慢性阻塞性肺疾病住院患者的经济负担研究
摘要
研究背景
作为最常见的慢性呼吸系统疾病,慢性阻塞性肺疾病(COPD)的患病率、致残率和死亡率,以及所构成的疾病负担,逐年增加。据估计,我国目前的COPD患者已超过4,300万,从而成为呼吸学界乃至整个社会必须面对的严峻挑战。
慢性阻塞性肺疾病负担的意义在于它比较全面的反映了COPD对社会、家庭、患者所带来的影响。根据美国国家心、肺、血液研究所(NHLBI)的资料,美国1993年因COPD所带来的经济负担是239亿美元,其中包括147亿美元直接医疗费用,4.7亿美元间接费用和45亿美元与过早死亡有关的费用。我国目前还没有这方面的权威资料。为了收集和完善与COPD疾病经济负担相关的资料,《慢性阻塞性肺疾病全球倡议(GOLD)》执行委员会从2002年开始筹划在全球范围内进行COPD的负担研究。钟南山院士和冉丕鑫教授作为中国参与该项全球研究项目的负责人与协调者,已经开始启动相关的研究工作。
本研究来自于广东省自然科学基金项目,旨在为制定降低COPD经济负担的卫生策略提供基线数据和量化分析结论。
研究目的
了解华南地区慢性阻塞性肺疾病住院患者的经济负担情况,为更加广泛和深入地研究COPD的经济负担,以及制定减轻COPD经济负担的卫生政策,提供基线数据和量化分析结论。
资料与方法
选取2008年在广州呼吸疾病研究所(广州医学院第一附属医院)入院的COPD患者作为研究对象,数据资料从医院病案统计管理系统和病案资料获取。COPD住院患者的疾病经济负担包括直接经济负担和间接经济负担两个方面,直接经济负担以COPD患者的住院费用来表示,间接经济负担用COPD住院患者的伤残调整寿命年(DALY)结合人力资本法(Human Capital Approach)来测算。
研究结果
1. 669例COPD住院患者,基于均数的人均直接经济负担为22,341.58元,基于中位数的人均直接经济负担是12,666.57元。
2. 669例COPD住院患者,基于均数的人均间接经济负担为40,503.02元,基于中位数的人均间接经济负担是14,335.34元。
3. 669例COPD住院患者,基于均数的人均疾病经济负担是62,844.60元,其中,直接经济负担占35.55%,间接经济负担占64.45%;基于中位数的人均疾病经济负担是29,915.73元。
小结
1.住院天数、是否手术、婚姻状况以及患者来源是COPD患者产生较高直接经济负担的主要影响因素。
2.加强合理用药、合理检查以及合理治疗的规范,缩短平均住院日,坚持三级预防的卫生策略,从而降低COPD的发病率和病残率,提高患者生活质量,是减轻疾病经济负担的有效方式。
Background
As the most common chronic respiratory disease, the morbidity, disability rate, mortality, and disease burden of chronic obstructive pulmonary disease (COPD), are increasing year by year. According to statistics, the number of patients with COPD in China is above 35 million. And COPD has posed great challenge to public health.
The burden of COPD fully reflects its influence on society, families and patients. And the economic burden of disease includes two parts, direct burden and indirect burden. The direct economic burden refers to health-care costs, and the indirect economic burden stands for loss of production capacity and time as a result of disease. According to the information from the National heart, Lung, and Blood Institute (NHLBI), the economic burden of COPD in the United States in 1993 is 23.9 billion dollars, including 14.7 billion in direct medical expenses, 470 million dollars indirect economic burden and 4.5 billion dollars with premature death related expenses. Late-stage COPD needs long-term oxygen therapy and rehabilitation therapy, and may partly and totally cause self-care ability; therefore, it will bring a lot of family and social problems. There is no authority data in China at the present stage. In order to collect and perfect related data about economic burden of COPD, "Chronic Obstructive Pulmonary Disease Global Initiative" (GOLD) executive committee is planning on global burden of COPD research. Academician Zhong Nanshan and Professor Ran Pixin, as China's participation in the global research project leader and coordinator, has already started related research.
This study comes from the Guangdong Province Natural Science Fund Project. We recognized that it is necessary for us to measure the total burden of disease and per capita burden of disease in a certain population, and then, take health interventions, and collaborative research. Therefore, we started from the economic burden of COPD study, in order to provide baseline data and quantitative analysis of findings for health policy makers.
Objective
This study explored the assessment of economic burden for hospitalized patients with COPD and its related factors in South China, aiming to provide baseline data and quantitative analysis for making health policies mitigating the economic burden of COPD.
Materials and Methods
Patients admitted in Guangzhou Institute of Respiratory Disease (the First Affiliated Hospital of Guangzhou Medical College) in 2008 were collected as research samples. Related data was obtained from Medical Records and Statistics Management System of Guangzhou Institute of Respiratory Disease and medical records of hospitalized patients with COPD. Economic burden of COPD consists of two parts, direct and indirect economic burden. Direct economic burden of COPD stands for inpatient expenditure in 2008 and indirect economic burden is measured by human capital approach with the index of disability adjusted life years (DALY).
