Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China.
BMC Med Inform Decis Mak. 2021 Jul 30;21(Suppl 2):71. doi: 10.1186/s12911-021-01429-6.
Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the medical costs associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the problem, we investigated the trend of direct medical costs and associated factors in patients with chronic HBV infection.
A retrospective cohort study of 65,175 outpatients and 12,649 inpatients was conducted using a hospital information system database for the period from 2008 to 2015. Generalized estimating equations (GEE) were applied to explore associations between annual direct medical costs and corresponding factors, meanwhile quantile regression models were used to evaluate the effect of treatment modes on different quantiles of annual direct medical costs stratified by medical insurances.
The direct medical costs increased with time, but the proportion of antiviral costs decreased with CHB progression. Antiviral costs accounted 54.61% of total direct medical costs for outpatients, but only 6.17% for inpatients. Non-antiviral medicine costs (46.06%) and lab tests costs (23.63%) accounted for the majority of the cost for inpatients. The direct medical costs were positively associated with CHB progression and hospitalization days in inpatients. The direct medical costs were the highest in outpatients with medical insurance and in inpatients with free medical service, and treatment modes had different effects on the direct medical costs in patients with and without medical insurance.
CHB patients had a heavy economic burden in Guangzhou, China, which increased over time, which were influenced by payment mode and treatment mode.
虽然中国现行医疗保险计划下的重大疾病基金涵盖了肝硬化的费用，但乙型肝炎病毒（HBV）相关疾病的医疗费用尚未得到妥善解决。为了提供解决该问题的证据，我们调查了慢性 HBV 感染患者的直接医疗费用趋势及其相关因素。
利用医院信息系统数据库，对 2008 年至 2015 年期间的 65175 名门诊患者和 12649 名住院患者进行回顾性队列研究。采用广义估计方程（GEE）探索年度直接医疗费用与相应因素之间的关系，同时采用分位数回归模型评估治疗模式对不同医疗保险分层下年度直接医疗费用分位数的影响。
直接医疗费用随时间增加，但抗病毒治疗费用占比随 CHB 进展而降低。抗病毒治疗费用占门诊患者总直接医疗费用的 54.61%，但仅占住院患者的 6.17%。非抗病毒药物费用（46.06%）和实验室检查费用（23.63%）占住院患者费用的大部分。直接医疗费用与 CHB 进展和住院天数呈正相关。有医疗保险的门诊患者和享受免费医疗服务的住院患者的直接医疗费用最高，且治疗模式对有和无医疗保险患者的直接医疗费用有不同的影响。
中国广州的 CHB 患者经济负担沉重，且随时间推移而增加，这种负担受支付方式和治疗模式的影响。
