College of Humanities and Management, Zhejiang University of Chinese Medicine, Hangzhou, 311402, China.
Sci Rep. 2024 Sep 11;14(1):21212. doi: 10.1038/s41598-024-71917-y.
The cost fluctuations associated with chemotherapy, radiotherapy, and immunotherapy, as primary modalities for treating malignant tumors, are closely related to medical decision-making and impose financial burdens on patients. In response to these challenges, China has implemented the Diagnosis-Related Group (DRG) payment system to standardize costs and control expenditures. This study collected hospitalization data from patients with malignant tumors who received chemotherapy, radiotherapy, and immunotherapy at Hospital H from 2018 to 2022. The dataset was segmented into two groups: the intervention group, treated with traditional Chinese medicine (TCM) alongside standard therapies, and the control group, treated with standard therapies alone. Changes and trends in hospitalization costs under the DRG policy were analyzed using propensity-score matching (PSM), standard deviation (SD), interquartile range (IQR), and concentration index (CI). Findings showed a decreasing trend in the standard deviation of hospitalization costs across all treatment modalities. Radiotherapy exhibited the most significant decrease, with costs reducing by 2547.37 CNY in the control group and 7387.35 CNY in the intervention group. Following the DRG implementation, the concentration indexes for chemotherapy and radiotherapy increased, while those for immunotherapy did not exhibit this pattern. Costs were more concentrated in patients who did not receive TCM treatment. In summary, DRG reform positively impacted the cost homogeneity of inpatient treatments for malignant tumors, particularly in the control group not receiving TCM treatment. The effects of DRG reform varied across different treatment modalities. Although short-term fluctuations in hospitalization costs may occur, initial evidence during the study period shows the positive impact of DRG reform on cost homogeneity.
化疗、放疗和免疫治疗作为治疗恶性肿瘤的主要手段，其相关成本波动与医疗决策密切相关，并给患者带来经济负担。针对这些挑战，中国实施了按疾病诊断相关分组（DRG）付费制度，以规范成本，控制支出。本研究收集了 2018 年至 2022 年 H 医院接受化疗、放疗和免疫治疗的恶性肿瘤患者的住院数据。数据集分为两组：干预组，在标准治疗的基础上加用中药治疗；对照组，仅采用标准治疗。采用倾向评分匹配（PSM）、标准差（SD）、四分位间距（IQR）和集中指数（CI）分析 DRG 政策下住院费用的变化和趋势。结果显示，所有治疗方式的住院费用标准差呈下降趋势。放疗的下降幅度最大，对照组费用降低 2547.37 元，干预组降低 7387.35 元。DRG 实施后，化疗和放疗的集中指数增加，而免疫治疗则没有表现出这种模式。未接受中药治疗的患者费用更加集中。总之，DRG 改革对恶性肿瘤住院治疗的成本同质性产生了积极影响，特别是在未接受中药治疗的对照组中。DRG 改革对不同治疗方式的影响不同。尽管住院费用可能会出现短期波动，但研究期间的初步证据表明，DRG 改革对成本同质性具有积极影响。
