广州市结直肠癌及癌前病变患者疾病经济负担及影响因素分析

Economic Burden of Patients with Colorectal Cancer and Precancerosis in Guangzhou and Its Influencing Factors

[目的]对广州市结直肠癌及癌前病变患者进行疾病经济负担调查,并分析影响因素,为后期成本效果评价提供依据。[方法]整群抽取广州市辖范围内的教育部附属、省、市属的4家三级医疗机构,采用问卷调查和病案摘录相结合的方式调查结直肠癌及癌前病变患者(家属)相关人口社会学信息、临床信息、医疗及非医疗费用信息等。[结果]广州市结直肠癌前病变患者的例均直接医疗费用、直接非医疗费用、间接费用和总费用分别为14437元、1268元、7967元和23672元,结直肠癌患者的例均直接医疗费用、直接非医疗费用、间接费用和总费用分别为135258元、10268元、27363元和172888元。多因素分析显示,临床分期、治疗方案、住院次数和住院天数对直接医疗费用和总费用有明显影响。癌前病变的费用最低,癌症临床期别越晚,费用越高;单纯手术治疗费用最低;住院次数越多,住院天数越长费用越高。非广州市来源的患者直接非医疗费用和间接费用比广州市来源的患者高。拥有医疗保险的患者比其他患者间接费用更高。[结论]广州市结直肠癌患者的疾病经济负担重,有必要进一步加强健康教育宣传,大力推进结直肠癌筛查工作,通过发现并切除腺瘤,降低未来结直肠癌的发病率,同时提高结直肠癌的早发现、早诊断、早治疗比例,对于降低结直肠癌对社会和家庭的经济负担和社会负担,具有重大意义。

[Purpose]To survey the economic burden of colorectal cancer and precancerous lesions in Guangzhou,and to analyze the influencing factors.[Methods]Patients with colorectal cancer and precancerosis were selected from 4 hospitals of ministrial,provincial and municipal levels in Guangzhou with cluster sampling.The demographic data,clinical information,medical and nonmedical costs of patients(families)with colorectal cancer or precancerosis were collected with questionnaires and medical records.[Results]The data of 355 patients with colorectal cancer and 30 patients with colorectal precanerosis were included for analysis.The direct medical cost,direct non-medical cost,indirect cost and total cost of per patient with colorectal precancerosis in Guangzhou were 14437 Yuan,1268 Yuan,7967 Yuan and 23672 Yuan,respectively.The direct medical cost,direct non-medical cost,indirect cost and total cost of per patient with colorectal cancer were 135258 Yuan,10268 Yuan,27363 Yuan and 172888 Yuan,respectively.Multivariate analysis showed that clinical stage,treatment strategy,times of hospitalization and length of hospital stay had significant effects on direct medical expenditure and total expenditure.The cost of precancerosis patients was lower than that of cancer patients.In cancer patients the costs were positively correlated with the clinical stage,treatment modalities,times of hospitalizations,and the length of hospital.The direct non-medical costs and indirect costs of patients in Guangzhou were higher than those from other regions.Patients with medical insurance had higher indirect costs than those without insurance.[Conclusion]The economic burden of patients with colorectal cancer in Guangzhou is high.The early detection,early diagnosis and early treatment of colorectal cancer would decrease the economic and social burdens of patient families and society.