濮阳市髋关节疾病患者行人工髋关节置换术经济负担及影响因素分析

Economic burden of artificial hip joint replacement and its influencing factors in patients with hip joint disease in Puyang City

目的探讨濮阳市髋关节疾病患者行人工髋关节置换术的直接费用、间接费用和总费用,并探讨其可能的影响因素。方法采用时间阶段整群抽样的方法,对2018年1月—2019年12月在濮阳市人民医院行人工髋关节置换手术的患者进行面对面问卷调查,待患者出院后3 d内查阅患者住院病历,记录住院费用及相关信息。总费用包括直接费用和间接费用,直接费用包括直接医疗费用和直接非医疗费用,间接费用采用人力资本法转换成费用,分别以直接费用、间接费用和总费用为应变量,对影响因素进行多元线性回归分析。结果共调查患者258例,应答率95.20%。行人工髋关节置换手术患者总费用为55163.03元,其中,直接费用51514.42元(占93.39%),间接费用3648.61元(占6.61%),直接费用与间接费用之比为14.12∶1;直接医疗费用远高于直接非医疗费用(68.01∶1),而直接医疗费用中,住院费用占了99.64%。患者总费用占患者年均收入的比例为484.24%,占家庭年均收入的比例为42.09%,其中,直接费用占患者年均收入和家庭年均收入的比例分别为452.21%和39.31%;患者间接费用为1831.24元,陪护间接费用为1817.37元,相应的误工人天数分别为16.14 d和14.47 d。单因素分析结果显示,总费用和直接费用在不同性别、年龄、婚姻状况、出院主要诊断、单双侧和假体材料间差异有统计学意义(Z=3.078和3.190、χ^(2)=69.410和72.459、Z=2.491和2.629、Z=64.599和68.392、Z=178.679和181.249,P<0.05);间接费用在不同职业、医疗保障和出院主要诊断间差异有统计学意义(Z=3.676、Z=3.027、χ^(2)=8.558,P<0.05)。多元线性回归分析结果显示,单双侧(β=45502.603和45350.504,95%CI:39723.378~51281.828和39828.956~50872.051)和假体材料(β=6837.012和6853.304,95%CI:5036.419~8637.606和5132.993~8573.615)是总费用和直接费用的共同影响因素(t=15.507和16.176,t=7.478和7.846,P<0.05),而职业(β=-1091.337,95%CI:-1568.287~-614.387)和医疗保障(β=3564.858,95%CI:2196.003~4933.713)是间接费用的影响因素(t=-4.506和5.129,P<0.05)。结论行人工髋关节置换术患者及家庭经济负担十分沉重,直接费用高于间接费用,直接医疗费用远高于直接非医疗费用,其中尤以其他费用(人工髋关节假肢)占比最高,是影响患者经济负担的主要因素。

Objective To investigate the direct,indirect and total costs due to artificial hip joint replacement in patients with hip joint disease in Puyang City,and to explore the possible influencing factors.Methods The time-phase cluster sampling method was used to conduct a face-to-face questionnaire survey on patients undergoing artificial hip replacement surgery in the People’s Hospital of Puyang City from January 2018 to December 2019.All the patients’hospitalization records were checked within 3 days after discharge,and the hospitalization expenses and related information were recorded.The patients’total costs included direct and indirect costs.The direct costs were further divided into direct medical costs and direct non-medical costs.The human capital method was employed to evaluate the indirect costs.Multiple linear regression analysis was conducted to identify the influencing factors linked to the direct,indirect and total costs.Results A total of 258 patients were investigated and analyzed,with the response rate of 95.20%.The total cost of the patients undergoing artificial hip replacement surgery was RMB 55,163.03 Yuan,among which,the direct cost was 51,514.42 Yuan(accounting for 93.39%),the indirect cost was 3,486.61 Yuan(accounting for6.61%),and the ratio of the direct cost to the indirect cost was 14.12∶1.The direct medical cost was much higher than the direct non-medical cost(68.01∶1),and the hospitalization expenses accounted for 99.64%of the direct medical expenses.The patients’total cost accounted for 484.24%of the patients’average annual income and 42.09%of their households’average annual income,of which the direct cost accounted for 452.21%of the patients’average annual income and 39.31%of their households’average annual income.The patients’indirect cost was 1,831.24 Yuan,the indirect cost for caregivers was 1,817.37 Yuan,and the corresponding work-loss days were 16.14 d and 14.47 d,respectively.The results of univariate analysis showed that there were statistically significant differences in the total cost and the direct cost between genders and among different ages,marital status,main diagnosis of discharge,the unilateral or bilateral and prosthetic material(Z=3.078,Z=3.190;χ^(2)=69.410,χ^(2)=72.459;Z=2.491,Z=2.629;Z=64.599,Z=68.392;Z=178.679,Z=181.249,all P<0.05)as well as in the indirect cost among different occupations,medical insurance and main diagnosis of discharge(Z=3.676,Z=3.027,χ^(2)=8.558,P<0.05).Multiple linear regression analysis revealed that the unilateral or bilateral(β=45,502.603,β=45,350.504,95%CI:39,723.378-51,281.828,95%CI:39,828.956-50,872.051)and prosthetic material(β=6,837.012,β=6,853.304,95%CI:5,036.419-8,637.606,95%CI:5,132.993-8,573.615)were the common factors influencing the total cost and the direct cost(t=15.507,t=16.176,t=7.478,t=7.846,P<0.05),while occupations(β=-1,091.337,95%CI:-1,568.287--614.387)and medical insurance(β=3,564.858,95%CI:2,196.003-4,933.713)were the factors influencing the indirect cost(t=-4.506,t=5.129,P<0.05).Conclusions Economic burden of the patients and families undergoing artificial hip arthroplasty is very heavy.The direct cost is higher than the indirect cost,and the direct medical cost is much higher than the direct non-medical cost,among which,other expenses(artificial hip prostheses)account for the highest proportion,which are the main factor affecting the financial burden of the patients.