急性淋巴细胞白血病初诊患儿诱导缓解阶段总医疗费用的影响因素分析

Analysis of influencing factors of total medical expenses in children with newly diagnosed acute lymphoblastic leukemia during induction of remission

背景儿童急性淋巴细胞白血病(ALL)所致家庭经济负担沉重。目的探索影响ALL患儿医疗费用的影响因素,为合理控制费用提供依据。设计横断面研究。方法回顾性纳入重庆医科大学附属儿童医院血液肿瘤专科收治的初诊ALL患儿,分析诱导缓解治疗过程的总医疗费用,并采用秩相关分析和广义线性模型统计分析影响医疗负担的因素。主要结局指标ALL患儿诱导缓解阶段住院总费用。结果1081例初诊ALL患儿纳入本文分析,男622例(57.5%),女459例;平均年龄(70.5±44.5)月龄。诱导缓解阶段平均总诊疗费用(59860±25989)元,日均住院费用(1244±581)元,平均血液制品输注费用(7106±5391)元。单因素秩相关分析显示,按患儿年龄,疾病免疫分型,初诊危险度分层,是否发生院感、真菌感染以及败血症,是否非血液专科入院,是否入住PICU治疗,住院时长,血液制品输注费用分组,诱导缓解阶段总医疗费用组间差异有统计学意义。广义线性模型构建结果提示,是否转入PICU、是否非血液专科入院、是否发生院感、免疫分型、是否发生真菌感染、住院时长和输血治疗费用为影响诱导缓解阶段总医疗费用的独立风险因素。结论儿童ALL医疗费用受到疾病严重程度、并发症严重程度以及院感、专科入院等医疗管理相关因素的影响。

Background Family financial burden due to childhood acute lymphoblastic leukemia(ALL)is high.Objective To explore the factors affecting the medical costs of children with ALL and to provide a basis for reasonable cost control.Design Cross-sectional study.Methods Children with newly diagnosed ALL were retrospectively enrolled at the Department of Hematology and Oncology of Children's Hospital of Chongqing Medical University.The total medical expenses during remission induction therapy were analyzed,and the factors affecting medical burden were analyzed using rank correlation analysis and generalized linear model statistics.Main outcome measures The total hospitalization costs during the remission induction course in children with ALL.Results A total of 1081 children with newly diagnosed ALL were included in this analysis,including 622 males(57.5%)and 459 females with an average age of(70.5±44.5)months.The average total cost of diagnosis and treatment in the remission induction course was 59860 yuan,the average daily hospitalization cost was(1244±581)yuan,and the average blood product transfusion cost was(7106±5391)yuan.Univariate rank correlation coefficients showed there was a statistically significant difference between the medical costs during the remission induction and age,disease immunotype,risk stratification at initial diagnosis,nosocomial infection,fungal infection and sepsis,non-hematology admission,PICU admission,length of hospitalization and cost of blood product transfusion.Generalized linear model construction indicated that transfer to PICU,non-hematology admission,nosocomial infection,immunotype,fungal infection,length of hospital stay and cost of blood transfusion were independent risk factors affecting the total medical expenses in the remission induction course.Conclusions The medical costs of ALL children were influenced by disease severity,complication severity,and factors related to medical management such as nosocomial infection and specialty admissions.