2018-2020年结核病定点医院肺外结核和结核性胸膜炎患者次均住院费用及影响因素分析OA北大核心CSTPCD

Objective:To analyze the average hospitalization costs,cost components and their influencing factors for patients with extrapulmonary tuberculosis(EPTB)and tuberculous pleurisy,in order to reduce the economic burden on patients.Methods:All of 2940 patients(a total of 3211 admissions)aged ≥15 years with EPTB and tuberculous pleurisy discharged from 9 designated tuberculosis hospitals from 2018 to 2020 were selected to collect their demographic characteristics(gender,age,marital status,region,medical insurance,etc.),clinical characteristics(nature and level of hospital,time and route of admission,transfers,surgery,type of tuberculosis,time of discharge,duration of hospitalization,etc.),and hospitalization expenses(total cost and individual costs,etc.).Non-parametric rank sum test was used to analyze the influencing factors of hospitalization expenses;multiple linear regression model was used for multifactor analysis.Results:The median expense of hospitalization for patients with extrapulmonary tuberculosis and tuberculous pleurisy was 9408.16(IQR:5768.50,15 540.58)Yuan,the highest median hospitalization expense was for neurological tuberculosis(12 865.89 Yuan).In the composition of hospitalization expenses,drug expenses(27.96％(4317.48/15 438.94))account for the highest proportion,followed by the cost of laboratory tests(18.40％(2841.42/15 438.94)).Of the drug cost components,the highest proportion of cost was for other drugs(49.33％(2129.80/4317.48)),the followed by second-line anti-tuberculosis drugs(22.80％(984.75/4317.48))and first-line anti-tuberculosis drugs(18.52％(799.41/4317.48)).Length of stay was 17(IQR:9,28)days.Multiple linear regression model analysis showed that hospitalization costs were significantly associated with the hospitalization days(β'=0.644,P＜0.001),age(β'=0.076,P＜0.001),male(β'=0.033,P=0.008),living in the West(β'=0.172,P＜0.001),insurance participation(β'=0.045,P=0.002),general hospital diagnosis and treatment(β'=0.170,P＜0.001),referral for treatment(β'=0.103,P＜0.001),surgical treatment(β'=0.208,P＜0.001),tuberculosis pleurisy(β'=0.047,P＜0.001),and bone and joint tuberculosis(β'=0.067,P＜0.001),negative correlation with discharged in 2018(β'=-0.039,P=0.004),married(β'=-0.045,P=0.005),diagnosis and treatment in tertiary hospitals(β'=-0.047,P=0.015),first admitted(β'=-0.044,P=0.004)and lymph node tuberculosis(β'=-0.068,P＜0.001).Conclusion:Compared with the income of the population,the hospitalization costs of patients with extrapulmonary tuberculosis and tuberculous pleurisy are still high,exacerbating the financial burden on individuals and families,and measures to reduce the hospitalization costs of patients with extrapulmonary tuberculosis can be formulated in the areas of reasonable control of hospitalization days,optimization of the structure of costs,increase in the scope of medical care coverage,specialized hospital treatment,and standardization of hospital diagnostic and therapeutic behaviors.