Main C L, Ying E, Wang E E
Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario.
Can J Infect Dis. 1998 Nov;9(6):354-8. doi: 10.1155/1998/507497.
Tuberculosis (TB) is a major infection with nearly eight million cases annually worldwide. Although the majority of these cases are in the developing world, TB is also a problem in Canada.
To determine the cost of diagnosis and management of paediatric TB in Canada.
Cross-sectional study.
In-patients and out-patients at The Hospital for Sick Children, Toronto, a tertiary care centre.
Patients were included if they had clinical or radiological evidence of TB infection with a positive tuberculin skin test or a positive culture result, and were treated from July 1, 1995, to June 30, 1996. Twenty-two patients met the criteria for inclusion in the study.
Patient characteristics, types of disease, types and numbers of investigations, number of in-patient days and out-patient appointments, course of TB treatment, TB-related complications and antimicrobial resistance were obtained from charts. Costs were derived from allocated hospital costs, Ontario Health Insurance Plan billings and costs provided by the Pharmacy Department at The Hospital for Sick Children.
The total cost for one year of management of paediatric TB in a tertiary care centre was $211,576. Pulmonary TB affected one-half of the study patients but accounted for one-quarter of the cost. One case of meningitis resulted in almost the same costs as all cases of pulmonary TB. Hospitalization was the largest contributor to overall cost, accounting for three-quarters of the total. The remaining costs in order of their contribution to overall costs were antimicrobial treatment, out-patient appointments, diagnostic imaging and TB cultures.
From a hospital's perspective, the costs of managing each of the 22 patients was approximately $10,000. However, there was great variability between patients, with much greater costs for those who required hospitalization or numerous investigations because TB was not suspected. To the authors' knowledge, this is the first time that such a cost analysis has been performed for a paediatric population. A cost analysis provides a better measure of the burden of illness than is indicated by the absolute number of patients.
结核病是一种主要的传染病，全球每年有近800万例病例。尽管这些病例大多数发生在发展中世界，但结核病在加拿大也是一个问题。
确定加拿大儿童结核病诊断和管理的成本。
横断面研究。
多伦多病童医院的住院和门诊患者，这是一家三级医疗中心。
如果患者有结核病感染的临床或放射学证据，结核菌素皮肤试验呈阳性或培养结果呈阳性，并在1995年7月1日至1996年6月30日期间接受治疗，则纳入研究。22名患者符合纳入研究的标准。
从病历中获取患者特征、疾病类型、检查类型和数量、住院天数和门诊预约次数、结核病治疗过程、结核病相关并发症和抗菌药物耐药性。成本来自分配的医院成本、安大略省医疗保险计划账单以及多伦多病童医院药房提供的成本。
在一家三级医疗中心，儿童结核病一年管理的总成本为211,576美元。肺结核影响了一半的研究患者，但占成本的四分之一。1例脑膜炎病例的成本几乎与所有肺结核病例的成本相同。住院是总成本的最大贡献者，占总成本的四分之三。其余成本按对总成本的贡献顺序依次为抗菌治疗、门诊预约、诊断成像和结核培养。
从医院的角度来看，管理这22名患者中的每一位的成本约为10,000美元。然而，患者之间存在很大差异，对于那些因未怀疑结核病而需要住院或进行大量检查的患者，成本要高得多。据作者所知，这是首次对儿童人群进行此类成本分析。成本分析比患者绝对数量更能衡量疾病负担。
