广东省26家三甲医院新生儿科超未成熟儿与超低出生体重儿的住院费用分析

Costs of hospitalization for extremely preterm and extremely low birth weight infants discharged from neonatology department of 26 tertiary hospitals in Guangdong Province

目的探讨广东省新生儿科出院的超未成熟儿(extremely preterm infants,EPI)与超低出生体重儿(extremely low birth weight infants,ELBWI)的住院费用情况及其影响因素。方法收集广东省26家三甲医院新生儿科于2013-2017年出院的EPI与ELBWI的住院情况和住院费用,并按救治结局、出生胎龄、出生体质量、出院年份、出院地区和医院类型等进行分组,分别计算和比较各组的住院天数、日均住院费用和住院总费用。结果共2392例EPI与ELBWI进入分析,整体患儿的中位住院天数为52(4,73)d,中位日均住院费用为2060(1441,3404)元,中位住院总费用为78044(20176,134440)元。死亡/转院组(n=1117)与存活/非转院组(n=1275)比较,存活/非转院组的中位住院天数和中位住院总费用均大于死亡/转院组(Z=-35.600、-29.394,均P<0.001),但中位日均住院费用低于死亡/转院组(Z=-24.511,P<0.001)。在存活/非转院组中,中位日均住院费用、中位住院总费用与出院年份呈正相关(r=0.302、0.259,均P<0.001),各年的中位住院总费用分别相当于当年常住居民人均可支配收入的3.56、3.74、4.11、4.10和4.05倍;中位住院天数、中位住院总费用分别与出生胎龄、出生体质量呈负相关(均P<0.001),中位日均住院费用仅与出生胎龄呈负相关(P<0.001);中位日均住院费用、中位住院总费用与出院医院所处地区的经济发展水平呈正相关(r=0.356、0.392,均P<0.001);综合性医院的中位日均住院费用、中位住院总费用均低于专科医院(Z=-2.230、-3.373,P=0.026、P<0.001)。结论EPI与ELBWI的救治费用与救治结局、出生胎龄、出生体质量、出院年份、出院地区、医院类型等因素相关。

Objective To investigate the medical costs of hospitalization for extremely preterm and extremely low birth weight infants.Methods The hospitalization records and medical costs of extremely preterm and extremely low birth weight infants discharged from neonatology department of 26 tertiary hospitals in Guang-dong Province from 2013 to 2017 were collected.The infants were divided into groups according to the outcome,gestational age,birth weight,discharged year,discharged region,and type of discharged hospital respectively.The median length of hospitalization,median cost per day,and median total cost in each group were calculated,and comparisons were made among/between groups respectively.Results A total of 2392 cases of extremely pre-term and extremely low birth weight infants were enrolled.The median length of hospitalization was 52 days(P25~75:4~73 days),median cost per day was 2060 yuan(P25~75:1441~3404 yuan),and median total cost was 78044 yuan(P25~75:20176~134440 yuan).Compared to the infants who were dead or transferred to other hospitals,the median length of hospitalization was larger(Z=-35.600,P<0.001),the median total cost was higher(Z=-29.394,P<0.001),and the median cost per day was lower(Z=-24.511,P<0.001)for the survived infants discharged from the original hospitals.When further analyses were made for the survived infants discharged from the original hospitals,it showed that the median cost per day and median total cost were both positively correlated with the dis-charged year from 2013 to 2017(r=0.302 and 0.259,both P<0.001).And the median total cost from 2013 to 2017 were 3.56,3.74,4.11,4.10,and 4.05 times as much as the per capita disposable income of the permanent residents in the same year.The median length of hospitalization and median total cost were both negatively correlat-ed with gestational age or birth weight(all P<0.001),and the median cost per day was negatively correlated with gestational age(P<0.001).The median cost per day and median total cost were both positively correlated with the economic development level of the region where the discharged hospitals were located(r=0.356 and 0.392,both P<0.001).The median cost per day and median total cost in general hospitals were both lower than that in special-ized hospitals(Z=-2.230 and-3.373,P=0.026 and P<0.001).Conclusions The costs of hospitalization for extremely preterm and extremely low birth weight infants were related to the factors such as outcome,gestational age,birth weight,discharged year,discharged region,and type of discharged hospital.