失能调整寿命年与人力资本法结合估计间接经济负担的研究

Evaluation on the indirect economic burden of stroke using combination of disability-adjusted life years and human capital method

目的介绍失能调整寿命年(DALY)与人力资本法结合估计间接经济负担的方法。方法按照全球疾病负担研究(GBD)中计算DALY的方法,以年龄组分别计算出DALY,再利用DALY与人力资本法结合的方法中推荐的生产力权重加权求和。结果首先在计算DALY中,固定取值均参照GBD,惟一的主观指标是失能评估,在GBD中,要求8～12名各个国家和地区的不同专业的专家组成团,采用人数交换法和时间交换法评估失能,显然这样的方法在大多数研究中均无法实现。采用稍加修改的日常生活行为能力(ADL)量表,按照GBD中失能的理解重新赋值后计算出失能权重;其次,依据国民生产总值(GNP)及不同年龄组在社会价值的创造中赋予的不同生产力权重,分别计算出不同年龄组的间接经济负担,最后相加求得总人口的间接经济负担。结论DALY与人力资本法结合的方法估算间接经济负担是目前较为合理的方法,但其中DALY的计算较困难。

Objective Using the indirect economic burden of stroke in a rural population to develop rational allocation of future health resources, in Hanzhong area. Methods Cluster sampling which involved 53 natural villages with a total number of 75 000 people selected from the ＇stroke monitoring base＇ of rural population was adopted in this study in the Hanzhong area. All of the 164 stroke cases were studied through a self-designed questionnaire. In calculating disability-adjusted life years（DALYs）, fixed value was used in accordance with the value of GBD, The disability assessment was simplified in DALYs calculation and modified Barthel＇s ADL was used in disability assessment of stroke patients. In indirect economic burden analysis, the human capital method combined with DALYs was adopted with the formula as： indirect economic burden = GNP per capita × DALYs × productivity weight. Results The total DALYs were 598.88, with an average DALY of stroke as 3.65 per case. The total indirect economic burden of stroke patients in rural areas was 1 993 977.8 RMB and the average of indirect economic burden of stroke was 12 158.4 RMB per ease with the largest seen in the 45-59 age group, accounted for 74.4%. Conclusion In our study, the use of method in combining the human capital with DALYs was the first time being adopted in calculation of the indirect economic burden of stroke in rural population in China. The burden seemed to be much lower than literature cited from other countries. It was reasonable to evaluate indirect economic burden of stroke using method in integrating DALYs with human capital, but it was difficult to calculate the DALYs.