广州市乙型肝炎相关疾病住院病例无形费用及其影响因素分析

Estimation on the intangible cost and influencing factors for patients with hepatitis B-related diseases

目的了解乙型肝炎（乙肝）相关疾病住院病例年均无形费用以及占总费用的比例和影响因素，探讨无形费用的调查方法。方法利用自制结构式问卷，对乙肝相关疾病住院病例进行面对面询问，比较支付意愿法三种引导技术获得的无形费用数值特征；采用多元线性回归分析，探讨无形费用的影响因素。结果开放式估价和重复投标式相结合调查得到564例乙肝相关疾病患者年无形费用均值为54320．4元，占总费用的比例为53．0％，高于直接费用和问接费用所占比例（分别为38．5％和8．5％），即乙肝相关疾病无形费用占总费用的比例较高。无形费用占患者和家庭年收入的比例分别为262．6％和67．6％，形成沉重的经济负担。开放式估价、开放式估价和重复投标式结合、支付卡式i种引导技术的反映率分别为55．9％、76．6％和74．7％；综合比较发现，开放式估价和重复投标式结合技术获得的结果较为合理。乙肝相关疾病患者的无形费用高低与疾病的严重程度关系不明显；无形费用12个可能的影响因素中，医院类型和是否购买商业医疗保险进入多元线性回归模型。结论在降低乙肝相关疾病直接和间接费用的同时，应采取措施降低其无形费用；支付意愿法中开放式估价和重复投标式结合作为乙肝相关疾病无形费用调查的引导技术较为可靠。

Objective To estimate the intangible cost and associated factors on patients with hepatitis B-related diseases, so as to explore the differences of the three elicitation techniques on the ＇willingness to pay approach＇ （WTP）. Methods Face-to-Face interviews were conducted to collect health economics-related information by trained investigators, using a structured questionnaire. WTP was employed to estimate the intangible cost while an open-ended question format, together with iterative bidding game and payment card were respectively used to elicit WTP for the hypothetical cure of hepatitis B-related diseases. A Multiple linear stepwise regression model was determined to identify those factors potentially affecting the intangible cost. Results A total of 564 subjects from 641 patients with hepatitis B-related diseases were identified for the inclusion of this study. The average annual intangible cost of patient with hepatitis B-related diseases was 54 320.4 Yuan （Ren Minbi）. The intangible cost accounted for 53.0% of the total cost, which was much more than the proportions of the direct and indirect costs （38.5% and 8.5%, respectively）. Among annual personal and the household income of the patient, proportions of intangible cost were 262.6% and 67.6% respectively, suggesting that the patients were under huge spiritual and psychological pressure. Response rate of the approach, combined open-ended questions with iterative bidding game, was the highest （76.6%） among the three elicitation formats. Considered the characteristics of data being gathered, the approach seemed to be more reasonable. Further studies were needed to examine the results yielded from other WTP elicitation formats. We also noticed that the progression of disease was associated with the increase of direct and indirect costs, but not with the intangible cost. Data from the multiple linear stepwise regression analysis indicated that the types of hospital and commercial medical insurance were significantly different in explaining the variation of the intangible cost. Conclusion Measures should be taken to reduce the intangible cost of hepatitis B-related diseases. The approach regarding the combination of open-ended questions with iterative bidding game should be recommended when carrying our further WTP studies of this kind.