Results
1. The direct economic burden of 669 patients with COPD was $22,341.58 per case based on mean, and $12,666.57 based on median.
2. The indirect economic burden of 669 patients with COPD was $40,503.02 per case based on mean, and $14,335.34 based on median.
3. The economic burden of 669 patients with COPD was $62,844.60 per case based on mean, the proportion of direct economic burden and indirect economic burden was 35.55% and 64.45% respectively. And the economic burden of 669 patients with COPD was $29,915.73 per case based on median.
Conclusions
1. Marital status,mode of payment, hospital-stay length, operation treatment and origin of patients were main factors influencing the direct economic burden of COPD.
2. Rational examination, medication and treatment, shortening hospital-stay length and tertiary prevention are effective ways to reduce the economic burden of COPD.
作为最常见的慢性呼吸系统疾病,慢性阻塞性肺疾病(COPD)的患病率、致残率和死亡率,以及所构成的疾病负担,逐年增加。据估计,我国目前的COPD患者已超过4,300万,从而成为呼吸学界乃至整个社会必须面对的严峻挑战。
慢性阻塞性肺疾病负担的意义在于它比较全面的反映了COPD对社会、家庭、患者所带来的影响。根据美国国家心、肺、血液研究所(NHLBI)的资料,美国1993年因COPD所带来的经济负担是239亿美元,其中包括147亿美元直接医疗费用,4.7亿美元间接费用和45亿美元与过早死亡有关的费用。我国目前还没有这方面的权威资料。为了收集和完善与COPD疾病经济负担相关的资料,《慢性阻塞性肺疾病全球倡议(GOLD)》执行委员会从2002年开始筹划在全球范围内进行COPD的负担研究。钟南山院士和冉丕鑫教授作为中国参与该项全球研究项目的负责人与协调者,已经开始启动相关的研究工作。
本研究来自于广东省自然科学基金项目,旨在为制定降低COPD经济负担的卫生策略提供基线数据和量化分析结论。
研究目的
了解华南地区慢性阻塞性肺疾病住院患者的经济负担情况,为更加广泛和深入地研究COPD的经济负担,以及制定减轻COPD经济负担的卫生政策,提供基线数据和量化分析结论。
资料与方法
选取2008年在广州呼吸疾病研究所(广州医学院第一附属医院)入院的COPD患者作为研究对象,数据资料从医院病案统计管理系统和病案资料获取。COPD住院患者的疾病经济负担包括直接经济负担和间接经济负担两个方面,直接经济负担以COPD患者的住院费用来表示,间接经济负担用COPD住院患者的伤残调整寿命年(DALY)结合人力资本法(Human Capital Approach)来测算。
研究结果
1. 669例COPD住院患者,基于均数的人均直接经济负担为22,341.58元,基于中位数的人均直接经济负担是12,666.57元。
2. 669例COPD住院患者,基于均数的人均间接经济负担为40,503.02元,基于中位数的人均间接经济负担是14,335.34元。
3. 669例COPD住院患者,基于均数的人均疾病经济负担是62,844.60元,其中,直接经济负担占35.55%,间接经济负担占64.45%;基于中位数的人均疾病经济负担是29,915.73元。
小结
1.住院天数、是否手术、婚姻状况以及患者来源是COPD患者产生较高直接经济负担的主要影响因素。
2.加强合理用药、合理检查以及合理治疗的规范,缩短平均住院日,坚持三级预防的卫生策略,从而降低COPD的发病率和病残率,提高患者生活质量,是减轻疾病经济负担的有效方式。
Background
As the most common chronic respiratory disease, the morbidity, disability rate, mortality, and disease burden of chronic obstructive pulmonary disease (COPD), are increasing year by year. According to statistics, the number of patients with COPD in China is above 35 million. And COPD has posed great challenge to public health.
The burden of COPD fully reflects its influence on society, families and patients. And the economic burden of disease includes two parts, direct burden and indirect burden. The direct economic burden refers to health-care costs, and the indirect economic burden stands for loss of production capacity and time as a result of disease. According to the information from the National heart, Lung, and Blood Institute (NHLBI), the economic burden of COPD in the United States in 1993 is 23.9 billion dollars, including 14.7 billion in direct medical expenses, 470 million dollars indirect economic burden and 4.5 billion dollars with premature death related expenses. Late-stage COPD needs long-term oxygen therapy and rehabilitation therapy, and may partly and totally cause self-care ability; therefore, it will bring a lot of family and social problems. There is no authority data in China at the present stage. In order to collect and perfect related data about economic burden of COPD, "Chronic Obstructive Pulmonary Disease Global Initiative" (GOLD) executive committee is planning on global burden of COPD research. Academician Zhong Nanshan and Professor Ran Pixin, as China's participation in the global research project leader and coordinator, has already started related research.
