标题：湖北省慢性乙肝及乙肝相关疾病住院患者直接医疗费用特征及影响因素

      作者：文正源 1，黎相麟 2，郭丹丹 2    1.湖北医药学院公共卫生与健康学院，湖北 十堰 442000；2.华中科技大学同济医学院医药卫生管理学院，湖北 武汉 430030

      卷次： 2022年33卷14期

      【摘要】 目的 掌握湖北省慢性乙肝及乙肝相关疾病住院患者直接医疗费用特征及影响因素，为当地制定适宜的慢性乙肝及乙肝相关疾病防控举措和医保策略提供决策依据。方法 采用多阶段整群抽样方法，以湖北省东、中、西三个地级市共5所医院2018年1月1日至12月1日期间因慢性乙肝及乙肝相关疾病而住院的患者为样本，收集患者人口学特征、住院特征及医疗费用等信息，对费用数据进行描述性分析，并采用多元线性回归方法分析其相关因素。结果 共有680例患者纳入分析，其中慢性乙型肝炎301例(44.26%)、肝硬化代偿期118例(17.35%)、肝硬化失代偿期208例(30.59%)和肝癌53例(7.79%)；人均住院次数分别为1.43次、1.45次、2.21次和1.86次；单次住院天数四分位数间距分别为9 d、9 d、10 d和11.5 d；次均住院费用(中位数)分别为6 285.0元、7 913.0元、9 853.5元和14 451.5元，差异均有统计学意义(P<0.05)；住院费用构成中诊疗服务费、耗材费、药品费和其他费用在不同疾病期构成差异均有统计学意义(P<0.05)，其中药品费用在四类慢性乙肝及乙肝相关疾病住院费用占比重均最高；多元线性回归分析结果显示，患者住院直接医疗费用与地区、性别、疾病分期存在显著相关(P<0.05)。结论 慢性乙肝及乙肝相关疾病患者住院天数和住院总费用随着疾病进展显著增加，药品费用在慢性乙肝及乙肝相关疾病住院费用中占比最大；为有效控制慢性乙肝及乙肝相关疾病住院费用，建议将更多有效的抗病毒药纳入慢性乙肝疾病医保目录，以延缓疾病进展，提高慢性乙肝及乙肝相关疾病防治效果并切实减轻患者费用负担。
      【关键词】 乙型病毒性肝炎；直接医疗费用；影响因素；医保政策；湖北省
      【中图分类号】 R512.6+2 【文献标识码】 D 【文章编号】 1003—6350（2022）14—1887—04

Direct medical expense and influencing factors of hospitalized patients with chronic hepatitis B and hepatitisB-related diseases in Hubei Province.
WEN Zheng-yuan 1, LI Xiang-lin 2, GUO Dan-dan 2. 1. School of Public Healthand Health, Hubei University of Medicine, Shiyan 442000, Hubei, CHINA; 2. School of Medical and Health Management,Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei, CHINA
【Abstract】 Objective To understand the direct medical expense and influencing factors of hospitalized pa-tients with chronic hepatitis B and hepatitis B-related diseases in Hubei Province, and to provide evidence and sugges-tions for further improving prevention and control strategies and medical insurance policy of chronic hepatitis B and hep-atitis B-related diseases in Hubei. Methods A multi-stage cluster sampling method was used to sample patients whowere hospitalized with chronic hepatitis B and hepatitis B-related diseases from 5 hospitals in three prefecture-level cit-ies in the east, central, and west of Hubei Province from January 1 to December 1, 2018. Information such as patient de-mographic characteristics, hospitalization characteristics, and medical expenses were collected. Then descriptive analysisof cost data was conducted, and multiple linear regression method was used to analyze its related factors. Results A to-tal of 680 patients were included in the analysis, including 301 of chronic hepatitis B (44.26%), 118 of compensatory cir-rhosis (17.35%), 208 of decompensated cirrhosis (30.59%), and 53 of liver cancer (7.79%); the yearly average admissionwas 1.43 times, 1.45 times, 2.21 times, and 1.86 times; the interquartile range of the length of a single hospital staywas 9 d, 9 d, 10 d, and 11.5 d; the medical expenditure per admission (median) was RMB 6 285.0 yuan, 7 913.0 yuan,9 853.5 yuan, and 14 451.5 yuan, respectively; the differences were statistically significance (P<0.05). In medical expen-diture, there were significant differences in the composition of diagnosis and treatment service fees, consumables fees,drug costs, and other fees in different disease stages, and drug costs accounted for the largest share of expenditures ineach period. Multiple linear regression analysis showed that the patient's direct medical expense was related to region,gender, and disease stage. Conclusion The length of hospital stay and direct medical expense of hospitalized patientswith chronic hepatitis B and hepatitis B-related diseases increased significantly with the progress of the disease, and drugcosts accounted for the largest proportion in the hospitalization expenses. In order to effectively control the hospitalizationcost of chronic hepatitis B and hepatitis B-related diseases, intervention measurements to delay disease progression shouldbe carried out as early as possible, and more effective antiviral drugs should be included in the medical insurance list.
      【Key words】 Hepatitis B; Direct medical expense; Influencing factors; Medical insurance policy; Hubei Province　　　·调查研究·doi:10.3969/j.issn.1003-6350.2022.14.032基金项目：华中科技大学研究项目(编号：20180253