广州市SARS病人疾病负担研究

Research on disease burden of SARS patients in Guangzhou city

目的估计广州市严重急性呼吸道综合征(SARS)临床确诊病例的直接经济负担和间接经济负担,为急性传染性疾病疾病负担估计建立方法。方法收集2003年SARS暴发流行期间1 059例SARS确诊病例的有关资料。对399例愿意配合的患者进行问卷调查;将伤残调整寿命年(DALYs)和误工损失通过人力资本法折算为经济损失,评估SARS病例的直接和间接的经济损失。结果1 059例SARS确诊病例的人均住院费用20 263.56元,日均住院费用1 160.57元;339例SARS病人的人均门诊费用为463.43元,人均复查费用848.28元;自行购买营养品、药品等人均花费2 646.91元。推算广州市2003年1 283例SARS病例的直接经济负担为3 107.59万元;SARS死亡病例因早死造成的寿命损失年(YLLs)为654.71,经济损失1 489.43万元;SARS存活病例平均误工时间为51.76 d,经济损失为577.48万元,间接经济损失共2 067.44万元。有34.2%被调查者回答愿意倾全部财产避免罹患SARS,表明SARS给患者造成的伤害无法用金钱衡量;另有26.3%的病人愿出1万元以上换取不患SARS。结论综合直接经济负担和间接经济负担,广州市SARS临床确诊病例的总经济负担为5 175.03万元,人均4.03万元。

Objective To evaluate the direct and indirect health costs of clinically diagnosed SARS patients in Guangzhou, to establish methods far evaluation of disease burden of acute infectious disease and to provide scientific evidence for the formulation of disease prevention and controlling measures. Methods Relevant information of the confirmed eases in 2003 SARS epidemic was collected. A standard questionnaire survey was conducted among patients who agreed to be investigated. Disease-adjusted life years （DALYs） and loss of work hours were converted into economic indices through human capital method for further evaluation. Immaterial losses caused by SARS epidemic were also analyzed. Results Of the 1059 SARS patients investigated, the mean hospitalization cost amounted to RMB ￥20 263.56 per person. The average daily hospitalization cost was RMB ￥ 1 160.57 per person. Results of the questionnaire survey among 339 SARS patients showed that the mean outpatient cost was RMB ￥ 463.43 per person, the mean follow-up examination cost was RMB ￥ 848.28 per person, and expenses for nutriments and medicines purchased by the patients themselves averaged RMB ￥2 646.91. Based on the above calculation, the direct health costs of SARS averaged RMB ￥ 24 221.31 per person. As 1 283 cases of SARS occurred in Guangzhou in 2003, the direct health costs attributable to SARS totaled to RMB ￥31 075 900. The years of life lost due to premature mortality of SARS （YLLs） were 654.71, with 306.19 for males and 348.52 for females. When YLLs were converted into economic indices by human capital method, the total economic loss amounted to RMB ￥ 14 894 300, with RMB ￥6 874 600 for males and RMB ￥8 019 700 for females. The length of work hour lost of the patients who survived averaged 51.76 days. When converted into economic indices, the total economic loss amounted to RMB ￥ 5 774 800, with RMB ￥ 2 603 100 for males and RMB ￥ 3 177 000 for females. Based on the above calculation, the indirect health costs were RMB￥ 9 477 700 for males and RMB ￥11 196 700 for females. The total was RMB ￥20 674 400. Thus the direct and indirect healthcosts of the clinically diagnosed SARS patients totaled to R MB ￥51 750 300 and the average was RMB ￥40 300 per person. Conclusion The outbreak of SARS did increase the direct and indirect health costs to patients.