慢性阻塞性肺疾病并发慢性呼吸衰竭患者长期家庭无创正压通气治疗的成本效益分析

Cost-effectiveness analysis of long-time domiciliary noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease complicated with chronic respiratory failure

目的探讨长期家庭无创正压通气治疗慢性阻塞性肺疾病并发慢性呼吸衰竭的临床经济学意义。方法共选择34例慢性阻塞性肺疾病并发慢性呼吸衰竭患者，治疗组17例，应用长期家庭无创通气治疗；对照组17例，常规治疗。观察比较治疗组治疗后与治疗前及治疗组治疗后与对照组的年平均疾病急性发作次数、年平均住院次数、年平均住院天数及年平均医疗花费情况，将购买家用呼吸机的支出作为治疗组的额外成本，对治疗组治疗后与治疗前、治疗组治疗后与对照组的年平均花费进行成本效益分析。结粜治疗组治疗后患者的年平均疾病急性发作次数、平均住院次数、平均住院天数、平均医疗费用较治疗前及对照组均显著减少（P〈0．01）；治疗组治疗后较治疗前及对照组年平均节省的医疗费用（B）分别为5．51万元和5．48万元，购买呼吸机的平均费用（C）为2．3万元，B／C值分别为2．40和2．38，有明显的临床经济学意义。结论长期家庭无创正压通气治疗慢性阻塞性肺疾病并发慢性呼吸衰竭可明显降低总的医疗费用支出。

Objective To study the clinical economy value of long-time domiciliary noninvasive positive pressure ventilation （LTDNIPPV） in the treatment of chronic obstructive pulmonary disease （COPD） complicated with chronic respiratory failure. Methods 34 COPD complicated with chronic respiratory failure cases were selected, then divided into two groups randomly, one group treated with LTDNIPPV,the other with traditional therapy,the therapeutic course was a year. The overall incidence （person per year） for acute attack of COPD complicated with chronic respiratory failure, the hospitalization, the mean times of hospitalization and the mean medical cost including the expense of domiciliary respirator were compared before and after treatment in LTDNIPPV group and traditional group. The cost-benefit of both groups was figured out. Results After LTDNIPPV treatment, the incidence for acute attack, the hospitalization, the mean times of hospitalization and the mean medical cost decreased significantly in LTDNIPPV group（ P 〈0.01）,51.5 thousand yuan and 54.8 thousand yuan medical expenditure were saved after LTDNIPPV treatment compared with before LTDNIPPV treatment and traditional group, the cost of respirator is 23 thousand yuan, B/C is 2.40,2.38 respectively, which shows great clinical economy value. Conclusions LTDNIPPV is a good method to prevent acute attack and decrease overall medical expenditure in patient with COPD complicated with chronic respiratory failure.