【摘要】 目的 分析中国4个地市带状疱疹(Herpes zoster,HZ)患者直接医疗费用及其影响因素。方法 通过山东省济南市、江苏省南通市和无锡市、四川省绵阳市健康信息平台收集2022-2023年就诊HZ患者直接医疗费用信息，分析直接医疗费用的构成和中位数，采用广义线性模型分析其影响因素。结果 共纳入140 409例HZ患者，其中门诊、住院患者分别为134 679例、5 730例。所有HZ患者直接医疗费用为8 398.4万元，其中门诊、住院患者费用分别占50.47%、49.53%;手术、检查、药品、非手术治疗和耗材、其他费用分别占2.13%、10.13%、48.71%、26.70%、12.32%。门诊、住院患者直接医疗费用中位数分别为141.7元、5 393.5元。门诊患者直接医疗费用随年龄增加而上升(β=0.001,95%CI:0.001～0.001)，女性患者低于男性(β=-0.04,95%CI:-0.05～-0.02)，眼部受累、播散型患者低于普通型患者(β=-0.11,95%CI:-0.18～-0.04; β=-0.16,95%CI:-0.20～-0.12)，有带状疱疹后神经痛(Postherpetic neuralgia,PHN)患者高于无PHN患者(β=0.21,95%CI:0.18～0.23)，无锡市、济南市、绵阳市患者低于南通市患者(β=-0.47,95%CI:-0.50～-0.45; β=-0.13,95%CI:-0.15～-0.11; β=-0.39,95%CI:-0.42～-0.37)，二级及以上医院就诊患者高于基层医疗卫生机构患者(β=1.01,95%CI:0.99～1.03);随着就诊次数增加而上升(β=0.34,95%CI:0.33～0.34)。住院患者直接医疗费用随年龄增加而上升(β=0.01,95%CI:0.00～0.01)，有PHN患者高于无PHN患者(β=0.16,95%CI:0.06～0.26)，无锡市、济南市、绵阳市患者低于南通市患者(β=-0.40,95%CI:-0.56～-0.23; β=-0.42,95%CI:-0.55～-0.28; β=-1.02,95%CI:-1.18～-0.87)，二级及以上医院就诊患者高于基层医疗卫生机构患者(β=0.32,95%CI:0.18～0.46)，随就诊次数、住院时间增加而上升(β=0.15,95%CI:0.11～0.19; β=0.08,95%CI:0.08～0.09)。结论 中国4个地市2022-2023年HZ住院患者直接医疗费用中位数显著高于门诊患者;直接医疗费用主要受PHN并发症、就诊医疗卫生机构类别、就诊次数和地区的影响。更多还原

【Abstract】 Objective To explore direct medical costs of medically-attended herpes zoster( HZ) and factors influencing direct medical cost in four prefectures of China.Methods We obtained data on direct medical costs for HZ patients who sought medical care during 2022-2023 from health information platforms in Jinan of Shandong province,Nantong and Wuxi of Jiangsu province,and Mianyang of Sichuan province.We analyzed composition and median values of direct medical costs,and examined factors influencing direct medical cost using a generalized linear model. Results A total of 140 409 HZ patients( 134 679 outpatients and 5 730 inpatients) were included. The total direct medical cost was 83. 984 million yuan,of which 50. 47% were outpatient costs and 49. 53% were inpatient costs. Surgery, examination,medication,non-surgical treatment and consumables,and other costs accounted for 2. 13%,10. 13%,48. 71%,26. 70%,and 12. 32%,respectively. Median direct medical costs were 141. 7 yuan for outpatients and 5 393. 5 yuan for inpatients. Direct medical costs for outpatients increased with increasing age( β = 0. 001,95% CI: 0. 001 to 0. 001),were lower in females than males( β =-0. 04,95% CI:-0. 05 to-0. 02),were lower in ophthalmic-involved and disseminated HZ patients than ordinary HZ patients( β =-0. 11,95% CI:-0. 18 to-0. 04; β =-0. 16,95% CI:-0. 20 to-0. 12),were higher in postherpetic neuralgia( PHN) patients than in non-PHN patients( β = 0. 21,95% CI: 0. 18 to 0. 23),were lower in Wuxi,Jinan,and Mianyang than in Nantong( β =-0. 47,95% CI:-0. 50 to-0. 45; β =-0. 13,95% CI:-0. 15 to-0. 11; β =-0. 39,95% CI:-0. 42 to-0. 37),were higher in patients from secondary or above hospitals than in primary healthcare institutions( β = 1. 01,95% CI: 0. 99 to1. 03),and increased with increasing frequency of medical visits( β = 0. 34,95% CI: 0. 33 to 0. 34).Direct medical costs for inpatients increased with increasing age( β = 0. 01,95% CI: 0. 00 to 0. 01),were higher in PHN patients than non-PHN patients( β = 0. 16,95% CI: 0. 06 to 0. 26),were lower in Wuxi,Jinan,and Mianyang than in Nantong( β =-0. 40,95% CI:-0. 56 to-0. 23; β =-0. 42,95% CI:-0. 55 to-0. 28; β =-1. 02,95% CI:-1. 18 to-0. 87),were higher in patients from secondary or above hospitals than in primary healthcare institutions( β = 0. 32,95% CI: 0. 18 to 0. 46),and increased with increasing frequency of medical visits and duration of hospitalization( β = 0. 15,95% CI: 0. 11 to 0. 19; β = 0. 08,95% CI: 0. 08 to 0. 09).Conclusions The average direct medical cost for inpatients was significantly higher than for outpatients during 2022-2023 in four prefectures of China.Direct medical costs were associated with PHN,type of medical/healthcare institution,frequency of medical visits,and region.更多还原