DRG付费改革背景下慢加急性肝衰竭患者住院费用的真实世界研究  

Real-World Study on Hospitalization Costs for Patients with Acute-on-Chronic Liver Failure under the DRG Payment Reform

作　　者：于月玮 武羽 杨雪[3] 段小宛 陈煜 徐曼曼[3] YU Yuewei;WU Yu;YANG Xue;DUAN Xiaowan;CHEN Yu;XU Manman(Capital Medical University,Beijing 100069,China;Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research,Beijing 100069,China;Beijing Youan Hospital Affiliated to Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学,北京100069 [2]肝衰竭与人工肝治疗研究北京市重点实验室,北京100069 [3]首都医科大学附属北京佑安医院,北京100069

出　　处：《中国医药导刊》2025年第2期166-170,共5页Chinese Journal of Medicinal Guide

基　　金：北京市高层次公共卫生技术人才建设基金资助项目(学科带头人-01-12);北京市医院管理中心“登峰”计划专项经费资助项目(DFL20221501);北京肝胆相照公益基金会人工肝专项基金(iGandanF-1082024-RGG068)。

摘　　要：目的:分析影响慢加急性肝衰竭(ACLF)患者住院费用的影响因素,并针对接受人工肝(ALSS)治疗的ACLF患者进行卫生经济学评价,提出控制ACLF患者住院费用的建议,促使ACLF患者成本效益最大化,减少患者经济负担的同时保证患者的生命质量。方法:本研究以首都医科大学附属北京佑安医院2022年3月至2023年12月住院治疗的ACLF患者为研究对象,采用多元线性回归分析ACLF患者住院费用的影响因素,并对接受ALSS治疗的患者进行成本效益分析。结果:经筛选,共纳入662例诊断为ACLF的患者,中位年龄为52岁,中位住院天数为16 d,中位住院总费用为38 676元,住院病死率为10.3%;住院天数、接受ALSS治疗与住院费用正相关;与未接受ALSS患者相比,接受ALSS治疗的患者住院时间更长(22 d vs. 15 d),30 d再住院率更高(25.2%vs. 9.02%),住院总费用更高(P<0.05)。两组患者的住院病死率差异无统计学意义。结论:在DRGs付费改革政策的真实世界背景下,住院时间长、接受ALSS治疗的ACLF患者住院费用更高,接受ALSS治疗相对于仅内科治疗患者住院时间长、30 d再住院率高,ACLF患者中ALSS治疗最佳适用人群有待进一步探索。Objective:To analyze the factors influencing hospitalization costs for patients with acute-on-chronic liver failure(ACLF)and to conduct a health economic evaluation for ACLF patients receiving artificial liver support systems(ALSS)therapy,so as to put foru-ard suggestions to control the hospitalization cost of ACLF patients,to maximize the cost effectiveness of ACLF patients,and to reduce the economic burden of patients while ensuring the quality of life of patients.Methods:This study included ACLF patients in Beijing Youan Hospital affilinted to Capital Medical University from March 2022 to December 2023.Multiple linear regression was used to ana-lyze influencing factors of hospitalization costs of ACLF patients,and cost-effectiveness analysis was conducted for patients receiving ALSS therapy.Results:662 patients diagnosed with ACLF were included after screening.The median age was 52 years,with a median hospital stay of 16 d and a median total cost of 38676 yuan.The in-hospital mortality rate was 10.3%.The hospital stay length and receiving of ALSS treatment were positively correlated with hospital expenses,which was statistically significant.Compared to patients who did not receive ALSS treatment,patients treated with ALSS had a longer hospital stay(22 d vs.15 d),a higher 30 d readmission rate(25.2%vs.9.02%),and higher total hospitalization costs,with significant differences(P<0.05).There was no statistically sig-nificant difference in in-hospital mortality rates between the two groups.Conclusion:In the context of DRG payment reform and real-world settings,ACLF patients with longer hospital stays and receiving ALSS treatment incur higher hospitalization costs.Patients receiv-ing ALSS treatment,as compared to patients receiving only medical treatment,have longer hospital stays and higher 30 d readmission rates.Further exploration is needed to identify the optimal patient population for ALSS treatment among ACLF patients.

关 键 词：慢加急性肝衰竭 疾病诊断相关分组 住院费用 人工肝治疗 成本效果比 

分 类 号：R575[医药卫生—消化系统]