关键词: 结核, 肺/诊断, 结核, 肺/经济学, 误诊, 费用, 医疗, 患病代价

Abstract: Objective  To investigate the influence of TB timely diagnosis on TB patients, family, government and social economic burden.   Methods  386 active pulmonary tuberculosis patients, which were obtained by stratified random cluster sampling method from 6 different poverty level country/district institutions of TB Prevention and Control in Hunan, were given the TB economic burden questionnaire surveys including seven indicators: the diagnosis and treatment of TB, medical expenses, and so on. We totally issued 386 questionnaires took 381 back and acquired 354 effective questionnaires. We compared the difference of TB patients, family, government and social direct and indirect economic burden before and after TB diagnosed by t test. Ordered univariate logistic regression was used to analyze the influence of TB timely diagnosis on TB economic burden.   Results  The total family disease economic burden of 354 patients was 829 524.5 Yuan, 478 435 Yuan (57.68%) and 351 089.5 Yuan (42.32%) derived from before and after confirmed diagnosis respectively. For the direct economic burden of patients’ families (300 989 Yuan before diagnosis, 215 795 Yuan after diagnosis), the direct medical costs of patients (265 299 Yuan before diagnosis,183 321 Yuan after diagnosis), direct non-medical costs (35 690 Yuan before diagnosis, 32 474 Yuan after diagnosis), lost income of patients (161 882.5 Yuan before diagnosis, 126 182.5 Yuan after diagnosis) and the loss income of their accompanies (15 563.5 Yuan before diagnosis,9112 Yuan after diagnosis),the after diagnosis costs are higher than before diagnosis,and the difference was statistically significant(t=3.6879, 3.7278, 2.1429, 1.9902, 5.995, P<0.05).Hunan provincial government invested 145 140 Yuan of direct medical cost within 1 year after the illness, among which 74 340 Yuan and 70 800 Yuan before and after the diagnosis respectively. The total disease’s social economic burden of Hunan province was 160 742 351.7 Yuan. 88 813 229.25 Yuan and 71 929 122.45Yuan respectively before and after the confirmed diagnosis. Days of diagnosis-delay, diagnosis delay or not, and number of times that patient visit the doctor before confirmed diagnosis were positively correlated with family economic burden of TB (β=0.604, 0.815, 0.662; Wald χ²=7.574,10.234,8.215;OR=1.829,2.259,1.939; 95%CI=3.004-5.709，1.519-3.36，1.311-2.863). That the first visit of Tuberculosis Prevention and Control institutions has a negative correlation with family economic burden (β=－1.98, Wald χ²=21.429，OR=0.138，95%CI＝0.058-0.327).   Conclusion  The economic burden of TB (including the patient’s family, government and society)whether direct or indirect economic burden were mainly derived from the period before the confirmed diagnosis. The timeliness of patient visiting a doctor and the therapy level of hospital are the main factors affecting TB economic burden.

Key words: Tuberculosis, pulmonary/diagnosis, Tuberculosis, pulmonary/economics, Diagnostic errors, Fees, medical, Cost of illness