上海市松江区肺结核患者治疗药品的种类及费用分析

Analysis of the types and expense of therapeutic drugs for pulmonary tuberculosis in Songjiang District of Shanghai

目的分析肺结核患者治疗药品的使用和支出费用情况,为完善"减轻结核病患者经济负担"的政策提供依据。方法纳入2014年12月1日至2015年12月31日于上海市松江区完成疗程且符合入组标准的248例肺结核患者,整理汇总全部患者治疗全疗程的收费票据,统计各类药品的使用及药费支出情况。药品支出及占比等非正态分布资料均以"中位数(四分位数)[M(Q1,Q3)]"描述,数据的比较采用Mann-Whitney U检验,以P<0.05为差异有统计学意义。结果248例患者每例平均药品总费用为3719.0(2483.4,5634.9)元,其中用于抗结核药品、保肝药、其他辅助用药分别为16.8%(11.5%,24.0%)、62.1%(47.5%,74.6%)和23.0%(12.2%,40.7%)。除抗结核药品外,全部患者均使用过保肝药,其中241例(97.2%)在就诊1个月内使用,179例(72.2%)于就诊后每月规律服用,82例在治疗期间使用2种及以上保肝药。大部分患者间歇性使用其他辅助用药,其中中草药/中成药、抗生素和免疫调节剂的费用占比分别为14.8%(5.9%,28.9%)、9.7%(5.3%,17.2%)和8.6%(0.7%,14.0%);使用上述药品的患者占比分别为58.1%(144/248)、40.3%(100/248)和27.0%(67/248)。市级定点医院每例平均药品总费用和其他辅助用药的费用分别为6392.7(3371.5,9769.0)元和2097.6(789.0,3828.0)元,明显高于区级定点医院的3424.1(2362.0,4796.1)元和889.2(305.5,1826.0)元(Z=-3.534,P<0.001;Z=-3.113,P=0.002)。结论保肝药和其他辅助用药的费用占比均高于抗结核药品支出,无减免额度,是造成患者经济负担的主要原因;应规范保肝药与其他辅助用药的临床使用,减免相应的合理费用,切实减轻患者经济负担。

Objective To analyze the usage and expense of therapeutic drugs in pulmonary tuberculosis patients,and to provide the basis for improving the policy of reducing the economic burden of tuberculosis patients.Methods A total of 248 tuberculosis patients registered for treatment in Songjiang District,Shanghai and met the enrollment criteria were included from Dec 1,2014 to Dec 31,2015.The bills of expense for the whole treatment of all the patients were collected to analyze the usage and expense of therapeutic drugs.Non-normally distributed data such as drug expenditures and the proportions were all described as median(quartile)(M(Q1,Q3)).Data were compared using Mann-Whitney Utest and P<0.05 was considered statistically significant.Results The average total drug cost of the 248 patients was 3719.0(2483.4,5634.9)yuan per case.Among them,anti-tuberculosis drugs accounted for 16.8%(11.5%,24.0%),62.1%(47.5%,74.6%)was liver protection drugs,and 23.0%(12.2%,40.7%)was other adjuvant drugs.Except for anti-tuberculosis drugs,all patients were treated with hepatoprotective drugs:241 patients(97.2%)started to use hepatoprotective drugs within one month after diagnosis and initial treatment,179 patients(72.2%)regularly used hepatoprotective drugs every month after consultation.Eighty-two patients used two or more kinds of hepatoprotective drugs during treatment.Most patients used other adjuvant medications intermittently,of which the costs of Chinese medicines,antibiotics and immunemodulators accounted for 14.8%(5.9%,28.9%),9.7%(5.3%,17.2%)and 8.6%(0.7%,14.0%).The proportions of patients who used the above drugs were 58.1%(144/248),40.3%(100/248)and 27.0%(67/248),respectively.The average total cost of medicines and other adjuvant medications for per case in municipal designated hospitals were 6392.7(3371.5,9769.0)yuan and 2097.6(789.0,3828.0)yuan,which were significantly higher than those in the district-level designated hospitals(3424.1(2362.0,4796.1)yuan,Z=-3.534,P<0.001;889.2(305.5,1826.0)yuan,Z=-3.113,P=0.002).Conclusion The expense of hepatoprotective drugs and other adjuvant drugs was higher than that of anti-tuberculosis drugs.However,and these two kinds of drugs were not allowed or highly limited to get reimbursement form the free tuberculosis treatment policy and hence the usage of these drugs were the main cause of the economic burden on tuberculosis patients.The use of these drugs should be regulated and the related health policy need to be further concerned to reduce the financial burden on patients.