摘要
目的了解肺结核患者疾病经济负担及影响因素，为制定结核病控制策略、提高患者治疗依从性和治疗成功率提供依据。方法以江苏省张家港市为研究现场，采用整群抽样法抽取23个样本村，以2010年1月至2013年3月期间登记报告且已完成规定抗结核疗程的340例肺结核患者为研究对象，采用自行设计的问卷，调查患者的诊治经过和相关费用，描述疾病经济负担并分析影响因素。最终有274例患者参与调查，应答率80．6％（274／340），问卷有效率100．o％。患者因病产生的经济负担包括直接费用和间接费用两部分。直接费用包括患者因病支出的医疗费（门诊费、住院费）、患者及其陪同家属支付的食宿交通费等。间接费用指患者及其家属因本次结核病造成的误工损失费。考虑费用一般呈非正态分布，故采用均数结合中位数（P25，P75）表示费用大小。组间费用比较采两样本秩和检验（Mann-Whitney U）。结果患者人均年收入19159．9元，年收入中位数（P25，P75）15000元（4530，27500）元。因病平均支出费用18793．3元，中位数（P25，P75）9965元（3200，24400元）。人均直接费用11936．9元，中位数（P25，P75）4590元（2024，14600）元，除去医疗保险支付部分，人均自付7448．0元，中位数（P25，P75）3315元（1200，8570）元。人均间接费用6856．4元，中位数（P25，P75）1575元（0，9000）元。影响患者疾病经济负担的因素包括住院治疗（未住院治疗者平均8512．9元，中位数3800元，有住院经历者平均24381．4元，中位数15500元，Z=-8．119，P〈o．001）；服用保肝药（未服用保肝药者平均9911．8元，中位数5900元，使用保肝药者平均17075．9元，中位数8150元，Z=-2．645，P=0．008）；使用二线抗结核药（未使用二线药者平均13294．5元，中位数6785元。使用二线药者平均18065．3元，中位数10325元，Z=—2．029，P=0．043）；诊断延误时间长（首诊至确诊小于14d者平均12656．5元，中位数6110元，大于14d者平均17457．7元，中位数11065元，z=-2．970，P=0．003）。结论张家港市结核病患者的疾病经济负担较重，患者负担的费用高低与住院治疗、使用保肝药和二线药物、诊断延误等有关。
Objective To explore the economic burden of patients with pulmonary tuberculosis and risk factors, in order to provide evidences for development of tuberculosis control strategies and improving patients＇ treatment adherence and treatment success rate. Methods We chose Zhangjiagang, a relatively rich county in Jiangsu province, as the study area. Twenty three villages were selected as the study sites based on a cluster sampling method. Three hundred and forty patients who were diagnosed as pulmonary tuberculosis during January 2010 and March 2013 and had already completed the standard anti-tuberculosis treatment before March 31, 2013 were invited for the investigation. We used a self-designed questionnaire to collect data on patient＇s healthcare seeking experience and costs of illness. Patient＇s economic burden due to the disease was analyzed and the influencing factors were explored. Eventually 274 patients accepted the investigation with the response rate of 80.6% and the questionnaire efficiency rate of 100. 0%. The economic burden included two parts： direct costs and indirect costs. Direct costs in cluded medical costs related to tuberculosis diagnosis and treatment （clinical and hospitalization expenses）, transpor tation costs, accommodation costs and food costs. Indirect costs were calculated as loss of income due to inability to work following tuberculosis diagnosis and treatment. Considering the dislribution of data, we used the mean together with the median （P25,P75） to describe the costs. We used the rank sum test （Mann Whitney U） to compare the costs between groups. Results The average annual income of patients was 19 159.9 yuan and the median income was 15 000 yuan. The average total cost was 18 793.3 yuan and the median （P25,P75） cost was 9965 （3200 24 400） yuan. Per capita direct cost was 11 936.9 （median： 4590） yuan. After excluding costs covered by health insurance, the per capita out o^pocket cost was 7448.0 yuan, with the median of 3315 yuan. The per capita indirect cost was 6856.4 （median： 1575） yuan. Factors associated with the economic burden included hospitalization （the average （median） out-of-pocket cost was 8512.9 （3800） yuan for patients without hospitalization history, and 24 381.4 （15 500） yuan for patients with hospitalization history, respectively. Z=-8. 119, P〈0. 001）; taking li ver protective drugs （the average （median） out-of-pocket cost was 9911.8 （5900） yuan for patients not taking liver protective drugs, and 17 075.9 （8150） yuan for patients taking liver protective drugs, respectively. Z=--2. 645, P=0. 008）; using the second-line anti-tuberculosis drugs （the average （median） out-of-pocket cost was 13 294.5 （6785） yuan for patients not taking second line drugs, and 18 065.3 （10 325） yuan for patients taking second line drugs, respectively. Z=-2. 327, P=0. 020）; and diagnosis delay （the average （median） out of-pocket cost was 12 656.5 （6110） yuan for patients with the diagnosis delay less than 14 days, and 17 457.7 （11 065） yuan for pa tients with the diagnosis delay over 14 days, Z=-2. 970, P=0. 003） etc. Conclusion The economic burden of patients with tuberculosis in Zhangjiagang was relatively high. The costs were related to hospitalization, taking liver protective drugs and the second-line anti-tuberculosis drugs, and diagnosis delay, etc.
出处
《中国防痨杂志》
CAS
2014年第2期98-103,共6页
Chinese Journal of Antituberculosis
基金
国家自然科学基金（81072351）
江苏省科技支撑计划（BE2011841）
苏州市科技计划（SYSD2011001）
关键词
结核
N
经济学
患病代价
费用
医疗
张家港市
Tuberculosis, pulmonary
economics
Cost of illness
Fees, medical
Zhangjiagang city
