恶性肿瘤患者医院感染疾病经济负担

The economic burden of nosocomial infections in malignant tumor patients

目的分析医院感染对恶性肿瘤患者疾病经济负担的影响。方法收集某三级甲等综合医院2020年1月1日—2022年12月31日所有恶性肿瘤患者住院资料,采用倾向得分匹配(PSM)和边际分析法,估算医院感染给恶性肿瘤患者、家庭和医院带来的经济负担。结果共纳入21484例恶性肿瘤患者,其中205例发生医院感染(发生率为0.95%)。经PSM后,3年间发生医院感染的恶性肿瘤患者医疗总费用为7115755元,其中医院感染导致医疗费用增加5473910元,增加金额占总费用的76.93%;在增加的医疗费用中,以实验室诊断费用、抗菌药物费用、影像学诊断费用和手术治疗项目费用为主;医院感染导致每例恶性肿瘤患者延长住院天数20.0天,间接经济负担7600元。3年间恶性肿瘤患者发生医院感染导致医院损失229760元[边际利润率(M%)=5%],期间损失利润比与感染率系数约为3.52。结论恶性肿瘤患者发生医院感染将会延长住院时间、增加住院费用、影响医疗护理质量的提升,对患者、家庭及医院造成沉重的经济负担。控制抗菌药物费用、实验室诊断费用、影像学诊断费用和手术治疗项目费用是降低医院感染恶性肿瘤患者住院总费用的重要切入点。

Objective To analyze the economic burden of nosocomial infections(NIs)in malignant tumor patients.Methods Clinical data of malignant tumor patients treated in a tertiary Grade A hospital from January 1,2020 to December 31,2022 were collected.Propensity score matching(PSM)and marginal analysis were used to estimate the economic burden of NIs in malignant tumor patients.Results Among 21484 malignant tumors patients,205 patients developed NIs and the infection rate was 0.95%.PSM indicated that the total medical expense was 7115755 Yuan RMB for malignant tumor patients with NIs from 2020 to 2021,among which the incremental medical expense due to NIs was 5473910 Yuan RMB,accounting for 76.93%of the total expenses.The increment in medical expenses was mainly due to the cost of laboratory diagnosis,antibacterial drugs,imaging fee and surgical treatment.NIs extended the length of hospital stay for 20.0 days per malignant tumor patient,and the indirect economic burden was 7600 Yuan RMB.The economic loss of hospital stay due to NIs was 229760 Yuan RMB(M%=5%)in the 3-year period.The ratio of hospital profit loss due to NIs was about 3.52.Conclusions NIs in malignant tumor patients will extend the length of hospital stay,increase hospital expenses and affect the improvement of medical care quality which will cause heavy economic burden to patients,families and hospitals.Controlling the cost of antimicrobial drugs,laboratory diagnosis,imaging diagnosis and surgical treatment will be a key to reducing the total hospitalization cost of malignant tumor patients with NIs.