关键词: 结核,肺, 利福平, 抗药性, 卫生经费支出, 横断面研究

Abstract:

Objective: To evaluate the cost burden of rifampicin-resistant pulmonary tuberculosis patients in Yunnan Province, and analyze the influencing factors, to provide a basis for reducing the economic burden of patients and improving the investment of health resources. Methods: A cross-sectional survey was conducted to collect all rifampicin-resistant pulmonary tuberculosis patients who received drug resistant treatment in designated hospitals of Kunming, Baoshan, Pu’er, Lincang, Honghe, Wenshan, Dali, and Zhaotong in Yunnan Province from January 1, 2020 to March 1, 2022. A total of 214 cases were investigated. Basic demographic characteristics, diagnosis and treatment information, and cost information of them were collected, and the economic burden and influencing factors were analyzed. Results: The median (quartile) total cost of the survey subjects from the first visit to the completion of treatment was RMB 88114.02 (70260.45, 118130.37) yuan, of which the median (quartile) direct economic burden was RMB 76164.03 (59589.27, 94893.69) yuan, accounting for 85.60% (18.3605 million/21.44899 million), and the median (quartile) direct medical cost in the direct economic burden was RMB 70999.33 (55405.57, 88420.54) yuan, accounting for 79.93% of the total expenses (17.1451 million/21.4489 million). Medical insurance reimbursement accounted for 42.75% (9.1693 million/21.4489 million) of the total expenses, followed by self-paid direct medical expenses (25.78%, 5.5285 million/21.4489 million), indirect economic burden (14.40%, 2.4454 million/21.4489 million), policy reduction (11.40%, 2.4454 million/21.4489 million), and direct non-medical expenses (5.67%, 1.2154 million/21.4489 million). The median (quartile) self-paid expenses of the survey subjects was RMB 39648.35 (26397.11, 56458.26) yuan. Of the survey subjects, 186 (86.92%) were found that the proportion of self-paid expenses to family annual income was ≥20%, which was a high economic burden for the family. Multivariate logistic analysis showed that patients who had been hospitalized twice or more during the diagnosis stage had a 18.522 times (95%CI: 1.855-184.981) higher risk of high family economic burden than those who had not been hospitalized. Patients with an annual income of over 75% of the family annual income had a 8.320 times (95%CI: 1.466-47.223) higher risk of high family economic burden than those who with an annual income of less than 25% of the family annual income. Conclusion: With existing policies, the economic burden of rifampicin-resistant pulmonary tuberculosis patients in Yunnan Province is still heavy, especially for patients who have been hospitalized twice or more during the diagnosis stage and whose annual income accounts for over 75% of their family’s annual income. It is recommended that the proportion of medical insurance reimbursement should be increased in Yunnan Province, and support measures such as social assistance to patients should be provided, to reduce their economic burden.

Key words: Tuberculosis, pulmonary, Rifampin, Drug resistance, Health expenditures, Cross-sectional studies