摘要
目的 明确深圳市乙型肝炎（乙肝）相关疾病的直接费用、间接费用和无形费用及探讨其影响因素.方法 采用时间阶段连续病例整群抽样方法,对符合条件的乙肝患者进行问卷调查 待患者出院后,收集住院费用及其相关信息.总费用包括直接、间接和无形费用.采用多元线性回归分析,对各种费用的影响因素进行探讨.结果 ＊乙肝所致相关疾病患者年均总费用为81 590.23元,其中直接、间接和无形费用分别为30 914.79元（37.9%）、15 258.01元（18.7%）和35 417.43元（占43.4%）.原发性肝癌的总费用最高,为194 858.40元,其次为重型乙肝144 549.20元、失代偿期肝硬化120 333.60元、代偿期肝硬化79 528.81元、慢性乙肝66 282.46元、急性乙肝为39 286.81元.直接与间接费用之比为2.0∶1,其中原发性肝癌为0.7∶1、慢性乙肝2.2∶1、肝硬化2.5∶1、重型乙肝2.8∶1和急性乙肝3.3∶1 直接医疗费用大于直接非医疗费用（16∶1）.乙肝相关疾病每例年均总费用占患者年均收入的比例为285.3%,占家庭年均收入的比例为75.4% 其中直接费用占患者和家庭年收入的比例分别为108.1%和28.6%.各类乙肝相关疾病患者间接费用合计为8123.38元,陪护间接费用为7134.63元,相应的误工天数分别为55.74 d和19.83 d.多元线性回归分析表明,年龄是各种费用的影响因素.结论 乙肝相关疾病患者和家庭承受着沉重的经济负担,随病情加重费用趋于增高 直接费用大于间接费用,直接医疗费用大于直接非医疗费用,患者误工费大于陪护误工费.
Objective To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Methods Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected fiom eligible hepatitis B-related patients. By pre-trained professional investigators,health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital.Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden.Results On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan （account for 37.9% ）, 15 258.01 Yuan （18.7% ）, 35 417.43 Yuan （43.4%）, respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis,compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0∶1, increased from hepato-eellular carcinoma （0.7∶1）to compensated cirrhosis （3.5∶ 1 ）, followed by acute hepatitis B （3.3∶1 ）, severe hepatitis B （2.8∶1 ）, decompensate cirrhosis （2.3：1）and chronic hepatitis B（2.2∶1 ）.Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16∶1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows：complicated with other diseases, antiviral medication, monthly household income and selfmedications. Conclusion The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones.Indirect costs based on patients were larger than the ones of caregivers.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2010年第12期1340-1345,共6页
Chinese Journal of Epidemiology
基金
基金项目：“十一五”国家科技重大专项（2008ZX10002-001）
