江苏某农村地区结核病患者疾病经济负担及其影响因素分析

Analysis on economic burden of patients with tuberculosis and influencing factors in a rural area of Jiangsu Province

目的了解江苏某农村地区结核病患者疾病经济负担及其影响因素。方法以江苏某县级市为研究现场,采用整群抽样抽取34个样本村,以2010年1月～2011年5月期间登记报告且已完成规定的抗结核疗程的肺结核患者为研究对象。采用统一的问卷调查表收集患者的基本信息、就诊和治疗经过、因结核病所支付的直接费用和间接费用等。结果共316例肺结核患者完成调查,人均支出费用6 598.3元,中位数2 263.4元(四分位数间距982.6～6 687.5元),其中直接费用人均3 524.8元(中位数931.6元),间接费用人均3 073.5元(中位数900元)。影响疾病经济负担的因素包括既往结核病史、不良反应、服用保肝药、使用二线抗结核药物、结核病诊断延误时间长等。结论尽管国家为结核病人提供免费抗结核治疗服务,但患者仍需支付很高的医疗费用,给其造成沉重的经济负担。有必要规范结核病管理,以病人为中心,切实降低病人的负担。

Objective To analyze the economic burden of patients with tuberculosis and influencing factors in a rural area of Jiangsu Province.Methods One county from Jiangsu Province was purposely selected and 34 villages were randomly selected as the study sites.Tuberculosis patients who were registered from January 2010 to May 2011 in the study sites,and had completed the standard antituberculosis treatment episode were recruited.Face to face interviews were performed by using a standard questionnaire.Basic characteristics of patients,history of seeking healthcare services,treatment experience,and direct and indirect costs due to the tuberculosis disease were collected.Results 316 tuberculosis patients were recruited for the analysis.The average cost of diagnosis and treatment on the tuberculosis disease was 6 598.3 RMB and the median（25%-75%） cost was 2 263.4（982.6-6 687.5） RMB.The mean（median） direct and indirect costs were 3 524.8（931.6） RMB and 3 073.5（900） RMB,respectively.Factors associated with the cost included previous tuberculosis history,adverse drug reactions,taking putative liver protection compounds,using the second line antituberculosis drugs,and diagnosis delay,etc.Conclusions Although the government of China has established a ＂free TB service policy＂,the financial burden on patients was still heavy.More patient-centered interventions and greater attentions to tuberculosis management are essential,with aims to reduce patients＇ economic burden.