糖尿病足患者医疗费用分析

The medical cost of diabetic patients with foot problems duo to peripheral artery disease

目的调查和分析糖尿病足医疗费用及其影响因素。方法前瞻性地对全国14家三级甲等医院的2004年全年门诊和住院糖尿病足患者的足局部情况进行 Wagner 分级、Texas 分期和溃疡性质分析及住院天数、医疗费用等调查。结果 573例患者的平均费用(14906±7072)元;其中药品费占56%、检查费占19%;患者职业、糖尿病病程对住院天数及费用有显著影响,合并糖尿病肾病患者住院费用显著增加,随着溃疡深度的加重,住院天数及费用明显增加;随足溃疡数量增加,住院天数无明显增加,但住院费用显著增加;合并感染及缺血的足病患者住院天数及住院费用均明显增加;缺血性溃疡较神经性和混合性的住院天数及住院费用均明显增加;合并坏疽足患者住院天数延长、住院费用增加。结论糖尿病足医疗费用高。糖尿病足医疗费用与合并肾病、溃疡、缺血和感染的严重程度明显正相关。

Objective To investigate the medical cost of diabetic patients with foot problems and peripheral artery disease. Methods Type 2 diabetic patients with foot problems admired into the endocrinology departments of 14 teaching hospitals from Jan. 1 to Dec. 31, 2004 were surveyed for their type and phase of foot ulcers, diabetic complications, medical cost and general personal characteristics. Results The average medical cost of the hospitalization of these patients was RMB ￥ 14 906 ± 7072 （ about US $ 1640 ±873 ） ; medicateon and examination cost was separately 56% and 19% of the total cost. There was obviously higher medical cost for these patients with longer diabetes duration of over 20 years and with the occupation of laborer and retired worker. Patients with kidney disease had significantly higher medical cost than those without （ RMB ￥11 690. 7 vs ￥9493.0 ; P = 0. 0013 ） , even if the hospital stay was nearly the same （21 days vs 20 days）. The medical cost increase with the severity of diabetic foot problems based on the classification of Wagner System or Texas System. Patients with infection, ischemic foot and gangrene foot stayed in the hospitals longer and had much higher medical cost. Conclusion The medical cost is higher for diabetic patients with foot problems and is related with the presence of complicating kidney disease, infection and ischemia as well as the severity of foot ulcers.