肺癌化疗不良反应的经济学研究

Pharmacoeconomic research on adverse drug reactions of chemotherapy for lung cancer

目的分析肺癌患者住院化疗直接卫生成本和药物不良反应(ADRs)直接卫生成本的构成。方法对236例病史资料完整的肺癌患者,按照不同治疗目的分析住院化疗的直接卫生成本,以及不同严重程度血液系统和胃肠道ADRs的处理成本。结果 236例肺癌患者每次住院化疗人均直接卫生成本(16 461.89±8 284.78)元,其中化疗期间药物成本(13 648.16±906.52)元。0～Ⅳ度骨髓抑制ADRs的处理成本分别占化疗直接卫生成本的1.93%、8.43%、18.37%、40.09%和46.62%,发生严重骨髓抑制(Ⅲ～Ⅳ度)组与未发生严重骨髓抑制(0～Ⅱ度)组的ADRs直接卫生成本和化疗直接卫生成本比较,差异均有统计学意义(P<0.05)。0～Ⅳ度胃肠道ADRs直接卫生成本分别占化疗直接卫生成本的3.48%、3.28%、4.63%、5.85%和9.92%,出现严重胃肠道反应(Ⅲ～Ⅳ度)组与未出现严重胃肠道反应(0～Ⅱ度)组的ADRs直接卫生成本和化疗直接卫生成本比较,差异均无统计学意义(P>0.05)。结论药物费用是肺癌患者化疗期间的主要费用。骨髓抑制越严重,化疗的直接卫生成本越高;而胃肠道ADRs对化疗直接卫生成本的影响较小。

Objective To analyse the constitution of direct medical costs of chemotherapy for lung cancer during hospital stay and adverse drug reactions（ADRs）.Methods The clinical data of 236 patients with lung cancer were selected.The direct medical cost of chemotherapy for lung cancer during hospital stay was investigated according to different treatment aims,and the direct medical cost of management of ADRs of hematological system and gastrointestinal tract was also analysed.Results The mean direct medical cost of chemotherapy for lung cancer during each hospital stay was（16 461.89±8 284.78） yuan per person,which included（13 648.16±906.52） yuan for drugs of chemotherapy.The expenditure of ADRs of 0 to Ⅳ degree bone marrow depression accounted for 1.93%,8.43%,18.37%,40.09% and 46.62% of direct medical cost of chemotherapy respectively,and there were significant differences in the direct medical cost of ADRs and direct medical cost of chemotherapy between patients with severe bone marrow depression（Ⅲ to Ⅳ degree） and those without severe bone marrow depression（0 to Ⅱ degree）（P0.05）.The expenditure of 0 to Ⅳ degree ADRs of gastrointestinal tract accounted for 3.48%,3.28%,4.63%,5.85% and 9.92% of direct medical cost of chemotherapy respectively,and there was no significant difference in the direct medical cost of ADRs and direct medical cost of chemotherapy between patients with severe ADRs of gastrointestinal tract（Ⅲ to Ⅳ degree） and those without severe ADRs of gastrointestinal tract（0 to Ⅱ degree）（P0.05）.Conclusion The cost of drugs occupies the major proportion of direct medical cost of chemotherapy for lung cancer.More severe bone marrow depression may lead to higher direct medical cost of chemotherapy.However,ADRs of gastrointestinal tract may have little effect on direct medical cost of chemotherapy.