Zhang Jing Hua, Yuan Juan, Wang Tao
School of Business, Macau University of Science and Technology, Taipa, Macau, China.
Zhongshan Center for Disease Control and Prevention, Zhongshan, China.
PLoS Negl Trop Dis. 2017 Aug 3;11(8):e0005784. doi: 10.1371/journal.pntd.0005784. eCollection 2017 Aug.
Zhongshan City of Guangdong Province (China) is a key provincial and national level area for dengue fever prevention and control. The aim of this study is to analyze how the direct hospitalization costs and the length of stay of dengue hospitalization cases vary according to associated factors such as the demographics, virus types and hospital accreditation.
This study is based on retrospective census data from the Chinese National Disease Surveillance Reporting System. Totally, the hospital administrative data of 1432 confirmed dengue inpatients during 2013-2014 was obtained. A quantile regression model was applied to analyze how the direct cost of Dengue hospitalization varies with the patient demographics and hospital accreditation across the data distribution. The Length of Stay (LOS) was also examined.
The average direct hospitalization cost of a dengue case in this study is US$ 499.64 during 2013, which corresponded to about 3.71% of the gross domestic product per capita in Zhongshan that year. The mean of the Length of Stay (LOS) is 7.2 days. The multivariate quantile regression results suggest that, after controlling potential compounding variables, the median hospitalization costs of male dengue patients were significantly higher than female ones by about US$ 18.23 (p<0.1). The hospitalization cost difference between the pediatric and the adult patients is estimated to be about US$ 75.25 at the median (p<0.01), but it increases sharply among the top 25 percentiles and reaches US$ 329 at the 90th percentile (p<0.01). The difference between the senior (older than 64 years old) and the adult patients increases steadily across percentiles, especially sharply among the top quartiles too. The LOS of the city-level hospitals is significantly shorter than that in the township-level hospitals by one day at the median (p<0.05), but no significant differences in their hospitalization costs.
The direct hospitalization costs of dengue cases vary widely according to the associated demographics factors, virus types and hospital accreditations. The findings in this study provide information for adopting hospitalization strategy, cost containment and patient allocation in dengue prevention and control. Also the results can be used as the cost-effective reference for future dengue vaccine adoption strategy in China.
中国广东省中山市是省级和国家级登革热防控重点地区。本研究旨在分析登革热住院病例的直接住院费用和住院时长如何因人口统计学特征、病毒类型和医院评级等相关因素而有所不同。
本研究基于中国国家疾病监测报告系统的回顾性普查数据。共获取了2013 - 2014年期间1432例确诊登革热住院患者的医院管理数据。应用分位数回归模型分析登革热住院的直接费用如何随患者人口统计学特征和医院评级在数据分布中变化。同时也对住院时长进行了研究。
本研究中登革热病例的平均直接住院费用在2013年为499.64美元，约占当年中山市人均国内生产总值的3.71%。住院时长的均值为7.2天。多变量分位数回归结果表明，在控制潜在复合变量后，男性登革热患者的住院费用中位数比女性患者显著高出约18.23美元（p<0.1）。儿童患者和成年患者之间的住院费用差异在中位数时估计约为75.25美元（p<0.01），但在第75百分位数时急剧增加，在第90百分位数时达到329美元（p<0.01）。老年患者（64岁以上）和成年患者之间的差异在各百分位数上稳步增加，尤其是在四分位数顶端也急剧增加。市级医院的住院时长中位数比乡镇级医院显著短一天（p<0.05），但它们的住院费用没有显著差异。
登革热病例的直接住院费用因相关人口统计学因素、病毒类型和医院评级而有很大差异。本研究结果为登革热防控中的住院策略制定、成本控制和患者分配提供了信息。这些结果也可作为中国未来登革热疫苗采用策略的成本效益参考。
