中国循证医学杂志

中国循证医学杂志

中国肝癌患者 2002~2011 年日均医疗费用趋势分析:多中心回顾性调查

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目的 分析 2002~2011 年中国肝癌住院患者日均医疗费用情况及变化趋势。 方法 基于国家重大公共卫生服务专项项目“城市癌症早诊早治项目”收集全国 12 个省份的多中心回顾性调查数据,分析 2002~2011 年我国肝癌患者日均医疗诊治花费及影响因素。 结果 共纳入 11 045 例肝癌患者,平均年龄 55 岁,平均住院日 16.76 天。肝癌 10 年的平均日均诊治费用为 1 251 元[95%CI(1 236,1 266)],且在不同地区(东部:1 356 元;中部:1 209 元;西部:1 068 元)、不同医院类型(综合医院:1 341 元,专科医院:1 213 元)和不同医院等级(三甲医院:1 293 元,非三甲医院:805 元)间差异均存在统计学意义(P<0.05)。对不同分期肝癌患者而言,Ⅰ期患者日均费用为 1 253 元,Ⅱ期为 1 169 元,Ⅲ期为 1 167 元,Ⅳ期为 1 092 元(P<0.05)。10 年趋势分析显示,2002~2011 年间的肝癌日均费用由 1 079 元[95%CI(1 021,1 136)]增长至 1 549 元[95%CI(1 486,1 613)],平均增长速度为 3.69%,增长速度从 2007 年起尤为明显。不同亚组分析提示,不同地区和医院级别的增长模式有较明显区别,不同治疗方案导致的增长趋势可能存在差别。 结论 我国肝癌日均诊治费用逐年增长,且存在地区和医院级别差异,结合次均住院日变化数据可为我国肝癌防治方案或策略的经济性评价提供参考数据。

Objective To analyze the average daily medical expenditure for primary liver cancer in China from 2002 to 2011. Methods This study was a retrospective survey from multiple centers from 12 province and cities in China during 2002 to 2011, based on the continuous data from Cancer Screening Program in Urban China Project. The average daily medical expenditure of primary liver cancer patients and influencing factors were analyzed. Results A total of 11 045 liver cancer patients from 12 provinces and cities were included in this study, with average age as 55 years and the average length of hospitalizaion as 16.76 days. The average daily medical expenditure of liver cancer patients during the 10 years was 1 251 yuan (95%CI 1 236 to 1 266). The average daily medical expenditure was significantly different in regions (1356 yuan in the east region, 1 209 yuan in the middle region and 1 068 yuan in the west region), type of hospital (1 341 yuan in general hospitals, 1 213 yuan in specialized hospitals) and hospital level (1 293 yuan in 3A grade hospital, 805 yuan in non-3A grade hospital) (P<0.05). The average daily medical expenditures were 1 253 yuan for stage Ⅰ, 1 169 yuan for stage Ⅱ, 1 167 yuan for stageⅢ and 1 092 yuan for stage Ⅳ (P<0.05). During 2002 to 2011, the average daily medical expenditure of hospitalization increased from 1 079 yuan (95%CI 1 021 to 1 136) to 1 549 yuan (95%CI 1 486 to 1 613), with an average growth rate of 3.69%. Since 2007, a continuous growth was observed. Subgroup analyzes suggest that there are obvious differences in growth patterns between different regions and hospitals, and there exists difference of treads between various treatments. Conclusion The average daily medical expenditure of liver cancer in China was increasing from 2002 to 2011 and there were significant differences between various regions and hospital levels. Combined with the change of length of hospitalization, it can provide evident data for the economic evaluation of our country's prevention and treatment policies for liver cancer.

关键词: 原发性肝癌; 经济负担; 日均医疗费用; 回顾性调查

Key words: Primary liver cancer; Economic burden; Average daily medical expenditure; Retrospective survey

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