浙江省结核患者疾病负担调查分析

Tuberculosis pulmonary diseases burden in Zhejiang province

目的:调查初治肺结核患者在抗结核减免治疗期间自费承担的诊疗费用,为科学修订肺结核患者减免政策提供参考依据。方法:研究采用分层整群抽样方法,根据人均GDP标准分层,将所有县区分发达与欠发达两类,从每个县的结核病定点医院抽取50例已经完成治疗的初治肺结核患者开展抗结核诊疗费用问卷调查。结果:调查结果显示患者在定点医院的结核门诊人均自费1 537元,其中检查费占25%,药品费占75%。43%的患者开展过CT检查,人均CT花费为307元。90%患者使用了保肝药物,人均保肝药花费696元;21%初治患者使用了非免费的二线药物。17%患者在DOTS治疗前曾住过院,平均住院24天,人均住院花费6 890元;11%患者在定点医院曾经住院,患者在定点医院的人均住院28天,人均住院花费5 311元。结论:本次调查发现初治肺结核患者抗结核治疗费用与2005年相比有了明显下降,主要得益于抗结核减免政策的执行,但是也存在CT检查比例过高、绝大部分患者护肝药要自费、初治患者二线抗结核药物使用比例过高等现象,可能会导致初治疗肺结核患者中断治疗、增加耐药风险,加强初治肺结核患者规范化诊疗行为的监管、进一步优化政策降低患者的疾病负担是非常必要的。

Objective To investigate the fees of newly diagnosed tuberculosis pulmonary patients at their own expense in tuberculosis hospitals and to provide a scientific reference for decreasing the disease fees of tuberculosis patients.Methods A stratified cluster sampling method was adopted to stratify the counties into the developed and underdeveloped ones according to GDP per capita standard and in each county 50newly diagnosed tuberculosis pulmonary disease patients who had completed the treatment in tuberculosis hospitals were taken to carry out surveys.Results The survey results showed that treatment cost was 1537yuan per capita,of which 25% was for inspection and 75%for drug.43%of patients carried out CT,the cost of which was 307yuan per capita.90%of patients used liver drugs,the cost of which was 696yuan per capita.21%of patients used non-free second-line drugs.17%of patients were hospitalized before the DOTS treatment,and the average hospital stay was 24days,with a cost of 6,890yuan per capita.11%of patients were hospitalized during the DOTS treatment,and the average hospital stay was 28days,with a cost of5,311yuan per capita.Conclusions The survey found that treatment cost paid by newly diagnosed tuberculosis pulmonary disease patients in tuberculosis hospitals decreased compared with costs in 2005,and hospitalization rate was markedly reduced mainly due to the implementation of anti-TB waiver policy,but there were still phenomenon of high proportion of CT examination,the vast majority of patients having to pay for liver drugs themselves,the too high proportion of newly diagnosed patients with second-line anti-TB drug use which increased the risk of resistance.It was necessary to strengthen the supervision of standardized treatment for pulmonary tuberculosis patients and further optimize the policy to reduce the fee of pulmonary tuberculosis disease.