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目的量化江苏省启东市HBV感染相关疾病的例均医疗费用,并分析其构成及影响因素。方法基于启东市人民医院与启东市传染病医院,采用时间阶段连续病例整群抽样法,选取2012年HBV感染相关原发性肝癌(n=217)、乙型肝炎肝硬化(n=234)、慢性乙型肝炎(CHB,n=136)住院患者,收集2010年1月-2012年12月住院及门诊费用合计(例均医疗费用)及相关基本和临床信息。采用专家咨询法,调查急性乙型肝炎、HBs Ag无症状携带者和HBV隐匿感染者的例均医疗费用。不同年份的费用采用2014年医疗保健消费价格指数进行转换。计量资料组间比较采用独立样本t检验,多组间比较采用方差分析,组内进一步两两比较采用SNK-q检验;采用多重线性回归分析(逐步回归法)进行例均医疗费用的影响因素探讨。结果 HBV感染相关原发性肝癌、乙型肝炎肝硬化、CHB患者2010-2012年的例均医疗费用分别为30 183元、22 066元和15 703元,住院费用分别为29 058元、21 383元和15 394元,占例均医疗费用的比例分别为96.3%、96.9%、98.0%;药品费用分别占例均住院费用的55.0%、73.4%和78.2%;3种疾病患者的住院次数(F值分别为89.1、67.7、11.5,P值均<0.001)、治疗方案(F=21.8、t=-2.1、t=-3.7,P值分别为<0.001、0.039、<0.001)、医保类型(t值分别为3.1、2.6、2.7,P值分别为0.002、0.011、0.012)是例均医疗费用的影响因素,临床分期仅为CHB患者例均医疗费用的影响因素(分为轻、中和重度,多因素分析:β=1.238,F=5.9,P=0.021)。急性乙型肝炎患者例均医疗费用为5950元,HBs Ag无症状携带者或HBV隐匿感染者的年均医疗费用为770~1540元。结论 HBV感染相关疾病的医疗费用随着病情加重逐步递增,该数据将为后期疫苗或筛查干预的经济学效果评价提供基线信息。
Objective To quantify the average medical costs of HBV infection-related diseases in Qidong City, Jiangsu Province, and to analyze its composition and influencing factors. Methods Based on the cluster sampling method of continuous cases in time period, based on the Qidong People’s Hospital and Qidong Infectious Diseases Hospital, the incidence of HBV-related primary hepatocellular carcinoma (n = 217), hepatitis B cirrhosis (n = 234) Inpatients with chronic hepatitis B (CHB, n = 136) were enrolled in this study. The total hospitalization and outpatient expenses (case-specific medical expenses) from January 2010 to December 2012 were collected together with relevant basic and clinical information. Using expert counseling, investigate cases of acute hepatitis B, HBs Ag asymptomatic carriers and HBV co-infected patients with medical costs per case. The costs for different years are translated using the 2014 Healthcare Consumer Price Index. Measurement data were compared between groups using independent samples t-test, multiple groups were compared using analysis of variance, further comparison between groups using SNK-q test; using multiple linear regression analysis (stepwise regression) to explore the impact of factors on average medical costs . Results The average medical costs of patients with HBV-related primary liver cancer, hepatitis B cirrhosis and CHB from 2010 to 2012 were 30 183 yuan, 22 066 yuan and 15 703 yuan respectively, and hospitalization expenses were 29 058 yuan and 21 383 yuan respectively Yuan and 15,394 yuan respectively, accounting for 96.3%, 96.9% and 98.0% respectively of the total medical expenses; the cost of medicines accounted for 55.0%, 73.4% and 78.2% of the average hospitalization expenses respectively; the number of hospitalizations for the three diseases (F = 21.8, t = -2.1, t = -3.7, P <0.001, 0.039, <0.001, respectively) t values were 3.1,2.6,2.7, P values were 0.002,0.011,0.012 respectively) were the influencing factors of medical expenses in each case. The clinical stage was only the influencing factor of the per capita medical expenses of CHB patients (light, moderate and severe , Multivariate analysis: β = 1.238, F = 5.9, P = 0.021). The average medical cost of patients with acute hepatitis B is 5,950 yuan per year, and the average annual medical expenses of those with HBsAg asymptomatic carriers or HBV co-infected persons are 770-1540 yuan. Conclusion The medical costs of HBV infection-related diseases increase gradually as the disease progresses. This data will provide baseline information for evaluating the economic effect of late vaccination or screening interventions.