目的:首次估计中国结核性脑膜炎(TBM)的直接经济负担。
方法:纳入2015年12月至2018年12月在中国西部医院首次诊断为TBM的患者。我们回顾性地收集了人口统计学和临床特征的数据,资源利用率,成本,和长期结果。随访15~53个月。我们进行了疾病成本研究,并使用广义线性模型分析了成本因素。
结果:总计,154例TBM患者(男性95例,59名女性,14-82岁)进行了审查。每人平均总直接成本为9,484美元(美元)(范围为1,822-67,285),平均直接医疗费用为8,901美元(1,189-67,049)。出院后平均住院费用和药物费用为6,837美元(范围为845-52,921)和1,967美元(范围为0-60,423),分别。平均直接非医疗费用为583美元(范围33-3,817),占直接总成本的6.2%。平均住院时间(LOS)为25.0天(范围6-152)。共有117例患者(76.0%)具有良好的预后(mRS=0-2)。成本没有显著差异,LOS,或农村和城市患者之间的结果。总直接成本的贡献者是明确的TBM,发烧,昏迷,癫痫发作,多药耐药,脑积水,糟糕的长期结果。
结论:尽管中国偏远和农村地区医疗资源的可及性有了显著提高,TBM的费用给患者带来了灾难性的负担.
OBJECTIVE: To estimate the direct economic burden of tuberculous meningitis (TBM) in
China for the first time.
METHODS: Patients who were first diagnosed with TBM from December 2015 to December 2018 in Western
China Hospital were enrolled. We retrospectively collected data on demographic and clinical features, resource utilization, costs, and long-term outcomes. The patients were followed up for 15-53 months. We performed a cost-of-illness study and analyzed the cost contributors with a generalized linear model.
RESULTS: In total, the cases of 154 TBM patients (95 males, 59 females, aged 14-82 years) were reviewed. The average total direct cost per person was USD (United States dollars) 9,484 (range 1,822-67,285), with a mean direct medical cost of USD 8,901 (range 1,189-67,049). The average inpatient cost and drug cost after discharge were USD 6,837 (range 845-52,921) and USD 1,967 (range 0-60,423), respectively. The mean direct nonmedical cost was USD 583 (range 33-3,817), which accounted for 6.2% of the total direct cost. The average length of stay (LOS) in hospital was 25.0 days (range 6-152). A total of 117 of the patients (76.0%) had good outcomes (mRS = 0-2). There was no significant difference in the costs, LOS, or outcomes between rural and urban patients. Contributors to total direct cost were definite TBM, fever, coma, seizures, multidrug resistance, hydrocephalus, and poor long-term outcome.
CONCLUSIONS: Although the accessibility of medical resources in remote and rural regions has significantly improved in
China, the cost of TBM imposes a catastrophic burden on patients.