摘要
目的研究2008-2012年广州市慢性乙型肝炎(chronic hepatitis B,CHB)住院患者的治疗模式的变化趋势及各模式药费的构成,为制定医保政策提供参考。方法从2008-2012年广州市第八人民医院信息系统中筛选出诊断为CHB的住院患者,采用自组织特征映射神经网络(self-organizing feature map,SOM)对其治疗方案进行聚类,比较不同治疗模式患者的住院费用、药费及费用构成。结果 CHB患者(n=5543)的治疗模式分为3类:保肝为主(hepatoprotective-based,HP-based)治疗模式(36.48%)、干扰素结合保肝(interferon-hepatoprotective,IFN-HP)治疗模式(29.33%)和核苷酸类似物结合保肝(nucleostide analogues-hepatoprotective,NAs-HP)治疗模式(34.19%)。NAs-HP患者比例有升高趋势(从2008年的8.21%增至2012年的34.19%);IFN-HP与NAs-HP患者的住院费用、药费均高于HP-based,但NAs-HP患者的药费主要源自保肝药费(41.64%~57.70%)和其他药费(19.11%~47.39%),NAs费用只占15%左右。结论尽管NAs-HP患者比例逐年升高,但仍处于较低水平;NAs费用并非该类患者药费的主要来源,提示医保部门应采取有效措施提高CHB患者NAs的使用率。
Objective We explored the treatment pattems of inpatients with chronic hepatitis B （CHB） and the composition of drug costs in Guangzhou from 2008 to 2012, providing evidences for reimbursement policy. Methods Clinical and claims data of 5543 inpatients with CHB were retrieved and analyzed from Guangzhou eighth people＇s Hospital between 2008 and 2012. Self-organizing feature map（SOM） was used to cluster the treatment patterns of inpatients with CHB. Total drug cost and its＇ costs components were compared among inpatients with different treatment patterns. Results The treatment patterns of inpatients with CHB were classified into hepatoprotective-based （HP-based）, interferon combined with hepatoprotective （IFN-HP） and nucleos （t）ide analogues combined with hepatoprotective （NAs-HP）. Although the utilization proportion of NAs-HP has increased from 8. 21% in 2008 to 34. 19% in 2012, the inpatients with HP-based still accounted for the large proportion （from 54. 06% in 2008 to 36.48% in 2012） of the inpatients. Total hospitalization costs and drug costs were higher for inpatients with antiviral treatment（ IFN-HP and NAs-HP） than those with HP-based. However, the most of total drug costs was explained by the costs of hepatoprotective drugs （41.64% - 57.7% in 2008 - 2012） and other drugs （ 19. 11% - 47.39% in 2008 - 2012）, while the NAs drugs costs made up a relatively low proportion of about 15% for inpatients with NAs-HP. Conclusion The proportion of the treatment pattern of NAs-HP has increased from 2008 to 2012 ,but remaining at a low level. NAs drug costs were not the main components of total drug costs for inpatients with antiviral treatment. The reimbursement policy should be formulated to improve the utilization of NAs among inpatients with CHB.
出处
《中国卫生统计》
CSCD
北大核心
2018年第1期7-10,共4页
Chinese Journal of Health Statistics
基金
国家自然科学基金资助(71573059)
广东省科技厅社会发展领域科技计划项目(2014A020212302)
关键词
神经网络聚类
慢性乙型肝炎
治疗模式
费用构成
Neural Network clustering
Chronic hepatitis B
Treatment pattern
Cost components
