颛桥社区老年高血压患者3种干预方式的直接成本-效用研究

Study of the direct cost utility of 3 intervention methods for elderly hypertensive patients in Zhuanqiao Community

目的 :调查评价颛桥社区老年高血压患者接受不同干预方式的疾病直接成本效用。方法 :采用方便抽样方法于2017年10月选取老年高血压合并症患者148例,其中颛桥社区卫生服务中心接受住院治疗干预的患者58例、颛桥敬老院接受巡回医疗干预的患者30例,颛桥各社区接受"1+1+1"组合签约门诊干预的患者60例(进一步细分为门诊高龄亚组与门诊低龄亚组)。计算三组患者于2016年5月1日—2018年4月30日2年时间内接受不同干预方式的疾病直接成本—效用。结果 :2年的抗高血压药物费用为门诊高龄组最高(2 679.91元),门诊低龄组最低(2 210.43元);单纯计算抗高血压药物治疗费用,每获得一个完整QALY的成本为住院组最高(2 521.22元),门诊低龄组最低(1 627.50元);从总直接成本、自付总金额来看,总直接成本为住院组最高(179 143.29元),门诊低龄组最低(19 215.47元),三组患者每获得一个完整QALY的费用差异有统计学意义(P <0.001);自付总金额为住院组最高(63 574.97元),门诊低龄组最低(9 929.61元)。结论 :"1+1+1"组合签约服务和巡回医疗等医疗模式的开展极大地减轻了老年高血压患者的疾病经济负担,具有现实意义。

Objective： To investigate and evaluate the direct cost utility of different chronic diseases intervention methods for elderly patients with hypertension in Zhuanqiao Community. Methods： In October, 2017, 148 elderly patients with hypertension complication were selected by convenience sampling, among them, 58 cases of patients received hospitalization intervention in Zhuanqiao Community Health Service Center, 30 patients received itinerant medical intervention in the Nursing Home of Zhuanqiao, and 60 patients in Zhuanqiao Community received the “1＋1＋1” combined signing outpatient intervention（further subdivided into an outpatient senior subgroup and an outpatient junior subgroup）. The direct cost utility of the patients in three groups receiving diferent interventions during the two years from May 1, 2016 to April 30, 2018 was calculated. Results： The cost of antihypertensive drugs for 2 years was the highest in the outpatient senior group（2 679.91 Yuan）, and the lowest in the outpatient junior group（2 210.43 Yuan）; the cost of antihypertensive medications was calculated simply and the cost of obtaining a complete QALY was the highest in the inpatient group（2 521.22 Yuan）, and the lowest in the outpatient junior group（1 627.50 Yuan）; in terms of total direct cost and total amount of self-payment, the total direct cost was the highest in the inpatient group（179 143.29 Yuan） and the lowest in the outpatient junior group（19 215.47 Yuan）, and there was a statistically signifcant diference in the cost of obtaining a complete QALY between the three groups（P〈0.001）; the total amount of self-payment was the highest in the inpatient group（63 574.97 Yuan）, and the lowest in the outpatient junior group（9 929.61 Yuan）. Conclusion： The “1＋1＋1” combined signing service and itinerant medical treatment modes have greatly reduced the economic burden of the elderly patients with hypertension, which is of practical signifcance.