藏区肝棘球蚴病患者手术医疗费用及其相关影响因素分析

A survey on medical expenditure of hepatic echinococcosis surgery in a Tibetan Region and the related influencing factors

目的了解藏区肝棘球蚴病患者手术治疗的费用及构成,并分析其影响因素,为合理设置手术费用提供参考依据。方法 2015年1-12月调查藏区某三甲医院住院的肝棘球蚴病手术患者。按入院先后顺序,在得到患者知情同意的情况下,采用查阅病历的方法获取患者基本资料,并了解患者的医疗费用及其各部分构成。采用Microsoft Office excel 2007建立数据库,使用SPSS 18.0统计学软件进行数据分析。计算棘球蚴病患者人均医疗费用及其各部分构成,并进行敏感性分析。结果本次共收集49例肝棘球蚴病患者的病历资料,人均住院28.6 d。各项辅助检查次数,除磁共振检查外,均超过2次。人均医疗费用47 146.0元,多房棘球蚴病患者人均医疗费用(60 810.7元)高于细粒棘球蚴病患者(42 211.5元)(P<0.05),多房棘球蚴病患者的各部分费用也均高于细粒棘球蚴病患者(P<0.05)。药品、耗材、治疗(含手术)和检查的人均费用依次为16 944.1元、12 903.0元、9 037.9元和4 823.5元,分别占35.9%、27.4%、19.2%和10.2%。手术治疗肝棘球蚴病患者的医疗费用随着住院天数的增加而升高,CT检查次数≤2次组的人均医疗费用为43 192.0元,>2次组的人均医疗费用为53 955.7元,两者差异有统计学意义(P<0.05)。药物费用是肝棘球蚴病患者医疗费用中最主要的敏感因素。结论肝棘球蚴病患者医疗费用很高,可采取合理使用药品和耗材,合理安排患者的检查次数、住院天数等措施,以降低医疗费用。

Objective To evaluate the medical expenditure of hepatic echinococcosis surgery in Tibetan area and analyze the influencing factors, in order for setting up a reasonable range of charge for echinococcosis treatment. Methods Echinococcosis patients having received surgical treatment in a hospital in Tibetan area from February to December, 2015 were enrolled. The basic medical information including a detailed list of medical cost was obtained based on their medical record. All the patients had given consent to this study. Data were entered into Microsoft excel 2007 and analyzed with SPSS 18.0. The average medical cost per patient was calculated and its composition was analyzed. Results Forty-nine patients were included in this survey, with an average hospitalization time of 28.6 days. The auxiliary examinations except MRI were performed more than twice for each patient on average. The average medical expenditure per patient was 47 146.0 yuan（RMB）. The mean expenditure of alveolar echinococcosis（AE） treatment was 60 810.7 yuan, which was significantly higher than that of cystic echinococcosis（CE, 42 211.5 yuan） （P 〈 0.05）, and which had compositions all significantly higher than those of CE（P 〈 0.05）. The expenditures on drugs, consumable materials, treatment fee （including surgery） and examination fee were 16 944.1 （35.9%）, 12 903.0 （27.4%）, 9 037.9（19.2%）, and 4 823.5 yuan（10.2%）, respectively, for each patient. The medical expenditure of hepatic echinococciasis increased with longer hospitalization duration. The expenditure for patients receiving ≤2 CT examinations（43 192.0 yuan） was significantly lower than those having 〉 2 CT examinations（53 955.7 yuan） （P 〈 0.05）. The drug cost was the most sensitive factor that influences the overall expenditure. Conclusion The medical expenditure of echinococcosis is high. Measures are needed to decrease the expenditure, such as reasonable use of medicines and consumable materials, reasonable arrangement of auxiliary examinations and adjustment of hospitalization duration.