摘要
目的分析中国6月龄至5岁以下实验室确诊手足口病重症病例（重症病例）的直接医疗费用及其影响因素。方法采用分层抽样方法，对2012年1月1日至2013年12月31日全国疾病监测信息报告管理系统中报告的6月龄至5岁以下的重症病例进行抽样。根据全国实验室确诊重症病例中3种病原学结果的构成比[肠道病毒A71型（EV-A71）、柯萨奇病毒A16型（CV—A16）和其他肠道病毒（OEV）分别占60％、4％和36％]分配病例，并将中国内地划分成7个区域（东北、华北、西北、华中、西南、华东、华南）进行抽样，收集重症病例患病期间并发症情况及直接医疗费用。排除具有基础疾病患者，以及不能清楚回忆主要诊断信息的患者后，共685例纳入直接医疗费用分析。采用秩和检验分析不同并发症患者直接医疗费用差异；采用Bootstrap多元线性回归模型分析影响重症病例直接医疗费用的因素。结果685例重症病例中男性456例（66．6％），女性229例（33．4％），直接医疗费用P50（R25P75）为14250（10301，20600）元。并发呼吸道感染者为127例（18．5％），无菌性脑膜炎者为38例（5．5％），脑炎／脑干脑炎／急性弛缓性麻痹者为378例（55．2％），心肌炎者为53例（7．7％），肺出血／肺水肿者为39例（5．7％），心肺衰竭者为50例（7．3％），其直接医疗费用只。（P25，P75）分别为12360（7313，16480）、13803（9064，19930）、14438（11000，20015）、14800（8500，21218）、20600（12500，31130）和20043（12772，28840）元（H=17．70，P〈0．001）。多元线性回归分析显示，华中地区的重症病例直接医疗费用比东北地区高7881（95％CI：3814～11949）元；OEV相关重症病例直接医疗费用比EV-A71低1987（95％CI：206～3769）元；病程≥21d的重症病例直接医疗费用比≤5d者高20480（95％CI：10985～29974）元；并发肺水肿，肺出血和心肺功能衰竭的重症病例分别比并发呼吸道感染的重症病例直接医疗费用高7874（95％CI：3723～12026）和9855（95％CI：328～19382）元。结论手足口病重症病例的经济负担较重，病程和并发症是其主要的影响因素。
Objective To estimate the direct medical cost of severe hand, foot and mouth disease （HFMD） in patients aged less than five years. Methods A stratified sampling method was used to collect data on severe HFMD cases reported in the National HFMD surveillance database between Jan 1, 2012, and Dec 31, 2013. The sampling was referenced with the national aetiologic distribution of Enterovirus A71 （EV-A71）, Coxsackievirus AI6 （CV-A16） and other Enteroviruses （OEV） for severe HFMD cases and the included cases were distributed among seven geographic regions （Northeast, North China, Northwest, Central China, Southwest, East China and South China）. A nationwide telephone interview using a structured questionnaire was conducted to obtain the direct medical cost and any complications that occurred in patients during the outbreak of laboratory-confirmed HFMD. After excluding the cases who could not recall their medical expenses or complications, a total of 685 cases were included in the analysis. Kruskal-Wallis H test was used to analyze the differences among patients who reported different complications. Multiple linear regression with bootstrap analysis of 500 replicates was used to explore the factors that influenced the direct medical costs. Results Of 685 patients analyzed, 456 （66.6%） were male and 229 （33.4%） were female. The direct medical costs P50 （P25, P75） were 14 250 （10 301, 20 600） Yuan. In total, 127 （18.5%） patients were diagnosed with severe HFMD patients with respiratory disease, 38 （5.5%） patients were diagnosed with aseptic meningitis, and 378 （55.2%） with encephalitis/brainstem encephalitis/acute flaccid paralysis. Furthermore, 53 （18.5%） patients were diagnosed with myocarditis, 39 （5.7%） with pulmonary hemorrhage/pulmonary edema and 50 （7.3%） with cardiopulmonary failure. The median （interquartile range） direct medical costs were 12 360 （7 313, 16 480） Yuan for severe HFMD patients with respiratory disease, 13 803 （9 064, 19 930） Yuan for aseptic meningitis, 14 438 （11 000, 20 015） Yuan for encephalitis/ brainstem encephalitis/acute flaccid paralysis, 14 800 （8 500, 21 218） Yuan for myocarditis, 20 600 （12 500, 31 130） Yuan for pulmonary hemorrhage/pulmonary edema, and 20 043 （12 772, 28 840） Yuan for eardiopulmonary failure （H=17.70, P〈0.001）. The results of multiple linear regression with bootstrap analysis revealed that the direct medical cost for severe HFMD patients from Central China was 7 881 （95% CI： 3 814-11 949） Yuan higher than that of North China; severe HFMD patients diagnosed with OEV had direct medical costs of 1 987 （95%CI： 206-3 769） Yuan less those associated with EV-A71; severe HFMD patients whose duration of illness was ≥21 d had 20 480 （95% CI： 10 985-29 974） Yuan higher direct medical costs those whose illness lasted ≤5 d; the direct medical costs for severe HFMD patients with pulmonary hemorrhage/pulmonary edema and cardiopulmonary failure were 7 874 （95%CI： 3 723-12 026） and 9 855 （95% CI： 328-19 382） Yuan higher, respectively, than that associated with respiratory disease. Conclusion The direct medical costs associated with severe HFMD were found to be substantial. The total cost was affected by the duration of the illness and the severity of any complications.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2017年第1期87-92,共6页
Chinese Journal of Preventive Medicine
基金
国家杰出青年科学基金项目（81525023）
国家自然科学基金（81473031）
关键词
手足口病
费用
医疗
重症
并发症
Hand, foot and mouth disease
Fees, medical
Severe
Complication
