药物性肝损伤相关成本的测算及风险评估指标体系的构建

发布时间：2018-01-30 10:52

本文关键词： 药物性肝损伤决策主体成本测算德尔菲法风险评估评估指标　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本文以DILI为研究靶点,从患者、医保支付方以及全社会三个决策角度对DILI的相关成本进行测算分析,并应用德尔菲法构建风险评估指标体系,旨在加强患者、医务工作者以及全社会对DILI的警觉性,为制定科学的DILI防治措施以便有效的及早识别DILI危险因素提供参考依据。方法1.从不同决策主体角度对药物性肝损伤相关成本进行测算分析采用回顾性方法,随机选取河南省4家医院病案管理系统中2014年6月—2015年6月第一诊断为DILI,且治疗结果为痊愈或好转的住院患者,经筛选共纳入60例作为研究对象,统计DILI患者的人口学特征、临床特征以及DILI相关成本,并从不同的决策主体(患者、全社会和医保支付方)角度对DILI相关成本的构成情况进行分析。2.应用德尔菲法构建药物性肝损伤风险评估指标体系通过广泛收集国内外关于药物性肝损伤影响因素、DILI防治以及监护等文献,进行汇总整理形成DILI风险条目池。采用德尔菲法对15位专家进行两轮的问卷咨询,主要对条目的重要性和权威性进行评分。通过条目得分的均值、满分比、变异系数、权威程度等指标分析专家问卷,并经过研究小组的讨论,最终确定风险评估体系的条目。结果1.60例DILI患者男性22例,女性38例,平均年龄为45.8±12.24岁,平均增加的住院天数为18.62±8.67d。引起DILI最常见的药物为中草药和中成药(28.33%),其次为抗结核药(18.33%)和解热镇痛药(10.00%)。60例患者的直接成本总额为615 206.20元,间接成本总额为169 379.95元;患者角度所承担的DILI相关成本总额为616 296.38元;全社会角度所承担的DILI相关成本总额为784 586.15元;医保支付方所承担的DILI相关成本总额为168 289.77元。2.专家的积极性较高,问卷的回收率为100%,专家权威系数Cr为0.82,两轮的专家意见协调系数分别为0.40和0.63。形成了包括药物因素、环境因素、宿主因素、行为因素以及认知因素五个方面,23个条目的DILI风险评估指标体系。结论1.DILI的发生给患者、社会以及国家都造成一定的经济损失,这部分费用是不可忽视的,提醒医务人员在为患者制定治疗方案时,应该考虑到药物引起的DILI,以便及早发现和治疗。2.引起DILI最常见的药物是传统中药,因此要加强中药的规范使用,同时进行DILI的防治宣传。3.敏感度分析发现,单纯的提高医保报销比表面上可以降低患者的医疗负担,但国家以及整个社会的负担并没有得到改善。4.应用德尔菲法构建的DILI风险评估指标体系的回收率、权威程度以及协调程度符合要求,条目简洁易懂,方便临床使用,可为临床及早识别DILI危险因素提供指导。5.本研究有一定的局限性。首先,DILI的风险指标体系没有涵盖种族因素和遗传因素。其次,本研究的风险条目主要来自往期文献以及专家的意见,并没有在DILI患者中进行DILI风险因素的调查,因此非常有必要采用更加客观准确的方法构建DILI的风险评估指标体系。
[Abstract]:Objective this paper takes DILI as the research target, estimates and analyzes the related cost of DILI from three aspects of patients, health insurance payers and the whole society, and applies Delphi method to construct the risk assessment index system. The aim is to strengthen the awareness of patients, medical workers and the whole society about DILI. To establish scientific DILI prevention and treatment measures in order to effectively identify the risk factors of DILI as soon as possible. Methods 1.The cost of drug-induced liver injury was measured and analyzed from different decision makers. 2. Retrospective approach. Randomly selected from 4 hospitals in Henan Province medical records management system from June 2014 to June 2015 the first diagnosed as DILI and the outcome of the treatment for recovery or improvement of the inpatients. A total of 60 patients with DILI were selected as study subjects. The demographic characteristics, clinical features and DILI related costs of DILI patients were analyzed and analyzed from different decision makers (patients). Social and Medicare payers). From the perspective of DILI related cost analysis of the composition of the application of Delphi method to establish a drug-induced liver injury risk assessment index system through a wide collection of domestic and foreign factors affecting drug-induced liver injury. DILI prevention and care and other literature collected to form a pool of DILI risk items. 15 experts using Delphi method to conduct two rounds of questionnaire consultation. The importance and authority of the items are mainly scored. Through the average of the entry score, full score ratio, coefficient of variation, authority degree and other indicators to analyze the expert questionnaire, and through the discussion of the study group. Results 1.An average age of 45.8 卤12.24 years, there were 22 males and 38 females in 60 patients with DILI. The average length of hospitalization was 18.62 卤8.67 days. The most common drugs causing DILI were Chinese herbal medicine and Chinese patent medicine (28.33). The direct cost of antituberculous drug 18.33) and antipyretic analgesics 10.00 were 615,206.20 yuan. The total indirect cost is 169,379.95 yuan; The total cost of DILI was 616,296.38 yuan. The total cost of DILI in the whole society is 784,586.15 yuan; The total cost of DILI was 168,289.77 Yuan 路2.The enthusiasm of experts was higher, the recovery rate of questionnaire was 100 and the authority coefficient of experts was 0.82. The coordination coefficients of the two rounds of expert opinions were 0.40 and 0.63 respectively. The factors including drug factors, environmental factors, host factors, behavioral factors and cognitive factors were formed. Conclusions 1. The occurrence of DILI to patients, society and countries have caused certain economic losses, this part of the cost can not be ignored. 2. Medical staff are reminded to consider DILIs caused by drugs in order to detect and treat DILI as early as possible. The most common drug causing DILI is traditional Chinese medicine. Therefore, we should strengthen the standardized use of traditional Chinese medicine, at the same time, the prevention and treatment of DILI propaganda. 3. Sensitivity analysis found that simply improving the medical insurance reimbursement ratio can reduce the medical burden of patients on the surface. However, the burden of the country and the whole society has not been improved. 4. The recovery rate, authority and coordination degree of the DILI risk assessment index system constructed by Delphi method are in line with the requirements, and the items are simple and easy to understand. Convenient for clinical use, can provide guidance for clinical early identification of DILI risk factors. 5. this study has some limitations. First of all. DILI's risk indicator system does not cover ethnic factors and genetic factors. Secondly, the risk items in this study are mainly from the previous literature and experts' opinions. DILI risk factors were not investigated in patients with DILI, so it is necessary to use more objective and accurate methods to construct the risk assessment index system of DILI.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

【相似文献】