Zhou Hai-Yang, Liu Shuang, Zheng Su-Jun, Peng Xiao-Xia, Chen Yu, Duan Carol, Zheng Qing-Fen, Wang Zhao, Duan Zhong-Ping
1Wu Jieping Medical Foundation, Beijing, China.
2Beijing Youan Hospital, Capital Medical University, Beijing, China.
Hepatol Med Policy. 2016 Apr 28;1:7. doi: 10.1186/s41124-016-0008-6. eCollection 2016.
Hepatitis C virus (HCV) imposes a considerable disease burden in China, with at least 10 million people chronically infected. Little is known about the financial impact of the HCV epidemic, nor about the extent to which various forms of insurance are providing HCV patients with financial protection. A cross-sectional multi-site study was conducted to acquire data that will aid policy-makers and other stakeholders in developing effective strategies to address this situation.
At 29 hospitals across China, inpatients and outpatients with chronic HCV were surveyed about their insurance coverage and medical costs. Percentages, means and medians were calculated, and differences in continuous variables among multiple groups were analyzed using the Kruskal-Wallis test or Wilcoxon two-sample test.
Many inpatients ( = 593) and outpatients ( = 523) reported being covered by one of three major types of government health insurance, but 13 % of inpatients and 43 % of outpatients reported having no insurance. Among inpatients, the total median cost per hospitalization per patient was 8212 Renminbi (RMB). The category of expenditure with the highest median cost per hospitalization was Western medicine, followed by lab tests and Chinese medicine. The median cost per hospitalization was far higher for patients who had hepatocellular carcinoma than for those with less severe forms of liver disease. Outpatient antiviral therapy costs ranged from a median of 377 RMB for ribavirin to a median of 37,400 RMB for pegylated interferon-alpha for up to one year of treatment.
For uninsured chronic HCV patients in China, inpatient and outpatient costs may be financially devastating. Research is needed on how different approaches to financing HCV treatment and care might improve health outcomes as well as achieve cost savings by enabling more people to be cured of HCV.
丙型肝炎病毒（HCV）在中国造成了相当大的疾病负担，至少有1000万人慢性感染。关于HCV流行的经济影响以及各种保险形式为HCV患者提供经济保护的程度，人们知之甚少。开展了一项横断面多地点研究，以获取有助于政策制定者和其他利益相关者制定有效策略来应对这种情况的数据。
在中国的29家医院，对慢性HCV住院患者和门诊患者进行了保险覆盖情况和医疗费用调查。计算了百分比、均值和中位数，并使用Kruskal-Wallis检验或Wilcoxon双样本检验分析了多组连续变量之间的差异。
许多住院患者（n = 593）和门诊患者（n = 523）报告参加了三种主要类型的政府医疗保险之一，但13%的住院患者和43%的门诊患者报告没有保险。住院患者中，每位患者每次住院的总费用中位数为8212元人民币。每次住院费用中位数最高的支出类别是西药，其次是实验室检查和中药。肝细胞癌患者的每次住院费用中位数远高于肝病较轻形式的患者。门诊抗病毒治疗费用从利巴韦林的中位数377元到聚乙二醇化干扰素-α长达一年治疗的中位数37400元不等。
对于中国未参保的慢性HCV患者，住院和门诊费用可能在经济上造成毁灭性影响。需要研究不同的HCV治疗和护理融资方式如何改善健康结果，并通过使更多人治愈HCV来实现成本节约。
