基于筛查的浦东新区结直肠癌患者住院费用构成及影响因素分析

Analysis of hospitalization fee and its influencing factors of colorectal cancer patients in Pudong based on the colorectal cancer screening program

目的分析筛查项目对结直肠癌患者住院费用的影响,为制定相关公共卫生政策提供参考。方法收集2013年1月~2016年12月入院的浦东新区新发结直肠癌患者诊断后第一年内的住院资料,采用秩和检验比较不同组别的结直肠癌患者住院总费用及各部分住院费用中位数的分布,并采用多元线性回归模型分析其对住院费用的影响。结果在纳入研究的2 930例结直肠癌患者中,未参与筛查的2 761例新发患者与169例参与筛查的患者住院总费用(Z=-2. 491,P=0. 013)、医疗综合服务费(Z=-6. 310,P <0. 001)、诊断费(Z=-3. 920,P <0. 001)、治疗费(Z=-2. 045,P=0. 041)、康复费(Z=-2. 173,P=0. 030)、中药费(Z=-4. 831,P <0. 001)和材料费(Z=-2. 074,P=0. 038)差异有统计学意义。多元线性回归模型分析发现支付性质、住院天数、筛查状态和医院等级与患者诊断后第一年内总住院费用有关,住院天数少(t=35. 52,P <0. 001)、参与筛查项目(t=-3. 05,P=0. 002)、全自费支付(t=2. 85,P=0. 004)及在高等级医院诊疗(t=-5. 98,P <0. 001)的患者住院费用支出较少。结论参加筛查项目是降低结直肠癌患者住院成本的有效途径之一。

Objective To analyze the impact of screening programs on the cost of hospitalization for colorectal cancer（CRC） patients, so as to provide references to formulate relevant public health policies. Methods Data of hospitalization fee of CRC patients diagnosed from January 1,2013 to December 31,2016 were enrolled. The median of total and parts of hospitalization costs in different groups were analyzed by Mann-Whitney U method, and the influencing factors were analyzed by multiple linear regression model. Results In the total of 2 930 CRC patients, there were significant difference in the total hospitalization costs （Z = -2. 491, P = 0. 013 ）, service costs （Z = -6. 310, P 〈 0. 001 ）, diagnostic costs （Z=- 3.920, P 〈 0.001）, treatment costs （Z = -2.045, P =0.041）, rehabilitation costs （Z = -2. 173, P = 0. 030）, Chinese medicine costs （ Z = - 4. 831, P 〈 0. 001 ）, and material costs （Z = - 2. 074, P = 0. 038）. The multiple linear regression model showed that the way of payment, the days of hospitalization, the status of screening, and the level of the hospital were related to the total hospitalization costs in the first year after the diagnosis of patients. Less hospitalization days （ t = 35.52, P 〈0. 001 ）, with screening（ t = - 3. 053, P = 0. 002 ）, at one＇s own expense （ t = 2. 85, P = 0. 004） , diagnosis and treatment in a high grade hospital （ t = - 5.98, P 〈 0. 001 ） were related to reducing the cost of hospitalization. Conclusions Screening program is one of the effective ways to reduce the cost of hospitalization for colorectal cancer patients.