关键词: 结核,肺, 抗结核药, 化学疗法,辅助, 药费支出, 患病代价, 数据说明,统计, 小地区分析

Abstract:

Objective To analyze the usage and expense of therapeutic drugs in pulmonary tuberculosis patients, and to provide the basis for improving the policy of reducing the economic burden of tuberculosis patients. Methods A total of 248 tuberculosis patients registered for treatment in Songjiang District, Shanghai and met the enrollment criteria were included from Dec 1, 2014 to Dec 31, 2015. The bills of expense for the whole treatment of all the patients were collected to analyze the usage and expense of therapeutic drugs. Non-normally distributed data such as drug expenditures and the proportions were all described as median (quartile) (M(Q₁,Q₃)). Data were compared using Mann-Whitney U test and P<0.05 was considered statistically significant. Results The average total drug cost of the 248 patients was 3719.0 (2483.4, 5634.9) yuan per case. Among them, anti-tuberculosis drugs accounted for 16.8% (11.5%, 24.0%), 62.1% (47.5%, 74.6%) was liver protection drugs, and 23.0% (12.2%, 40.7%) was other adjuvant drugs. Except for anti-tuberculosis drugs, all patients were treated with hepatoprotective drugs: 241 patients (97.2%) started to use hepatoprotective drugs within one month after diagnosis and initial treatment, 179 patients (72.2%) regularly used hepatoprotective drugs every month after consultation. Eighty-two patients used two or more kinds of hepatoprotective drugs during treatment. Most patients used other adjuvant medications intermittently, of which the costs of Chinese medicines, antibiotics and immune-modulators accounted for 14.8% (5.9%, 28.9%), 9.7% (5.3%, 17.2%) and 8.6% (0.7%, 14.0%). The proportions of patients who used the above drugs were 58.1% (144/248), 40.3% (100/248) and 27.0% (67/248), respectively. The average total cost of medicines and other adjuvant medications for per case in municipal designated hospitals were 6392.7 (3371.5, 9769.0) yuan and 2097.6 (789.0, 3828.0) yuan, which were significantly higher than those in the district-level designated hospitals (3424.1 (2362.0, 4796.1) yuan, Z=-3.534, P<0.001; 889.2 (305.5, 1826.0) yuan, Z=-3.113, P=0.002). Conclusion The expense of hepatoprotective drugs and other adjuvant drugs was higher than that of anti-tuberculosis drugs. However, and these two kinds of drugs were not allowed or highly limited to get reimbursement form the free tuberculosis treatment policy and hence the usage of these drugs were the main cause of the economic burden on tuberculosis patients. The use of these drugs should be regulated and the related health policy need to be further concerned to reduce the financial burden on patients.

Key words: Tuberculosis,pulmonary, Antitubercular agents, Chemotherapy,adjuvant, Drug costs, Cost of illness, Data interpretation,statistical, Small-area analysis