深圳市血脂异常人群社区健康管理成本效果评价研究

Cost-effectiveness analysis of comprehensive community intervention and health management of patients with dyslipidemia in Shenzhen

目的 评价深圳市血脂异常人群社区健康管理的成本效果,为社区血脂异常防治提供卫生经济学依据.方法 通过多阶段整群随机抽样的方法选取深圳市社区健康服务中心404例血脂异常患者,其中干预组204人,对照组200人.对干预组开展综合健康管理.收集干预组和对照组的机构干预成本（劳务费、公务费、卫生材料费、低值易耗品损耗费、业务费和固定资产折旧及贴现）,患者成本（直接医疗成本和间接医疗成本）,效果指标（血脂控制率、血脂改善率和血脂加重率）进行成本效果分析.结果 经过为期1年的干预,深圳市成人血脂异常健康管理项目干预组年人均总成本1321.62元,人均患者成本973.33元,人均机构成本348.29元.干预组干预前后胆固醇、三酰甘油和高密度脂蛋白胆固醇分别平均下降0.43 mmol/L、0.16 mmol/L和0.42 mmol/L,干预前后差异均有统计学意义（P〈0.05）.干预组干预后血脂控制率、血脂改善率和血脂加重率分别为17.6%、48.0%和7.4%,而对照组分别为10.5%、22.5%、和16.0%.干预组血脂控制率和改善率高于对照组,血脂加重率低于对照组,两组差异有统计学意义（χ2=43.774,P〈0.001）.从血脂相关生化指标和血脂改善情况看,对照组血脂控制率升高1%的人均成本为81.17元,血脂改善率升高1%的人均成本为37.88元,而相应干预组的人均成本分别为74.87元和27.51元,干预组成本-效果比值低于对照组,具有良好的成本-效果.结论 对社区血脂异常患者进行综合健康管理具有良好的成本-效果值,值得在社康中心长期实施和推广.

Objective To evaluate the cost-effectiveness of intervention and management of the patients with dyslipidemia in some districts in Shenzhen and provide health economic basis for prevention and control of dyslipidemia. Methods We conducted a comprehensive community intervention among patients for dyslipidemia management, enrolling 204 cases of dyslipidemia in the intervention group and 200 cases in the control group through multi-stage cluster random sampling. We collected baseline and intervention data, such as the cost of institutional intervention （labor costs, office expenses, material expenses, loss of low-value consumables, service costs, and depreciation of fixed assets）, patient costs （direct and indirect medical costs）, effect indicators （lipid control rate, lipid improvement rate, and lipid exacerbation rate） to analyze cost-effectiveness. Results After 12 months of the comprehensive community intervention, the total cost for the intervention group was 1 321.62 yuan per capita; the cost per patient was 973.33 yuan; and per capita institutional cost was 348.29 yuan. Total cholesterol, triglyceide, and high- density lipoprotein cholesterol of intervention group decreased by 0.43 mmol/L, 0.16 mmol/L, and 0.42 mmol/L, respectively, after the intervention, and there was a significant difference before and after the intervention （P〈0.05）. After intervention, the intervention group lipid control rate was 17.6%, the lipid improvement rate was 48.0%, and the lipid exacerbation rate was 7.4%, whereas those of the control group were 10.5%, 22.5%, and 16.0%, respectively. The lipid control rate and improvement rate in the intervention group were higher than those in the control group, and the lipid exacerbation rate was lower than that of the control group. The difference between the two groups was statistically significant （χ2=43.774, P〈0.001）. Patients in the control group had a unit cost of 81.17 yuan for 1% of blood lipid control rate and 37.88 yuan for one unit of blood lipid improvement rate. The corresponding per capita cost of the intervention group was 74.87 yuan and 27.51 yuan, respectively. The intervention group＇s cost-effect ratio was lower than that of the control group and had good cost-effectiveness. Conclusions The comprehensive community intervention and management of patients with dyslipidemia was effective in terms of health economics and it is worth the long-term implementation and promotion in the community health service center.