关键词: 结核,肺, 结核,抗多种药物性, 病例管理, 费用,医疗, 方案评价

Abstract:

Objective To analyze the effect of diagnosis and treatment management of rifampicin-resistant pulmonary tuberculosis (RR-PTB) and financing mode in Ningxia Hui Autonomous Region (Ningxia) during the third phase of China National Health and Family Planning Commission-Bill and Melinda Gates Foundation Tuberculosis Prevention Cooperation Project (Ningxia Zhonggai tuberculosis project). Methods From the Tuberculosis Management Information System of China Center for Disease Control and Prevention, information of 406 RR-PTB patients with positive pathogens (smear-positive, positive-only, positive-only in molecular biology) diagnosed in tuberculosis-designated hospitals of all levels in Ningxia between January 1, 2016 and December 31, 2020 was collected. In addition, the cost information of 120 outpatients and inpatients with RR-PTB successfully treated from January 1, 2016 to December 31, 2018 was collected from the Hospital Information System of Ningxia Fourth People’s Hospital. The changes of rifampicin-resistance screening, detection, treatment and successful treatment in PTB patients with positive etiology during 2016-2020 were analyzed (in 2019 and 2020, all the RR-PTB patients were not included in the analysis because that they had not yet finished treatment). Ratioes of outpatient critical illness medical insurance (medical insurance) expenses, government expenses and personal expenses were also analyzed. Results From 2016 to 2020, the detection rate of rifampicin resistance in etiologically positive PTB patients increased from 45.48% (392/862) to 96.96% (1116/1151), and the positive rate decreased from 17.09% (67/392) to 5.65% (63/1116). The differences were statistically significant (X²_trend values were 942.974 and 61.904, both P values were 0.000). The treatment rate of RR-PTB patients increased from 76.12% (51/67) to 88.89% (56/63), the difference was statistically significant (X²_trend=11.749, P=0.001). From 2016 to 2018, the success rate of treatment increased from 52.94% (27/51) to 61.84% (47/76), but the difference was not statistically significant (X²_trend=0.952, P=0.329). The cost analysis of patients successfully treated showed that, from 2016 to 2018,the costs of the full course of treatment for every paient were 104326 (99670, 107100) yuan, 102589 (96718, 106016) yuan, and 102774 (96429, 104643) yuan, respectively. Among them, proportions of medical insurance expenses (16.43% (13.83%,19.63%),36.56% (28.40%,45.48%), and 50.61% (34.80%,63.57%), respectively) and government expenses (0.00%, 0.00%, and 10.74% (9.17%,22.52%), respectively) increased year by year, while the proportion of personal expenses (53.57% (50.40%,62.23%),30.11% (29.68%,48.92%) and 15.74% (15.27%,24.29%), respectively) decreased year by year; all the differences were statistically significant (Z values were 34.741,47.247 and 50.296, respectively; all P values were 0.000). Conclusion The comprehensive model of tuberculosis prevention and treatment of “policy development, medical insurance first, government support, graded burden” implemented in the third phase of Ningxia Zhonggai tuberculosis project was significantly beneficial to the screening, treatment and reducing the economic burden of RR-PTB patients.

Key words: Tuberculosis,pulmonary, Tuberculosis,multidrug-resistant, Case management, Fees,medical, Program evaluation