江苏省233例耐多药/利福平耐药肺结核患者直接经济负担及影响因素研究

Study on the direct economic burden and relevant influencing factors of 233 multidrug/rifampicin-resistant pulmonary tuberculosis patients in Jiangsu Province

目的了解江苏省耐多药/利福平耐药肺结核(MDR/RR-PTB)患者直接经济负担及自付直接费用影响因素。方法纳入2021年1月1日至2022年12月31日在江苏省13家市级结核病定点医院确诊治疗的MDR/RR-PTB患者,通过调查问卷和医院信息系统获得患者基本信息和直接经济费用。使用逐步多重线性回归分析患者自付直接费用的影响因素。结果纳入的233例MDR/RR-PTB患者年龄为(44.04±15.64)岁。患者直接医疗费用M(Q_(1),Q_(3))为134051.00(98934.01,163205.73)元,其中医保报销或政策减免费用M(Q_(1),Q_(3))为100462.10(78120.00,130816.00)元,自付费用M(Q_(1),Q_(3))为21694.62(14734.83,37813.00)元。直接非医疗费用M(Q_(1),Q_(3))为4971.00(3138.00,7870.00)元。年龄、户籍所在地、结核病导致与配偶(伴侣)离异/分居、药敏情况和治疗方案是MDR/RR-PTB患者自付直接费用相关的影响因素。结论MDR/RR-PTB对江苏省造成的直接经济负担较重。需重视耐药患者的心理疏导与关怀,进一步提高MDR/RR-PTB诊断、治疗和管理水平,切实减轻耐药患者经济负担。

Objective To explore the direct economic burden and factors affecting out-of-pocket direct costs of multidrug-/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB)patients in Jiangsu Province.Methods MDR/RR-PTB patients diagnosed and treated at 13 municipal tuberculosis(TB)-designated hospitals in Jiangsu Province between January 1,2021,and December 31,2022,were included,and basic information and direct economic costs were obtained through questionnaires and hospital information systems.Stepwise multiple linear regression was used to analyze the factors influencing patients'out-of-pocket direct costs.Results The age of the 233 MDR/RR-PTB patients was(44.04±15.64)years.The M(Q_(1),Q_(3))direct medical expense of the patients was 134051.00(98934.01,163205.73)Yuan,of which the M(Q_(1),Q_(3))reimbursement by health insurance or policy reduction was 100462.10(78120.00,130816.00)Yuan,and the M(Q_(1),Q_(3))out-of-pocket direct medical expense was 21694.62(14734.83,37813.00)Yuan.The M(Q_(1),Q_(3))direct non-medical expense was 4971.00(3138.00,7870.00)Yuan.Age,registered residence location,TB resulting in divorce or separation from spouse or partner,drug resistance test results,and treatment regimens were the influencing factors associated with out-of-pocket direct costs for MDR/RR-PTB patients.Conclusions The direct economic burden caused by MDR/RR-PTB in Jiangsu Province is heavy.It is necessary to emphasize psychological guidance and care for MDR/RR-PTB patients,improve the diagnosis,treatment,and management of MDR/RR-PTB,and effectively reduce the economic burden of MDR/RR-PTB patients.