基于分位数回归的HIV感染者门诊费用影响因素研究

A quantile-based regression study on factors influencing outpatient costs for people living with HIV

目的应用分位数回归模型分析HIV感染者门诊费用的影响因素,为今后降低HIV感染者的前期门诊费用及后期机会性感染住院费用提供理论支持,并为艾滋病纳入门诊特定病种医保的针对性策略提供决策依据。方法利用2019年1-12月在武汉、黄石、襄阳、荆州市疾病预防控制中心与艾滋病ART定点医院就诊的703例HIV感染者门诊病案信息,采用分位数回归模型分析门诊费用的影响因素。结果门诊费用的25%、50%、75%分位数分别为382.94元、679.50元、1034.99元。在三个分位数点上,襄阳HIV感染者门诊总费用、常规检查费用与其他检查费用显著高于武汉,荆州HIV感染者门诊总费用、常规检查费用显著低于武汉,其他检查费用在25%、50%分位数点上显著低于武汉(P<0.05),ART时长3~5年在三个分位数点上对门诊总费用、常规检查费用有负向影响,在50%分位数点上对其他检查费用有负向影响(P<0.05),ART时长6年以上的在75%、50%分位数点上分别对门诊总费用、其他检查费用产生负向影响(P<0.05),CD4细胞最低值在50%分位数点上对门诊总费用、常规检查费用有负向影响(P<0.05)。结论不同地区、CD4细胞水平、ART时长均会对HIV感染者的门诊费用产生不同影响,因此,可以从不同地区入手,尽早让患者进入ART以降低门诊费用,提高治疗的可及性、依从性与及时性,从而减少HIV感染者的机会性感染的发生,进一步降低住院费用,减轻HIV感染者的经济负担。

Objective Quantile regression model was applied to analyze the factors influencing the outpatient costs of HIV-infected patients to provide theoretical support for reducing the upfront outpatient costs and later hospitalization costs of opportunistic infections among HIV-infected patients in the future and providing a basis for decision-making on targeted strategies for the inclusion of HIV in outpatient specific disease health insurance.Methods Collect the information of 703 outpatient of HIV-infected patients attending CDC and ART-designated hospitals in Wuhan,Huangshi,Xiangyang,and Jingzhou from January-December 2019.Factors influencing outpatient costs were analyzed using quantile regression models.Results The 25%,50%,and 75%quartiles of outpatient costs were 382.94,679.50 and 1034.99 RMB yuan,respectively.At the three quartiles,the total cost of outpatient clinics for HIV-infected patients,routine tests and other tests was significantly higher in Xiangyang than in Wuhan.However,the total cost of outpatient clinics for HIV-infected patients and the cost of routine tests were significantly lower in Jingzhou than in Wuhan and the cost of other tests was significantly lower in the 25%and 50%quartiles(P<0.05).In addition,an ART duration of 3-5 years negatively influenced total outpatient and routine examination costs at three quartile points and on other examination costs at 50%quartile points(P<0.05).ART duration of 6 years or longer negatively influenced total outpatient costs and other examination costs at 75%and 50%quartile points,respectively(P<0.05).The lowest value of CD4 cells negatively influenced total outpatient costs and other examination costs at 50%quantile point negatively influenced total outpatient costs and costs of routine investigations(P<0.05).Conclusions Different regions,CD4 cell levels,and ART duration have different effects on the outpatient costs of HIV-infected patients.Therefore,patients enter ART as early as possible can reduce outpatient costs and improve the accessibility,compliance,and timeliness of treatment.Thus,opportunistic infections in HIV-infected patients,hospitalization costs,and the financial burden of HIVinfected patients can all be reduced.