先天性心脏病患儿心内科介入治疗与心外科手术治疗疾病经济负担比较

Difference of economic burden of diseases between cardiac intervention and cardiac surgery to children with congenital heart disease

目的了解接受心内科介入治疗与心外科手术治疗先天性心脏病(先心病)患儿的疾病经济负担,为降低先心病患儿、家庭、社会疾病经济负担及卫生管理部门决策和完善社会保障体系提供参考依据。方法采用流行病学横断面调查方法,对2017年3~12月在广州市某三甲医院住院的先心病患儿(家长)进行调查,对其直接、间接、无形疾病经济负担进行比较。结果住院前先心病患儿接受心内科介入与心外科手术治疗直接医疗经济负担比较,差异无统计学意义[10050(5000~30000)元vs.10550(6800~20000)元,χ^(2)=0.33,P=0.5671];二组患儿直接非医疗经济负担比较,差异有统计学意义[2800(520~16227)元vs.200(0~966)元,χ^(2)=11.64,P=0.0006]。住院期间二组患儿直接医疗经济负担比较,差异有统计学意义[35033(29794~35870)元vs.34358(31197~39328)元,χ^(2)=8.29,P=0.0040]。二组患儿直接非医疗经济负担比较,差异有统计学意义[2000(1300~2950)元vs.1190(450~2780)元,χ^(2)=18.86,P<0.0001]。住院前二组患儿间接疾病经济负担比较,差异有统计学意义[1600(0~4600)元vs.0(0~350)元,χ^(2)=9.14,P=0.0025]。住院期间二组患儿间接疾病经济负担比较,差异有统计学意义[1500(600~3000)元vs.150(0~900)元,χ^(2)=39.05,P=0.0001]。住院前二组患儿无形疾病经济负担(生存质量得分损失值)比较,差异有统计学意义[22(14~32)分vs.36(22~50)分,χ^(2)=33.24,P<0.0001]。结论先心病患儿住院前心内科介入治疗直接非医疗经济负担高于心外科手术治疗;住院期间心内科介入治疗直接医疗经济负担稍高于心外科手术治疗,而直接非医疗经济负担高于心外科手术治疗;住院前及住院期间心内科介入治疗间接疾病经济负担高于心外科手术治疗,但住院前心内科介入治疗无形疾病经济负担低于心外科手术治疗。

Objectives To learn the economic burden of diseases caused by congenital heart disease(CHD)treated by cardiac intervention and surgery,to provide basis evidences for reducing the disease economic burden of CHD children,families and society,to provide evidences for decisions from health management departments,and to provide references for improving the social security system.Methods With an epidemiological cross-sectional survey,the CHD children(parents)from March to December,2017 in a Hospital in Guangzhou were investigated to understand the differences in the direct economic burden,indirect economic burden and intangible economic burden of diseases between cardiac intervention and surgery.Results Before hospitalization,the difference of direct medical economic burden of CHD children treated by cardiac intervention and surgery was with no significant difference[10050(5000-30000)yuan vs.10550(6800-20000)yuan,χ^(2)=0.33,P=0.5671];the difference of direct non-medical economic burden between the two groups was with statistical difference[2800(520-16227)yuan vs.200(0-966)yuan,χ^(2)=11.64,P=0.0006].During hospitalization,the difference of direct medical economic burden between the two groups was with statistical significance[35033(29794-35870)yuan vs.34358(31197-39328)yuan,χ^(2)=8.29,P=0.0040];and the difference of direct non-medical economic burden between the two groups was with significant difference[2000(1300-2950)yuan vs.1190(450-2780)yuan,χ^(2)=18.86,P<0.0001].Before hospitalization,the difference of indirect economic burden of diseases between the two groups was with statistical significance[1600(0-4600)yuan vs.0(0-350)yuan,χ^(2)=9.14,P=0.0025].During hospitalization,the difference of indirect economic burden of diseases between the two groups was with statistical significance[1500(600-3000)yuan vs.150(0-900)yuan,χ^(2)=39.05,P=0.0001].Before hospitalization,the difference of intangible economic burden of diseases(loss score of quality of life)between the two groups was with significant difference[22(14-32)score vs.36(22-50)score,χ^(2)=33.24,P<0.0001].Conclusions Before hospitalization,the direct non-medical economic burden of cardiac intervention was higher than that of cardiac surgery.During hospitalization,the direct medical economic burden of cardiac intervention was little higher than that of cardiac surgery,the direct non-medical economic burden of cardiac intervention was higher than that of cardiac surgery.Before and during hospitalization,the indirect economic burden of diseases of cardiac intervention was higher than that of cardiac surgery.But before hospitalization,the intangible economic burden of diseases of cardiac intervention is lower than that of cardiac surgery.