2015—2019年四川省结直肠癌患者住院费用水平及结构变动度分析

目的 了解四川省结直肠癌患者住院费用水平及结构变动度，为有关部门制定医疗费用控制措施、评价控费效果提供参考依据。方法 收集四川省二级及以上医疗机构2015年1月1日—2019年12月31日住院的结直肠癌患者病案数据，采用Mann - Kendall检验和结构变动度分析法评估结直肠癌患者的住院费用情况。结果 2015—2019年，四川省结直肠癌患者的次均住院费用由17 511.10元下降至15 964.97元，年均下降速度为2.28%。次均住院费用构成中，药费占比最高。近5年，诊断费和康复费呈上升趋势（Z = 2.205，P = 0.027；Z = 2.205，P = 0.027），药费呈下降趋势（Z = - 2.205，P = 0.027）。次均住院费用中结构变动贡献前4位的费用依次为药费（34.18%）、诊断费（23.05%）、治疗费（17.69%）和其他费用（12.14%），累积贡献度为87.06%。结论 四川省结直肠癌患者住院费用增长速度仍需控制，次均住院费用结构变动较为理想，但药占比仍为次均住院费用结构的重点调整对象。医疗卫生监管部门应加大对药品、临床路径等监管力度，强化问责机制，药企等机构应开发推广低成本、高疗效的抗肿瘤药物。

Analysis of hospitalization expense level and structural change of colorectal cancer patients in Sichuan Province from 2015 to 2019

Objective To understand the level and structural change of hospitalization expenses for colorectal cancer patients in Sichuan Province, and to provide reference for relevant departments to formulate medical expense control measures and evaluate the effect of cost control. Methods The medical records of colorectal cancer patients hospitalized from January 1, 2015 to December 31, 2019 in secondary and above medical institutions in Sichuan Province were collected. The hospitalization expenses of colorectal cancer patients were evaluated by Mann Kendall test and structural variability analysis. Results From 2015 to 2019, the average hospitalization cost of colorectal cancer patients in Sichuan Province decreased from 17 511.10 yuan to 15 964.97 yuan, with an average annual decline rate of 2.28%. Among the per-time hospitalization expenses, drug expenses accounted for the highest proportion. In the past 5 years, the cost of diagnosis and rehabilitation showed an upward trend (Z=2.205, P=0.027; Z=2.205, P=0.027), and the cost of medicine showed a downward trend (Z=-2.205, P=0.027). Among the average hospitalization expenses, the top 4 expenses that contributed to structural changes were drug expenses (34.18%), diagnosis expenses (23.05%), treatment expenses (17.69%) and other expenses (12.14%), with a cumulative contribution of 87.06%. Conclusion The growth rate of hospitalization cost of colorectal cancer patients in Sichuan Province still needs to be controlled, and the change of sub-average hospitalization cost structure is more desirable, but the drug ratio is still the key target for adjustment of sub-average hospitalization cost structure. Medical and health regulatory authorities should increase the supervision of drugs and clinical pathways and strengthen the accountability mechanism, and pharmaceutical companies and other institutions should develop and promote low-cost and highly effective anti-tumor drugs.