【摘要】 目的 分析当前安徽省阜阳市耐多药/利福平耐药肺结核(MDR/RR-PTB)患者疾病经济负担和灾难性卫生支出(CHE)发生情况，探索优化医疗补助新模式，以期为预防发生CHE、完善医疗服务保障措施提供依据。方法 利用问卷调查和医院、中国疾病预防控制信息系统收集数据，通过描述性分析和政策模拟掌握当前阜阳市MDR/RR-PTB的CHE发生情况和改善医疗补助水平策略。结果 患者完成全程治疗医疗卫生总费用中位数为80 740.29(59 956.46,98 532.76)元，自付费用为74 815.29(56 624.37,92 506.35)元，CHE发生率高达95.6%。治疗期前7个月，患者CHE累计发生率从2.22%急速上升至93.33%,以前两个月上升速度最快；4种模拟场景下CHE发生率分别为80.0%、22.2%、84.4%和73.3%除场景模拟2的增量成本效果比(ICER)为负值外，其余3种场景模拟下的ICER分别为10.70、3.52、8.65万元/CHE发生率。结论 MDR/RR-PTB患者医疗卫生总费用、自付费用、CHE发生率均较高，当前医疗补助政策一定程度上减轻了患者的经济负担，可通过实行单病种付费、提高患者报销比例以及个性化资助等策略进一步减少患者直接医疗卫生负担和CHE的发生。更多还原

【Abstract】 Objective To analyze the current economic burden of diseases and catastrophic health expenditure(CHE) of patients with multidrug-resistant/rifampicin-resistant pulmonary tuberculosis(MDR/RR-PTB) in Fuyang City, Anhui province, and to explore a new model of optimizing medical subsidy for patients’ economic burden, so as to provide basis for preventing CHE of MDR/RR-PTB and improving TB medical services. Methods Questionnaires and information systems of hospitals and China Disease Control and Prevention Information System were used to collect data. Descriptive analysis and policy simulation were used to know about the current CHE of MDR/RR-PTB in Fuyang City and the strategies to improve the level of medical subsidies. Results The median of the total medical costs of the full course of treatment was 80 740.29(59 956.46, 98 532.76) Yuan, and the out-of-pocket cost was 74 815.29(56 624.37, 92 506.35) Yuan. The incidence of CHE was as high as 95.6%. During the first 7 months of treatment, the cumulative incidence of CHE of the population increased rapidly from 2.22% to 93.33%, with the fastest rise especially in the first two months. The incidences of CHE under the four simulation scenarios were 80.0%, 22.2%, 84.4% and 73.3%, respectively. Except for the negative incremental cost-effectiveness ratio(ICER) of scenario 2, the ICER values under the other three simulation scenarios were 107.0, 35.2 and 86.5 thousand yuan/CHE incidence, respectively. Conclusions The total medical expenditure, out-of-pocket expenses, and the incidence of CHE are all relatively high for MDR/RR-PTB patients. The current medical subsidy policy has relieved the financial burden of patients to a certain extent, and strategies such as implementation of single disease payment, increase in patient reimbursement rates, and personalized assistance can be adopted to further reduce the direct medical burden on patients and the occurrence of CHE.更多还原