囊型肝包虫病手术规范化治疗前后成本—效果评价

发布时间：2018-04-26 05:07

本文选题：囊型肝包虫病 + 住院费用　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:通过对新疆地区9家经规范化培训的师、市级医院2005-2013年收治的囊型肝包虫病患者规范化治疗前后住院费用及影响因素进行分析,了解肝包虫病患者住院费用现况,探讨其主要的影响因素;同时采用成本-效果评价方法对规范化治疗前和规范化治疗后肝包虫病不同手术方式在不同时期、不同级别医院的有效性和经济性进行综合评价。方法:本研究采用回顾性调查方法选取2005-2013年新疆地区9家经规范化培训的医院收治的囊型肝包虫病手术住院患者为研究对象,以2010年为界,分为规范前和规范后,所有研究对象均至少随访2年,共收集有效病历900例。通过现场调阅病案、术后B超或CT结果的方式收集问卷信息,包括患者一般情况、手术方式、医院级别、术后是否胆漏、是否残腔感染及费用明细等信息。应用SPSS 20.0软件进行统计分析,计量资料采用均数、中位数及四分位数间距描述,两组间比较采用t检验或非参秩和检验,多组间比较采用方差分析或非参秩和检验,计数资料采用χ2检验或Fisher精确概率法,多因素分析采用多元回归分析,成本-效果分析采用成本-效果比、增量成本效果比和敏感度分析。结果:1.人均住院费用随年份增长呈上升趋势,由2005年10865.02元上升到2013年22260.77元,增长了1.05倍,差异均有统计学意义(P0.05);人均住院费用规范化治疗前为13533.15元,规范化治疗后为19680.02元;且规范化治疗前后均以药品费(38.36%、38.40%)和手术费为主(24.62%、18.99%)。2.规范化治疗前人均住院费用的影响因素依次是医院级别、住院天数、年龄和手术方式(P0.05);规范化治疗后人均住院费用的影响因素依次是医院级别、住院天数、年龄、年份和囊肿数目(P0.05)。3.二级医院规范化治疗前四种手术方式C/E依次为139.16、134.10、158.23、118.69;△C/△E依次为-321.94、245.70、48.99;敏感度分析结果与成本-效果分析结果一致;4.二级医院规范化治疗后四种手术方式C/E依次为209.40、182.56、176.10、158.42;△C/△E依次为31.84、91.20、14.21;敏感度分析结果与成本-效果分析结果一致。5.三级医院规范化治疗前四种手术方式C/E依次为371.86、253.44、254.12、218.86;△C/△E依次为-189.70、-187.53、2155.95;敏感度分析结果与成本-效果分析结果一致。6.三级医院规范化治疗后四种手术方式C/E依次为520.59、380.98、305.56、265.39;△C/△E依次为-315.71、-441.17、1257.26;敏感度分析结果与成本-效果分析结果一致。结论:新疆肝包虫病患者规范化治疗前后人均住院费用均随年份的增长、住院天数的延长、年龄的增长呈逐年上升趋势,且均以药品费和手术费为主;规范化治疗前人均住院费用的影响因素是医院级别、住院天数、年龄和手术方式,规范化治疗后人均住院费用的影响因素是医院级别、住院天数、年龄、年份和囊肿数目;外膜内外囊完整切除术是适宜不同级别医院、不同阶段的即有效又经济的最理想手术方式,值得实施推广。
[Abstract]:Objective: to analyze the hospitalization expenses and influencing factors of 9 standardized trained teachers and municipal hospitals in Xinjiang region from 2005 to 2013 before and after standardized treatment for patients with hepatic hydatid disease, so as to understand the current situation of hospitalization expenses of patients with hepatic hydatid disease. At the same time, the cost-effect evaluation method was used to evaluate the effectiveness and economy of different surgical methods of liver hydatid disease in different stages and different stages. Methods: a retrospective study was conducted in 9 hospitals in Xinjiang from 2005 to 2013. The patients with cystic liver hydatid disease were selected as the study subjects. The patients were divided into two groups: before and after the standardization. All subjects were followed up for at least 2 years and 900 effective medical records were collected. The information of questionnaire was collected by reading the medical records on the spot, the results of B ultrasound or CT after operation, including the general condition of the patients, the operation method, the hospital grade, the bile leakage after operation, the infection of residual cavity and the details of the expenses and so on. The statistical analysis was carried out by SPSS 20.0 software. The mean, median and quartile spacing were used to describe the measurement data. T test or non-parametric rank sum test were used for the comparison between the two groups, and the variance analysis or non-parametric rank sum test were used for the multigroup comparison. The counting data were analyzed by 蠂 ~ 2 test or Fisher accurate probability method, multivariate regression analysis, cost-effect ratio, incremental cost-effect ratio and sensitivity analysis. The result is 1: 1. The per capita hospitalization cost increased from 10865.02 yuan in 2005 to 22260.77 yuan in 2013, the difference was significant (P 0.05), the average hospitalization cost per capita was 13533.15 yuan before standardized treatment, 19680.02 yuan after standardized treatment, and the average per capita hospitalization cost increased from 10865.02 yuan in 2005 to 22260.77 yuan in 2013, the difference was statistically significant (P 0.05). And before and after the standardized treatment, 38.36 (38.40) and 24.622 (18.99) and operating expenses were mainly used. The influencing factors of per capita hospitalization cost before standardized treatment were hospital grade, hospitalization days, age and operation mode (P0.05N), and the influencing factors of per capita hospitalization cost after standardized treatment were hospital grade, hospitalization days, age, etc. Year and number of cysts P0.05. 3. The results of sensitivity analysis and cost effect analysis were consistent with the results of sensitivity analysis and cost-effect analysis. The C- / E was 139.16134.10U 158.23118.69 and C / E was -321.945.705.700.The results of sensitivity analysis were consistent with those of cost-effect analysis. The results of sensitivity analysis were consistent with that of cost-effect analysis. The C- / E of the four kinds of operation methods were 209.40182.56 / 176.10158.42 and 31.84 / 91.201.2014.21 respectively. The results of sensitivity analysis were consistent with those of cost-effect analysis. C / E of the first four modes of standardized treatment in tertiary hospitals was 371.86253.44 / 254.12218.86, and C / E was -189.70 / -187.53n 2155.95.The sensitivity analysis result was consistent with the cost-effect analysis result .6. After standardized treatment in tertiary hospitals, C / E was 520.59380.98 / 305.56265.39, and C / E was -315.71 / -441.17 / 1257.26.The results of sensitivity analysis were consistent with those of cost-effect analysis. Conclusion: before and after standardized treatment of liver hydatid disease patients in Xinjiang, the per capita hospitalization cost increased with the increase of years, the length of hospitalization days and the increase of age showed an increasing trend year by year. The influencing factors of per capita hospitalization cost before standardized treatment were hospital grade, hospitalization days, age and operation mode. After standardized treatment, the influencing factors of per capita hospital expenses were hospital grade, hospitalization days, age, year and number of cysts. The complete excision of internal and external capsule is the most effective and economical operation method in different level hospitals, and it is worth popularizing.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3;R197.3

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