Huang Jun, Yin Hongjun, Zhang Milun, Ni Qian, Xuan Jianwei
a The First Affiliated Hospital of Nanjing Medical University , Nanjing , PR China.
b Centennial Scientific Co. Ltd. , Warren , NJ , USA.
J Med Econ. 2017 May;20(5):549-553. doi: 10.1080/13696998.2017.1297309. Epub 2017 Mar 12.
This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China.
The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined.
A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities.
Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.
本研究有两个目的：（1）调查心力衰竭（HF）患者的医疗资源利用情况；（2）调查中国心力衰竭的治疗成本。
本研究使用的数据来自中国医疗保险研究会（CHIRA）主办的2014年全国保险数据库，该数据库涵盖全国城镇职工和居民。使用国际疾病分类第十版（ICD - 10）编码和表明心力衰竭诊断的关键词来识别心力衰竭患者。研究了不同服务类别的药物使用、医院就诊、再次入院情况以及治疗成本。
本分析共纳入7847例患者，其中1157例患者有1年的完整随访期。总体而言，48.16%的患者接受了血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）与β受体阻滞剂（BB）的联合治疗；22.87%的患者接受了ACEI/ARB、β受体阻滞剂和盐皮质激素受体拮抗剂（MRA）的联合治疗。每位心力衰竭诊断患者的年度治疗成本为28974元人民币，其中66%用于住院治疗。心力衰竭药物费用占年度成本的8.2%。省级直辖市的治疗成本远高于地级及其他城市。
住院是心力衰竭治疗成本的主要驱动因素。与国际治疗指南的要求相比，中国心力衰竭患者中标准护理药物治疗的使用率较低。中国患者的高再入院率表明心力衰竭的管理需要改进。用于治疗心力衰竭患者的国内生产总值（GDP）占比远低于发达国家。
