Nguyen Thi-Phuong-Lan, Nguyen Thi Bach Yen, Nguyen Thanh Trung, Vinh Hac Van, Le Hoa H, Schuiling-Veninga Ccm, Postma Maarten J
BMC Health Serv Res. 2014 Oct 28;14:514. doi: 10.1186/s12913-014-0514-4.
There is an economic burden associated with hypertension both worldwide and in Vietnam. In Vietnam, patients with uncontrolled high blood pressure are hospitalized for further diagnosis and initiation of treatment. Because there is no evidence on costs of inpatient care for hypertensive patients available yet to inform policy makers, health insurance and hospitals, this study aims to quantify direct costs of inpatient care for these patients in Vietnam.
A retrospective study was conducted in a hospital in Vietnam. Direct costs were analyzed from the health-care provider's perspective. Hospital-based costing was performed using both bottom-up and micro-costing methods. Patients with sole essential or primary hypertension (ICD-code I10) and those comorbid with sphingolipid metabolism or other lipid storage disorders (ICD-code E75) were selected. Costs were quantified based on financial and other records of the hospital. Total cost per patient resulted from an aggregation of laboratory test costs, drug costs, inpatient-days' costs and other remaining costs, including appropriate allocation of overheads. Both mean and medians, as well as interquartile ranges (IQRs) were calculated. In addition to a base-case analysis, specific scenarios were analyzed.
230 patients were included in the study (147 cases with I10 code only and 83 cases with I10 combined with E75). Median length of hospital stay was 6 days. Median total direct costs per patient were US$65 (IQR: 37 -95). Total costs per patient were higher in the combined hypertensive and lipid population than in the sole hypertensive population at US$78 and US$53, respectively. In all scenarios, hospital inpatient days' costs were identified as the major cost driver in the total costs.
Costs of hospitalization of hypertensive patients is relatively high compared to annual medication treatment at a community health station for hypertension as well as to the total health expenditure per capita in Vietnam. Given that untreated/undetected hypertension likely leads to more expensive treatments of complications, these findings may justify investments by the Vietnamese health-care sector to control high blood pressure in order to save downstream health care budgets.
高血压在全球及越南均带来经济负担。在越南，血压控制不佳的患者会住院以进行进一步诊断和开始治疗。由于尚无关于高血压患者住院护理成本的证据供政策制定者、医疗保险机构和医院参考，本研究旨在量化越南这些患者的住院护理直接成本。
在越南一家医院开展了一项回顾性研究。从医疗服务提供者的角度分析直接成本。采用自下而上和微观成本核算方法进行基于医院的成本核算。选取单纯原发性高血压（国际疾病分类代码I10）患者以及合并鞘脂代谢或其他脂质贮积病（国际疾病分类代码E75）的患者。根据医院的财务和其他记录对成本进行量化。每位患者的总成本由实验室检查成本、药品成本、住院日成本和其他剩余成本汇总得出，包括适当分摊间接费用。计算了均值、中位数以及四分位间距（IQR）。除了基础病例分析外，还分析了特定情景。
230名患者纳入研究（147例仅为I10代码，83例为I10合并E75）。中位住院时间为6天。每位患者的中位总直接成本为65美元（IQR：37 - 95）。高血压合并脂质异常患者群体的每位患者总成本高于单纯高血压患者群体，分别为78美元和53美元。在所有情景中，医院住院日成本被确定为总成本的主要成本驱动因素。
与社区卫生站高血压年度药物治疗以及越南人均卫生总支出相比，高血压患者的住院成本相对较高。鉴于未治疗/未检测到的高血压可能导致并发症的治疗费用更高，这些发现可能证明越南医疗保健部门进行投资以控制高血压从而节省下游医疗保健预算是合理的。
