百级层流病床预防粒细胞缺乏病人医院感染的卫生经济学评价

Health economic evaluation of prevention of nosocomial infection for patients with agranulocytosis admitted to class 100 laminar flow bed

目的研究百级层流病床预防粒细胞缺乏病人医院感染的疗效及卫生经济学成本,为病人治疗选择提供参考。方法采用队列研究,将2018年1月至2020年4月入住六安市人民医院血液内科的119例粒细胞缺乏病人根据其自身及其近亲属意愿分为两组,观察组入住百级层流病床(n=60),对照组入住普通病床(n=59),比较两组医院感染发生率、感染部位、住院日、直接治疗成本、间接治疗成本及总治疗成本。采用成本效果分析来评估层流病床的卫生经济学价值,通过上调50%的层流床费用来重新计算治疗成本以及采用多元线性回归对总治疗成本进行敏感性分析。结果观察组医院感染发生率[11/60(18.3%)]明显低于对照组[29/59(49.2%)](P<0.05)。两组感染部位比较,差异无统计学意义(P>0.05)。观察组住院日(8.60±5.47)d明显低于对照组(11.88±6.44)d(P<0.05)。观察组直接治疗成本、间接治疗成本及总治疗成本均明显低于对照组(均P<0.05)。每成功治疗1例粒细胞缺乏病人,观察组较对照组总治疗成本减少3610元。敏感性分析结果与基础研究结果相一致。结论对于粒细胞缺乏病人,入住百级层流病床不仅降低医院感染发生率,同时可以减轻病人经济负担,值得临床推广。

Objective To assess the efficacy and health economic cost of class 100 laminar flow bed in prevention of nosocomial in⁃fection for patients with agranulocytosis in order to provide reference for patients'treatment choice.Methods Cohort study was per⁃formedamong 119 patients with agranulocytosis admitted to Department of Hematology,Lu'an People's Hospital between January 2018 and April 2020.The patients were divided into two groups according to their own wishes and the wishes of their close relatives.The patients choosing laminar flow bed were served as observation group(n=60),and those choosing general bed were compared as control(n=59).The incidence of nosocomial infection,infection site,hospital stay,direct treatment cost,indirect treatment cost,and total treat⁃ment cost were compared between the two groups.The method of cost-effectiveness analysis was applied to evaluate the health economic value of laminar flow bed.The sensitivity analysis of the total treatment cost was carried out with multiple linear regression and recal⁃culation of treatment cost by increasing laminar bed cost by 50%.Results The incidence of nosocomial infection in the observation group[11/60(18.3%)]was significantly lower than that in control group[29/59(49.2%)](P<0.05).There was no statistical significance in infection site between two groups(P>0.05).The hospital stay in the observation group[(8.60±5.47)d]was lower than that in the control group[(11.88±6.44)d]with statistical difference(P<0.05).The direct treatment cost,indirect treatment cost,and total treatment cost of the observation group were lower than those of the control group with statistical difference(all P<0.05).Once a granulocytopia patient was cured,the total cost of per patient in the observation group could be reduced by 3610 RMB in comparison with that in the control group.The outcomes of sensitivity analysis were consistent with the basic research.Conclusion For patients with agranulocyto⁃sis,admission to the class 100 laminar flow bed can not only reduce the incidence of nosocomial infection,but also reduce the financial burden on patients,which is worthy of clinical promotion.