摘要
目的 了解我国类风湿关节炎（RA）患者的门诊药费情况,分析药费的影响因素和不同人群药费的差别.方法 面对面调查646例RA患者的回顾性用药情况,同时记录患者的一般资料、临床特点及关节功能状态评分.将其中病程1年以上并且药费资料完整的435例纳入分析,根据用药情况估计过去1年的药费,分析了药费与人口学特征、临床特点的关系,并评估不同药物的性价比.结果 ①RA患者过去1年内的人均门诊药费为人民币（8018±17 238）元,其中改善病情药的费用人均（1610±2138）元,占总药费的20%;生物制剂人均（3975±17 071）元,占总药费的49%;非甾体抗炎药的人均费用为（353±829）元,占总药费的4%;植物药人均费用为（1769±3528）元,占总药费的22%;人均激素费用为（48±160）元,外用药（74±386）元,各占药费的1%.②门诊药费相关因素分析显示,伴有关节外表现（OR：2.180,95%CI：1.335～3.558,P=0.002）、患者功能状态差（OR：1.373,95%CI：1.012～1.863,P=0.04.1）为导致药费增高的相关因素.③不同人群的药费分析提示大学以上学历、脑力劳动、月收入〉3000元、享受公费医疗的人群的改善病情抗风湿药（DMARDs）的费用高,门诊患者及功能状态好的患者的DMARDs的费用高.④不同药物的性价比分析显示DMARDs药物的性价比更高.结论 RA患者每年药费高,其中生物制剂、改善病情药及植物药占药费的主要部分,伴有关节外表现和患者功能状态差是高药费的相关因素.人群的学历、收入、付费方式均影响各项药费的分布.DMARDs药物的性价比更高.
Objective To describe the distribution of medication costs of rheumatoid arthritis patients, and to analyze the factors that may affect the costs. Methods Data were obtained from a 12-month retrospective investigation of patients with rheumatoid arthritis （RA） across China. Department of Rheuma-tology of 18 hospitals were randomly selected. The data about their social conditions, clinical conditions, medications associated with RA such as disease-modifying antirheumatic drugs （DMARDs）, non -steroidal anti -inflammtory drugs （NSAIDs）, steroids, biologic agents were collected, and the costs of drugs were calculated. A non-parameter test and multivariate logistic regression analysis were performed. Results Six hundred and forty six patients were enrolled into the study, 435 completed data were chosen for analysis. The results demonstrated that the average costs per patient for medications in the past year was 8018 . The total medication costs were further subdivided into the following parts： DMARDs, （represented 20% of the total costs）, biologic drugs （49%）, NSAIDs （4%）, herbal drugs （22%）, steroids （1%）. Data analysis showed that patients with higher education and higher incomes, with medical insurance,better health function status and outpatients paid more on DMARDs. Extra-articular manifestations increased the odds of the high-cost group （OR： 2.180, 95%CI： 1.335～3.558, P=0.002）, while poor health function status increased the probability of paying high costs （OR： 1.373, 95%CI： 1.012～1.863, P=0.041）. Conclusion High medication costs in RA do exist in RA patients. The costs of medication is associated with health function status and the presence of extra-articular manifestations.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2010年第6期368-372,共5页
Chinese Journal of Rheumatology
基金
国家自然科学基金（30972710）
首都医学发展科研基金（2007-2009）
