Abstract:

Objective To investigate the direct medical expenses of active pulmonary tuberculosis (PTB) patients in Chongqing and analyze the influencing factors. Methods Clinical data of PTB patients (excluded patients with simple extra-pulmonary tuberculosis and rifampicin-resistant tuberculosis) registered in 41 district/county level TB hospitals in Chongqing from January to December in 2019 were collected from the subsystem (Tuberculosis Information Management System) of the China Information System for Disease Control and Prevention, and match with the diagnosis, treatment and cost information (such as outpatient and inpatient records, charging and reimbursements, etc.) of TB medical institutions at the municipal and district/county level in Chongqing from January 1, 2019 to May 31, 2020. Finally, 11745 patients who had been cured or had completed the treatment were included. Single-factor analysis and multi-factor generalized linear model analysis were used to investigate the direct medical expenses and influencing factors. Results The total direct medical expenses of 11745 cases were 83856000 yuan, of which 34009000 yuan (40.56%) for drugs, 32053000 yuan (38.22%) for examinations, and 17794000 yuan (21.22%) for others. The median (quartiles) of direct medical cost per case was 4517.0 (2144.0, 8903.0) yuan. Multifactorial generalized linear model analysis showed that secondary hospitals, tertiary hospitals, workers with urban health insurance, complications and hospitalization were the influential factors that increased the direct medical costs of general PTB patients. The medians (quartiles) of the direct medical costs of these five factors are: 4701.0 (2262.0, 9165.0), 5258.0 (2198.0, 11197.5), 6158.0 (2960.0, 11619.0), 6289.0 (2658.0, 11417.0) and 10858.0 (7544.0, 16390.0)yuan, respectively; OR (95%CI) values are: 1.299 (1.062-1.437), 1.123 (1.020-1.366), 1.240 (1.114-1.379), 1.149 (1.096-1.205) and 3.115 (3.012-3.226), respectively. Conclusion The direct medical expenses of PTB patients in Chongqing were high. High-level medical institutions, workers with health insurance, complications and hospitalization were the influential factors that increased the direct medical costs. We should proactively develop and implement the medical insurance policy of single-disease payment should be promoted, second- and third-level TB hospitals and the treatment of employees with medical insurance should be regulated.

Key words: Tuberculosis,pulmonary, Fees,medical, Cost of illness, Factor analysis,statistical, Chongqing City