Gulácsi László, Májer István, Boncz Imre, Brodszky Valentin, Merkely Béla, Maurovich Horvath Pál, Kárpáti Krisztián
Budapesti Corvinus Egyetem, Egészség-gazdaságtani és Technológiaelemzési Kutatóközpont, Közszolgálati Tanszék, Fovám tér 8, 1093 Budapest.
Orv Hetil. 2007 Jul 8;148(27):1259-66. doi: 10.1556/OH.2007.28109.
The morbidity of acute myocardial infarction (AMI) is remarkable in Hungary, therefore understanding the disease burden more accurately is inevitable.
We assessed the hospitalized AMI patient's burden on the financer both in active and chronic hospital care as well as outpatient visits and we estimated the size of indirect social costs.
We assessed the active and chronic hospital care costs of 'new' AMI patients having the event in May 2003. The costs were assessed in the subsequent 12 and 24 months to the event in the population over 25 with the morbidity from the database of the National Health Insurance Fund Administration (NHIFA). Data were collected by gender and age (age groups 25-44, 45-64, 65 and over). Costs of GPs, specialist visits, transportation and productivity losses were taken into account as other costs.
Average health insurance costs of AMI's active hospital care in the first 12 months are generally higher in females as in males; 476.3 thousand HUF vs 391.1 thousand HUF (65 and over), 429.1 thousand HUF vs 389.4 thousand HUF (45-64) and 229.5 thousand HUF vs 240.6 thousand HUF (25-44). The burden in the chronic care is 15-40 thousand HUF per patient in the first year, which is similar to the active care costs in the 13-24th months after the AMI (22-54 thousand HUF).
NHIFA was estimated to spend 4.4 billion HUF on direct health care on behalf of the nearly 12 thousand annual AMI patients in the first 12 months, 3.6 billion HUF on the active and 370 million on the chronic hospital care. Avoiding one AMI could save 345-565 thousand HUF (depending on gender and age) direct health care cost in the first 12 months. In our estimation the annual indirect costs of AMI exceed 840 million HUF (177 829 HUF/patient) in the working age group.
急性心肌梗死(AMI)在匈牙利的发病率很高,因此更准确地了解疾病负担势在必行。
我们评估了住院AMI患者在住院期间及门诊就诊时给医保机构带来的负担,并估算了间接社会成本的规模。
我们评估了2003年5月发病的“新”AMI患者的住院成本。利用国家健康保险基金管理局(NHIFA)数据库中的发病率数据,对25岁以上人群在发病后的12个月和24个月内的成本进行了评估。按性别和年龄(25 - 44岁、45 - 64岁、65岁及以上)收集数据。全科医生诊疗费、专科医生诊疗费、交通费用和生产力损失等成本被视为其他成本。
AMI住院治疗头12个月的平均医保费用,女性总体高于男性;65岁及以上人群中,女性为47.63万福林,男性为39.11万福林;45 - 64岁人群中,女性为42.91万福林,男性为38.94万福林;25 - 44岁人群中,女性为22.95万福林,男性为24.06万福林。第一年每位患者的慢性病护理负担为1.5 - 4万福林,这与AMI发病后第13 - 24个月的住院护理成本(2.2 - 5.4万福林)相似。
据估计,NHIFA每年要为近1.2万名AMI患者在头12个月的直接医疗保健支出44亿福林,其中36亿福林用于住院治疗,3.7亿福林用于慢性病护理。避免一例AMI在头12个月可节省34.5 - 56.5万福林(取决于性别和年龄)的直接医疗保健成本。据我们估计,工作年龄组中AMI的年度间接成本超过8.4亿福林(每位患者177829福林)。