This study comes from the Guangdong Province Natural Science Fund Project. We recognized that it is necessary for us to measure the total burden of disease and per capita burden of disease in a certain population, and then, take health interventions, and collaborative research. Therefore, we started from the economic burden of COPD study, in order to provide baseline data and quantitative analysis of findings for health policy makers.
Objective
This study explored the assessment of economic burden for hospitalized patients with COPD and its related factors in South China, aiming to provide baseline data and quantitative analysis for making health policies mitigating the economic burden of COPD.
Materials and Methods
Patients admitted in Guangzhou Institute of Respiratory Disease (the First Affiliated Hospital of Guangzhou Medical College) in 2008 were collected as research samples. Related data was obtained from Medical Records and Statistics Management System of Guangzhou Institute of Respiratory Disease and medical records of hospitalized patients with COPD. Economic burden of COPD consists of two parts, direct and indirect economic burden. Direct economic burden of COPD stands for inpatient expenditure in 2008 and indirect economic burden is measured by human capital approach with the index of disability adjusted life years (DALY).
Results
1. The direct economic burden of 669 patients with COPD was $22,341.58 per case based on mean, and $12,666.57 based on median.
2. The indirect economic burden of 669 patients with COPD was $40,503.02 per case based on mean, and $14,335.34 based on median.
3. The economic burden of 669 patients with COPD was $62,844.60 per case based on mean, the proportion of direct economic burden and indirect economic burden was 35.55% and 64.45% respectively. And the economic burden of 669 patients with COPD was $29,915.73 per case based on median.
Conclusions
1. Marital status,mode of payment, hospital-stay length, operation treatment and origin of patients were main factors influencing the direct economic burden of COPD.
2. Rational examination, medication and treatment, shortening hospital-stay length and tertiary prevention are effective ways to reduce the economic burden of COPD.
引文
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[2]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[3] Agusti AG. Systemic effects of chronic obstructive pulmonary disease[J]. Proc Am Thorac Soc 2005,2(4): 367-370.
[4] Soriano JB, Visick GT, Muellerova H, et al. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care[J]. Chest, 2005,128(4): 2099-2107.
[5] Viegi G, Pistelli F, Sherrill DL. Definition, epidemiology and natural history of COPD[J]. Eur Respir J,2007,30(5):993-1013.
[6] Petty TL. Definition, epidemiology, course, and prognosis of COPD[J]. Clin Cornerstone,2003,5(1):1-10.
[7]蔡柏蔷.慢性阻塞性肺疾病的定义、诊断、鉴别诊断和病情分级[J].中华结核和呼吸杂志,2007,30(1):76-78.
[8]杨功焕,孔灵芝,赵文华,等.中国慢性病的挑战与应对[J].世界临床医学:柳叶刀中文版,2008,2(6):1056-1065.
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[2]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[3] Agusti AG. Systemic effects of chronic obstructive pulmonary disease[J]. Proc Am Thorac Soc 2005,2(4): 367-370.
[4] Soriano JB, Visick GT, Muellerova H, et al. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care[J]. Chest, 2005,128(4): 2099-2107.
[5] Viegi G, Pistelli F, Sherrill DL. Definition, epidemiology and natural history of COPD[J]. Eur Respir J,2007,30(5):993-1013.
[6] Petty TL. Definition, epidemiology, course, and prognosis of COPD[J]. Clin Cornerstone,2003,5(1):1-10.
[7]蔡柏蔷.慢性阻塞性肺疾病的定义、诊断、鉴别诊断和病情分级[J].中华结核和呼吸杂志,2007,30(1):76-78.
[8]杨功焕,孔灵芝,赵文华,等.中国慢性病的挑战与应对[J].世界临床医学:柳叶刀中文版,2008,2(6):1056-1065.
[9]周玉民,冉丕鑫.慢性阻塞性肺疾病的流行病学[J].中国呼吸与危重监护杂志,2004,3(2):68-70.
[10] Golshan M, Faghihi M, Marardi MM.Indor women jobs and pulmonary risks in rural areas of Isfahan,Iran,2000[J]. Respir Med,2002,96: 382-388.
[11]李小芡,胡志,李守田,等.安徽农村不同居住环境对慢阻肺患病率的影响[J].中国农村卫生事业管理,2002,22:46-48.
[12]卢冰冰,何权瀛,陈青,等.预测慢性阻塞性肺病患者子代肺功能的相关因素研究.中华医学杂志,2002,82:1136-1139.
[13] Halbert RJ, Isonaka S, George D, Iqbal A. Interpreting COPD prevalence estimates: what is the true burden of disease?[J]. Chest, 2003, 123(5): 1684-1692.
[14] Johannessen A,Omenaas ER,Bakke PS, et al. Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: acommunity study[J]. Thorax,2005, 60(10):842-847.
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