社区中西医结合康复治疗的卫生经济学评价

Health economics evaluation on rehabilitation mode of integrated traditional Chinese and western medicine applied in community

目的对在社区卫生服务中心开展中西医结合康复治疗进行卫生经济学评价。方法纳入在上海市某社区卫生服务机构门诊就诊的膝骨关节炎、颈椎病和腰椎间盘突出症患者各200例,随机分为中西医结合康复治疗干预组和常规中医综合治疗对照组。以视觉模拟评分法(VAS)为效果指标,以质量调整生命年(QALYs)为效用指标,进行成本-效果和成本-效用分析。结果每种疾病组中,治疗开始后患者VAS值均较治疗前降低(P<0.05),干预组患者的VAS值均分别低于对照组(P<0.05);患者QALYs值均较干预前升高(P<0.05),干预组患者的QALYs值均分别高于对照组(P<0.05)。膝骨关节炎、颈椎病和腰椎间盘突出症干预组增量成本-效果比(ICER)高于对照组,患者每多获得1个单位效果可分别少支出222.56、297.13和1 178.59元,增量成本-效用比(ICUR)亦高于对照组,每多获得1个QALYs可分别少支出741.86、3 178.60和2 862.29元。结论中西医结合康复治疗的治疗效果和成本效益均优于常规中医综合治疗。

Objective To observe the advantages and disadvantages the combination of traditional Chinese medicine and westernmedicine in community health service centers through cost-effectiveness and cost-utility analysis.Methods Take communitycommon diseases as an example,Knee Osteoarthritis（KOA）,Cervical Spondylosis（CS ） and Lumbar Disc Herniation （LDH）were used.A total of 200 cases were selected for each disease,and 100 cases in each one group.In the treatment group,therehabilitation mode was used.In the control group,comprehensive treatment of traditional Chinese medicine was adopted. Weanalyzed the cost-effectiveness and cost-utility,with VAS as the effect indicator and QALYs as the utility indicator. ResultsThe VAS values of the knee osteoarthritis,cervical spondylosis and lumbar disc herniation in the treatment group were lower thanthose in the control group after 14 days,30 days and6 months（P〈0.05 ） . The QALYs values of them in the treatment groupwere lower than those in the control group after 14 days,30 days and6 months（P〈0.05） . The treatment group has a higherincrease cost-effectiveness ratio（ICER） . Each get a unit effect can pay 222.56,297.13 and 1178.59 Yuan less . Thetreatment group hasa higher increase cost-utility ratio（ICUR ） . Each get a unit effect can pay 741.86,3178.60 and 2862.29Yuan less. Conclusion Community application in rehabilitation mode of integrated traditional Chinese and western medicinecan improve the treatment effect,and can reduce the cost of treatment and the loss of QALYs.