结直肠癌患者临床治疗经济负担研究

Hospital medical costs and specific chemotherapy drug costs compositions associated with colorectal cancer based on cost of illness

目的评估结直肠癌住院患者医疗费用组成情况及经济负担。方法选取2017年1月至2018年12月成都市第二人民医院结直肠癌住院患者,收集患者的基础特征数据、临床治疗信息和费用信息并进行分组分析。结果研究共纳入105例患者。Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者占比分别为1.91%、18.10%、34.29%和45.72%。卡培他滨是最常用的化疗药物(54.29%),治疗过程中药品平均费用最高的是贝伐珠单抗。患者一线治疗最常使用的治疗方案是奥沙利铂联合卡培他滨(CAPEOX),占39.48%。使用一线、二线和三线治疗的患者分别占比84.22%、11.86%和3.95%。患者治疗费用与治疗方式选择的差异有统计学意义(P<0.001),患者化疗组中位费用为49 336.40元,化疗组中位费用明显高于放疗组。医疗费用分组分析中,西药费用占首位,影像学费用和实验室费用分别排第二位和第三位。直肠癌的中位数费用比结肠癌高40.58%。直肠癌组与结肠癌组在放疗费用中差异有统计学意义(P<0.01)。结论结直肠癌医疗费用中西药费用最高,直肠癌放疗费用高于结肠癌,患者化疗组治疗费用高于放疗组。

Object To assess the medical cost composition and economic burden of colorectal cancer inpatients in a thirdgrade hospital. Methods Colorectal cancer patients were screened and their demographic,clinical and economic data were retrieved from the computerized records of hospital information system from January 2017 to December 2018 in Chengdu Second’s Hospital. Results A total of 105 patients were included in this study. The percentages of Stage Ⅰ,Stage Ⅱ,stage Ⅲ and stage Ⅳ stage was 1. 91%,18. 10%,34. 29% and 45. 72%,respectively. Capecitabine is the most commonly used chemotherapy agent(54. 29%). The highest average cost of drugs during treatment was Bevacizumab. The most commonly used chemotherapy treatment regimen was Oxaliplatin combined with Capecitabine(CAPEOX),accounting for 39. 48%. Colorectal patients who only used first-line treatment,those who used second-line and third-line treatment accounted for 84. 22%,11. 86% and 3. 95%,respectively. There was a significant difference between the treatment cost and the choice of treatment method(P<0. 001). The median cost of the chemotherapy group was 49 336. 40 yuan,which was significantly higher than that of the radiotherapy group. Western medicine costs accounted for the first place,the imaging costs and the laboratory costs ranked second and third respectively inthe grouping analysis. The median costs for rectal cancer were 40. 58% higher than for colon cancer. There was significant difference between rectal and colon groups in radiotherapy costs(P<0. 01). Conclusion Western medicine costs accounted for the first place in colorectal cancer. Rectal groups were more expensive than colon groups in radiotherapy costs. The costs in chemotherapy groups were more expensive than radiotherapy groups.