680例SARS临床确诊患者医疗费用和影响因素分析

目的 分析680例SARS临床确诊患的医疗费用及影响因素和典型药物的费用-效果，为临床医生和政府提供决策依据。方法 设计回顾性队列研究，比较重症型和普通型患在有、无基础疾病间的医疗费用及药品费用差异，分析影响因素。选择三种典型用药，比较其临床有效性和费用-效果。结果 重症型治愈率低于普通型治愈率(73．68%，99．38％，P=0．000)；普通型有基础疾病患治愈率低于无基础病患(96％，99．66％，P=0．00l6)，重症型患治愈率组内无统计学差异。两型患平均住院日组内比较无统计学差异；有基础疾病和无基础疾病的普通型患其医疗费用分别为7879．22和7172．23元/人，重症型患为24912．89和26433．53元/人，组内比较均无统计学差异；患年龄和病情均与医疗费用相关，y=4585．7l 79．04X1 17188．87X2；有基础疾病和无基础疾病重症型患使用中小剂量甲基强的松龙比较，医疗费用和临床效果无统计学差异；使用和不使用病毒唑的普通型无基础疾病患，其费用-效果比为6107和4225元；使用和不使用胸腺肽的无基础疾病普通型患费用-效果比分别为11651和6107元。结论 有基础疾病的普通型患治愈率低于无基础疾病；费用高低与患年龄和病情严重程度有关，病情越重，年龄越高，费用越高。药品费用占医疗费用比例最大；中小剂量激素在有基础疾病和无基础疾病重症型患的治愈率和费用无统计学差异；在无基础疾病的普通型患中使用和未使用胸腺肽的治愈率无统计学差异，但使用胸腺肽将增加人均医疗费用5877元。在无基础疾病的普通型患中使用和未使用病毒唑的治愈率一致，但使用病毒唑将增加人均医疗费用l882元。

Medical expenditure and influential factors analysis of 680 SARS cases

Objective This study analyzed the medical expenditure and its influential factors, and compared the clinical effectiveness and medical expenditure of three major drugs. Methods We designed the cohort study to compare the difference of medical and pharmaceutical expenditures between patients with and without underlying diseases. Multi-linear regression was applied to analyze the influential factors. Incremental expenditure-effectiveness ratio was applied to study three clinically important drugs. Results The curing rate of non-critical patients was statistically significant than critical patients (73.68%, 99.38%, P=0.000) .The curing rate of non-critical patients without underlying diseases was statistically significant than those with underlying diseases in the cohort (96%, 99.66%, P=0.001 6). No significance was identified in the critical patients cohort. The medical expenditure of non-critical patients with and without underlying diseases were 7 879.22 and 7 172.23 RMB per capita, respectively. Accordingly, the medical expenditure in critical patients was 24 912.89 and 26 433.53 RMB per capita. No significance was identified in the two cohorts. Medical expenditure was positively correlated with age and disease severity, with its equation y=4585.71+79.04X1+17188.87X2 (X1: age, X,: disease severity). Regarding the clinical effectiveness and medical expenditure, no significance was identified in critical patients who administered small and medium dose of Methylprednisolone. The expenditure-effectiveness ratios of Ribavirin that was administered by non-critical patients without underlying dissuades were 6 107 and 4 225 RMB, respectively. Accordingly, the expenditure-effectiveness ratios of Thymosin were 11 651 and 6 107 RMB. Conclusions The curing rate of non-critical patients without underlying diseases was higher than the counterpart in the cohort. No influence of underlying diseases was found in the critical patient cohort. Medical expenditure was positively correlated with age and disease severity. Small-and-medium dose of Methylprednisolone might not influence the curing rate and medical expenditure in critical patients. The effectiveness of Thymosin for non-critical patients with and without underlying diseases was not significantly different. However, additional 5 877 RMB occurred if Thymosin was administrated. Likewise, the effectiveness of Ribavirin for non-critical patients remains the same. However, additional 1 082 RMB was consumed in Ribavirin-administrated patient.