重症急性胰腺炎外科治疗的成本-效用分析

Cost-utility analysis of surgical treatment for SAP

目的对重症急性胰腺（SAP）外科治疗进行成本-效用分析及卫生经济学评价。方法收集2003年1月至2003年12月瑞金医院住院的SAP患者，通过患者帐单及调查问卷获得相关治疗成本；应用SF-36量表评价其健康相关生命质量，与普通人群比较，转换成rQALY，计算QALYs，从而获得其效用；进行成本-效用分析，计算成本-效用比，同时分析相关影响因素。结果98例患者，院内病死13例，出院85例。病历资料完整的59例获得随访，随访获知病死2例，院外病死率3．4％，不能完成问卷1例，无应答6例，收回有效SF-36问卷50份。98例患者住院总费用为989．91万元，人均10．10万元；校正后的后续治疗总费用为68．17万元，总成本为1058．08万元，其中西药费成本最高，占56％。SF-36的8个维度PF、RP、RE、BP、VT、MH、SF和GH的得分分别为83．00±14．64、61．50±42．32、68．67±36．52、79．98±14．90、68．80±18．94、72．40±14．75、75．00±17．53、64．70±18．28；与普通人群同年龄同性别比较，共获得1929．05个QALY，成本效用分析（CUA）=5485形QALY。年龄、住院时间、有无慢性并发症与治疗成本相关。结论SAP外科治疗从卫生经济学角度行成本．效用分析是值得的；药品费用构成成本的主要方面；影响其成本的主要因素有年龄、住院时间、有无慢性并发症。

Objective To assess the cost-utility and medical economics of surgical treatment for SAP. Methods A retrospective study of SAP patients admitted from January to December 2003 to Ruijin Hospital was carried out. The cost of treatment was obtained from financial department and patients questionnaire; health-related quality of life was assessed by using the SF-36 brief questionnaire and the results were compared with normal population and were converted into rQALY, then utility scores were obtained so as to conduct CUA （cost-utility analysis） and related factors were analyzed. Results 98 patients with SAP were discharged, 85 were discharged healthy; of them, 59 patients had complete records were followed up, 2 died during follow up, with a mortality of 3.4%, one patients could not finish the questionnaire and 6 did not respond, finally 50 finished the questionnaire; the total cost in hospital was 9899095 yuan, per capita 101011 yuan; the corrected post-discharge cost was 681737 yuan; the total cost was 10580832 yuan. The cost of medication was the highest, which accounted for 56% of all the cost. The means and deviations for each of eight scales （ PF, RP, RE, BP, VT, MH, SF, GH） scores of SF-36 in SAP patients were 83.00±14.64、61.50±42.32、68.67±36.52、79.98±14.90、68.80±18.94、72.40±14.75、75.00±17.53、64.70±18.28, compared with normal population, gained 1929.05 QALYs; the cost-utility analysis was 5485 yuan per QALY. The patient＇s age, length of stay, chronic co-morbidity was associated with the cost of treatment. Conclusions SAP treatment in surgery department was justified in medical economics. Medication contributed to the most part of total costs. The related factors of cost included age, length of stay and chronic co-morbidity.