人工关节置换术的成本效益分析

Cost-benefit analysis of artificial joint replacement

[目的]通过分析人工关节置换术患者的费用,为合理控制医疗费用提供依据。[方法]采用回顾性调查研究的方法,对2013~2018年在石河子大学医学院第一附属医院骨科行"人工关节置换术"的849例患者住院期间的费用构成及术后疗效情况进行数据采集,并结合期间医保相关政策进行影响因子分析。[结果] 2013~2018年,人工关节置换术中全髋关节置换的人均住院总费用为56 119.75元,膝关节置换术为55 518.69元,股骨头置换为45784.22元;不同手术类别的总体费用构成情况相似,材料费、药费和手术费三者占比重最大,分别为49.53%、26.87%和11.56%。人工关节置换术患者总住院费用逐年上涨,其中材料费平均每年增加28.16%,药占比从2015年开始逐渐下降。影响住院总费用的主要因素是材料费占比、药占比、住院天数和不同的手术类别。[结论]在人工关节置换术的治疗效果无显著差异的情况下,控制人工关节假体的材料费及严格把控临床用药指针,规范住院流程是降低人工关节置换术住院费用的关键。

[Objective] To analyze the medical expenses in artificial joint replacement, and provide a basis for reasonable control of medical cost. [Methods] A retrospective investigation was conducted on the data of the cost composition in 849 patients who underwent artificial joint replacement in our department from 2013 to 2018. Combined with the relevant policies of medical insurance during the period, the impact factor was assessed. [Results] During 2013~2018, the total cost of hospitalization was 56 119.75 yuan for total hip arthroplasty, 55 518.69 yuan for total knee arthroplasty and 45 784.22 yuan for femoral head replacement. The overall cost of different surgical categories was similar. Materials, medicines and surgery costs accounted for 49.53%, 26.87% and 11.56% respectively, which was the largest expense. The total hospitalization cost of artificial joint replacement increased year by year, and the material fee increased by an average of 28.16% per year, while the proportion of medicines gradually decreased from 2015. The main factors affecting the total cost of hospitalization were the proportion of materials, the proportion of medicines, hospital stays, and different types of surgery. [Conclusion] In the case of no significant impact on the therapeutic outcomes, controlling the material cost of the artificial joint prosthesis, strictly controlling the clinical medication and standardizing the hospitalization procedure are the key to reduce the hospitalization cost of artificial joint replacement surgery.