基于多中心研究的川崎病儿童住院治疗费用测算

A Drug Clinical Comprehensive Evaluation for Treatment of Children Kawasaki Disease:Multicenter Cost Estimation of Children Kawasaki Disease Inpatient

目的:为验证《儿童药品临床综合评价方法学指南》,开展儿童川崎病药品临床综合评价试点,验证基于真实世界数据开展儿童药品临床经济性评价的可行性。方法:采用医疗费用分析方法,进行川崎病药物治疗经济性初步评价。选取4家儿童专科医院,随机抽取2018—2019年度出院诊断为“黏膜皮肤淋巴结综合征”或“川崎病”病例的药物治疗相关数据。脱敏清洗后的数据以医院数据为单位,对住院总费用、药品总金额等经济指标进行描述性统计分析。结果:4家三级甲等儿童专科医院川崎病治疗平均住院时间为5~7 d;住院总费用平均为9962~16808元(相当于2019年全国居民4.5~7.6个人均月可支配收入),是家庭的较大负担,医院间存在一定差异;治疗药品总金额平均为5826~8281元,药占比为49%~61%;治疗药物中静注人免疫球蛋白总金额平均为5049~6300元,占药品总金额比平均为80%~89%,合理应用静注人免疫球蛋白对控制住院费用及提高资源使用效率具有重要意义;3家医院的医疗保险支付药品费用平均比例为53%~69%。结论:样本医院川崎病临床治疗真实世界数据用于儿童用药临床使用经济性在一定程度上是可行性的。开展与临床疗效关联的更深层次的经济学研究尚需进一步探索。

Objective:To verify the“Methodological Guidelines for clinical comprehensive evaluation of children′s drug”,carry out a pilot comprehensive clinical evaluation of Kawasaki disease drugs,and verify the feasibility of clinical economic evaluation of children′s drugs based on real-world data.Methods:Preliminary economic evaluation on the medical treatment for Kawasaki disease by medical cost analysis method.Selected 4 children′s hospitals,randomly selected case data of medical treatment with the diagnosis of“mucocutaneous lymph node syndrome”,or of“Kawasaki disease”in 2018 and 2019 were collected.Desensitization data performs descriptive statistical analysis of economic indicators such as total hospitalization expenses and total drug amount,in unit of hospital data.Results:The average length of stay for Kawasaki disease treatment in 4 tertiary-A children′s hospitals is 5~7 days.The total hospitalization cost averages 9962~16808 RMB(equivalent to 4.5~7.6 median of the national residents monthly disposable income in 2019),which is a relatively large burden for the family,and there are certain differences between hospitals.The total amount of medical treatment is 5826~8281 RMB on average,and the proportion of drugs is 49%~61%.The total cost of intravenous human immunoglobulin in the treatment is 5049~6300 RMB on average,accounting for an average of 80%~89%of the total amount of drugs.The rational application of intravenous human immunoglobulin is important for controlling hospitalization expenses and improving resource utilization efficiency.The average proportion of medical insurance payment for medicines in the three hospitals is 53%to 69%.Conclusion:It is feasible to use real-world data of clinical treatment of Kawasaki disease in sample hospitals to evaluate the clinical economics of children′s medicines.Further exploration is needed to develop deeper economic research related to clinical efficacy.