号：R726.5[医药卫生—儿科] R197.3[医药卫生—临床医学]