School of Management, Beijing University of Chinese Medicine, Beijing, China.
Australian National Institute of Management and Commerce, Eveleigh Sydney, NSW, Australia.
BMC Health Serv Res. 2022 Feb 19;22(1):230. doi: 10.1186/s12913-022-07626-x.
Hemophilia care in mainland China has been greatly improved since the establishment of the Hemophilia Treatment Center Collaborative Network of China (HTCCNC), and most of drugs for hemophilia have been covered by basic medical insurance schemes. This study assesses whether medical costs and hospital utilization disparities exist between hemophilia A and hemophilia B urban inpatients in China and, second, whether the prescription of coagulation factor concentrates for hemophilia A and hemophilia B inpatients was optimal, from the third payer perspective.
We conducted a retrospective nationwide analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) schemes from 2010 to 2016. Univariate analysis and multiple regression analysis based on a generalized linear model were conducted.
A total of 487 urban inpatients who had hemophilia were identified, including 407 inpatients with hemophilia A and 80 inpatients with hemophilia B. Total medical cost for hemophilia B inpatients was significantly higher than for hemophilia A inpatients (USD 2912.81 versus USD 1225.60, P < 0.05), and hemophilia B inpatients had a significantly longer length of hospital stay than hemophilia A inpatients (9.00 versus 7.00, P < 0.05). Total medical costs were mostly allocated to coagulation factor products (76.86-86.68%), with coagulation factor cost of hemophilia B significantly higher than hemophilia A (P < 0.05). Both hemophilia cohorts utilized greatest amount of plasma-derived Factor VIII, followed by recombinant Factor VIII and prothrombin complex concentrates.
Patients with hemophilia B experienced significantly higher inpatient cost, coagulation factor cost and longer length of hospital stay than patients with hemophilia A. Our findings revealed the suboptimal use of coagulation factor concentrate drugs and a higher drug cost burden incurred by hemophilia B than hemophilia A inpatients. Our results call for efforts to strengthen drug regulatory management for hemophilia and to optimize medical insurance schemes according to hemophilia types.
自中国血友病治疗中心协作网（HTCCNC）成立以来，中国大陆的血友病治疗水平得到了极大提高，大多数血友病药物已被纳入基本医疗保险计划。本研究从第三方支付者的角度评估了中国城市血友病 A 和血友病 B 住院患者的医疗费用和医院利用差异，其次评估了血友病 A 和血友病 B 住院患者凝血因子浓缩物的处方是否合理。
我们基于中国城镇职工基本医疗保险（UEBMI）和城镇居民基本医疗保险（URBMI）计划的索赔数据，进行了一项回顾性全国性分析，使用了 5%的随机样本。采用单变量分析和基于广义线性模型的多元回归分析。
共确定了 487 名患有血友病的城市住院患者，其中 407 名血友病 A 患者和 80 名血友病 B 患者。血友病 B 患者的总医疗费用明显高于血友病 A 患者（2912.81 美元 vs. 1225.60 美元，P < 0.05），血友病 B 患者的住院时间明显长于血友病 A 患者（9.00 天 vs. 7.00 天，P < 0.05）。总医疗费用主要分配给凝血因子产品（76.86%-86.68%），血友病 B 的凝血因子费用明显高于血友病 A（P < 0.05）。两个血友病队列均使用了最多的血浆源性凝血因子 VIII，其次是重组凝血因子 VIII 和凝血酶原复合物浓缩物。
血友病 B 患者的住院费用、凝血因子费用和住院时间均明显高于血友病 A 患者。我们的研究结果表明，凝血因子浓缩物药物的使用不合理，血友病 B 患者的药物费用负担高于血友病 A 患者。我们的研究结果呼吁加强血友病药物监管管理，并根据血友病类型优化医疗保险计划。
