关键词: 结核, 抗药性, 多药, 费用, 医疗, 因素分析, 统计学

Abstract:

Objective: With investigation on the out-of-pocket medical expenses and concerned influencing factors of multidrug-resistant/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) patients in Changsha City, to provide evidences for optimizing the medical insurance policies and local subsidy policies for MDR/RR-PTB patients. Methods: An investigation was conducted among 141 patients with MDR/RR-PTB who completed the full course of treatment in two designated drug-resistant tuberculosis hospitals in Changsha (Hunan Provincial Chest Hospital and Changsha Central Hospital) from January 1, 2020 to December 31, 2024. Data on the participants’ gender, age, occupation, and treatment classification were obtained through the Tuberculosis Information Management System. Meanwhile, data on marital status, educational level, type of medical insurance, and annual household income were collected via questionnaire surveys. In addition, data on patients’ classification, drug resistance type, treatment regimen, comorbidities, medical costs, and cost details were retrieved from the Hospital Information Management System. The medical expenses of patients were analyzed and stepwise multiple linear regression was used to analyze the influencing factors of out-of-pocket medical expenses for patients with MDR/RR-PTB. Results: The average medical costs of the full course treatment for the 141 MDR/RR-PTB patients were 185535 yuan, with 102594 yuan covered by medical insurance reimbursement, 57504 yuan out-of-pocket expenses incurred within the hospital, and 25437 yuan out-of-pocket expenses incurred outside the hospital. The out-of-pocket ratio was 44.7% (82941/185535). The medical costs with a relatively high proportion were 125386 yuan (67.6%) for medications, 27058 yuan (14.6%) for laboratory tests, and 4920 yuan (2.7%) for examinations. The results of stepwise multiple linear regression analysis showed that the out-of-pocket medical expenses for patients with rifampicin-monoresistant PTB were 1.21 (95%CI: 1.03-1.42) times as much as multidrug-resistant patients. The out-of-pocket expenses of the short-course chemotherapy regimen and the new long-course regimen (including Bdq) were 2.10 (95%CI: 1.21-3.67) times and 1.45 (95%CI: 1.23-1.70) times as much as those of the traditional long-course regimen (excluding Bdq), respectively. Conclusion: The out-of-pocket medical expenses of MDR/RR-PTB patients in Changsha city are relatively high, with drug resistance type and treatment regimen being the main influencing factors. It is urgent to optimize the medical insurance reimbursement policies for MDR/RR-PTB patients and introduce local subsidy policies as well.

Key words: Tuberculosis, Drug resistance, multiple, Fees, medical, Factor analysis, statistical