良性阵发性位置性眩晕患者诊治费用情况及影响因素的初步研究

Health care costs and influence factors in patients with benign paroxysmal positional vertigo:a pilot study

目的探讨良性阵发性位置性眩晕患者诊治费用情况和影响因素。方法连续收集2019年3~10月我科诊治的312例良性阵发性位置性眩晕患者,采集患者性别、年龄、既往史等基线情况、挂号方式、临床分型、诊疗费用等,以<726.18元人民币为正常诊治费用,≥726.18元为高诊治费用,计算患者诊治费用分布情况。对费用分布情况进行单因素回归,筛选可能危险因素(P<0.1),进行多因素回归分析,比较正常诊治费用组和高诊治费用组患者检查项目区别。结果312例患者中男性103例,女性209例,年龄61.22±9.53岁,正常诊疗费用253例(81.09%),高费用59例(18.91%)。单因素回归分析,P<0.1的因素包括性别、年龄、高血压病史、脑卒中病史、挂号方式、患病次数、临床分型。多因素回归分析:高血压病史(P=0.000)、脑卒中病史(P=0.011)、临床分型:水平半规管管石型(P=0.042)、水平半规管嵴帽型(p=0.019)为良性阵发性位置性眩晕发生高诊治费用的影响因素。高诊治费用组,患者常做的检查有:头CT(89.83%)、眼震电图(72.88%)、TCD(64.41%)、颈椎CT(52.54%);花费较多的检查:头MRI(19250元)、头CT(17110元)、颈椎CT(8990元)。正常诊治费用组,患者常做的检查有:眼震电图(73.52%)、TCD(24.11%)、头CT(14.23%)、心电图(12.25%);花费较多的检查:眼震电图(21948元)、头CT(10440元)、TCD(4697元)。结论良性阵发性位置性眩晕患者发生高诊治费用的比例为18.91%,合并高血压、脑卒中病史以及临床分型为水平半规管型更易发生高诊治费用,高费用组患者做头CT、TCD、颈椎CT比例高,头MRI、头CT、颈椎CT花费高。

Objective To investigate the incidence of high health care costs(HHCC)and its associated influence factors in patients with benign paroxysmal positional vertigo(BPPV).Methods A consecutive 312 patients with benign paroxysmal positional vertigo was inclued in the Shengjing hospital of China Medical University from March 2019 to October 2019.The baseline characteristics such as gender,age,past medical history,registration way,clinical classification,health care costs,ect.were collected.To calculate the mean of the costs and define high health care costs when it was higher than the mean.Meanwhile to calculated the proportion of high health care costs.Univariate regression was performed to screen possible influence factors for high health care costs(P<0.1),multiple factors regression analysis further.The examination items of patients in the normal health care costs group and the high health care costs group were compared.Results Among the 312 patients,there were 103 males and 209 females,aged 61.22±9.53 years,59 cases(18.91%)with high health care costs.According to univariate regression analysis,the factors with P<0.1 included gender,age,history of hypertension,history of cerebral stroke,registration way,frequency of diseases,and clinical classification.Multivariate regression analysis:history of hypertension(P=0.000),history of cerebral stroke(P=0.011),clinical classification:horizontal semicircular canalithiasis(P=0.042),horizontal semicircular canal cupulolithiasis(P=0.019)were the influencing factors for the high diagnosis and treatment cost of benign paroxysmal positional vertigo.In the high health care costs group,patients often did examination items:head CT(89.83%),electronystagmography(72.88%),TCD(64.41%),cervical vertebra CT(52.54%);more expensive examination items:head MRI(￥19250)and head CT(￥17110),cervical vertebra CT(￥8990).In the normal health care costs group,patients often did examination items:electronystagmography(73.52%),TCD(24.11%)and head CT(14.23%),electrocardiogram(12.25%);more expensive examination items:electrical diagram of nystagmus(￥21948),head CT(￥10440),and TCD(￥4697).Conclusion The proportion of patients with benign paroxysmal positional vertigo with high health care costs was 18.91%.Patients with hypertension,stroke history and clinical classification of horizontal semicircular canal were more likely to have high health care costs.In the high health care costs group,the proportion of head CT,TCD,cervical vertebra CT is high,and the head MRI,CT,cervical vertebra CT cost more.