热带病与寄生虫学

热带病与寄生虫学 ›› 2025, Vol. 23 ›› Issue (3): 183-188.doi: 10.20199/j.issn.1672-2302.2025.03.010

• 调查研究 • 上一篇    下一篇

利福平耐药肺结核患者的疾病经济负担分析

王涵飞1(), 胡冬梅1, 张晓萌2, 李涛1, 徐彩红1,3(), 刘慧慧4()   

  1. 1.中国疾病预防控制中心结核病预防控制中心，北京 102206
    2.天津市结核病控制中心
    3.传染病溯源预警与智能决策全国重点实验室
    4.中国疾病预防控制中心教育培训处
  • 收稿日期:2025-03-20 出版日期:2025-06-20 发布日期:2025-08-08
  • 通信作者: 徐彩红，E-mail: xuch@chinacdc.cn；刘慧慧，E-mail: liuhh@chinacdc.cn
  • 作者简介:王涵飞，男，硕士在读，研究方向：结核病防治。E-mail: wanghanfei0223@163.com
  • 基金资助:
    中央财政结核病预防控制项目(2528)

Disease economic burden in patients with rifampicin-resistant pulmonary tuberculosis

WANG Hanfei1(), HU Dongmei1, ZHANG Xiaomeng2, LI Tao1, XU Caihong1,3(), LIU Huihui4()   

  1. 1. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
    2. Tianjin Center for Tuberculosis Control
    3. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases
    4. Department of Education and Training, Chinese Center for Disease Control and Prevention
  • Received:2025-03-20 Online:2025-06-20 Published:2025-08-08
  • Contact: XU Caihong, E-mail: xuch@chinacdc.cn; LIU Huihui, E-mail: liuhh@chinacdc.cn

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摘要：

目的 了解利福平耐药肺结核患者诊疗费用，为耐药肺结核经济负担相关政策的制定或调整提供参考。方法 采用分层抽样和便利抽样相结合的方法，从我国东部、中部和西部地区分别抽取6、3和5个省份，每个省份抽取1~2个工作配合度较高的地市，每个地市抽取1家工作配合度较高的定点医疗机构开展调查。对2021年1—6月治疗的利福平耐药肺结核患者实施问卷调查，进行疾病经济负担分析。结果 本研究共调查162例患者，从出现症状到治疗完成平均总费用为109 452（69 530，182 365）元，其中直接医疗费用88 681（58 967，160 611）元，直接非医疗费用10 299（4 710，19 029）元，间接费用974（0，4 380）元。患者自付费用68 052（44 597，93 761）元，自付比例为63.78%（43.79%，81.07%）；其中直接医疗费用自付比例为54.88%（36.10%，78.21%），西部地区[71.35%（48.78%，96.10%）]和非住院患者[90.23%（65.90%，100.00%）]直接医疗费用自付比例较高（H=35.061，Z=38.650，P均<0.01）。患者家庭灾难性支出发生率为96.25%；自付总费用占家庭年收入的比例在不同文化程度、职业、地区，是否为家庭收入最高者以及是否为流动人口的患者间差异有统计学意义（H=21.536、38.579、11.439，Z=2.931、-3.830，P均<0.01）。多因素分析结果表明，与学生及老师患者相比，职业为农民（b=2.395，95%CI：1.249~3.541）和家务及待业（b=2.324，95%CI：0.753~3.894）是患者经济负担增加的危险因素。结论 我国利福平耐药肺结核患者疾病经济负担较重，尤其是直接医疗费用较高；需要重点关注农民、家务及待业人群的肺结核疾病经济负担。

关键词: 耐药肺结核, 利福平, 诊疗费用, 经济负担

Abstract:

Objective To understand the diagnosis and treatment costs for patients with rifampicin-resistant pulmonary tuberculosis in order to provide references for development or adjustment of the policies for this population group. Methods By stratified sampling and convenience sampling methods, we initially selected 6, 3 and 5 provinces from the eastern, central and western regions of China, respectively. Then one or two cities with higher degree of work cooperation was/were singled out from each province, and one designated medical institution with effective work cooperation was selected from each city for the survey. A questionnaire survey was conducted among rifampicin-resistant pulmonary tuberculosis patients who were treated from January to June 2021, and the economic burden of disease was analyzed. Results In this study, 162 patients underwent the survey. The mean total cost from the onset of symptoms to the completion of treatment was 109 452 (69 530, 182 365) yuan, of which the direct medical cost was 88 681 (58 967, 160 611) yuan, and the direct non-medical cost was 10 299 (4 710, 19 029) yuan. The mean indirect cost was 974 (0, 4 380) yuan. Self-paid expense was 68 052 (44 597, 93 761) yuan, with the proportion of individual payment being 63.78% (43.79%, 81.07%). The proportion of individual payment for direct medical expenses was 54.88% (36.10%, 78.21%), and the proportion was higher in western region [71.35% (48.78%, 96.10%)] and non-hospitalized patients [90.23% (65.90%, 100.00%)] (H=35.061, Z=38.650; all P <0.01). The incidence of catastrophic health expenditure of patients’ families was 96.25%. There were significant differences in the proportion of total out-of-pocket expenses in annual household income among patients with different education levels, occupations, regions, whether they were from families with the highest household income, or whether they were floating population (H=21.536, 38.579, 11.439; Z=2.931, -3.830; all P <0.01). The results of multivariate analysis showed that farmers (b=2.395, 95%CI: 1.249-3.541) and housework and unemployment (b=2.324, 95%CI: 0.753-3.894) were the risk factors for increased economic burden of patients compared with students and teachers. Conclusion The economic burden of patients with rifampicin-resistant pulmonary tuberculosis in China is relatively heavy, especially the direct medical expenses are relatively high. Meanwhile, special attention should be paid to the economic burden of such tuberculosis victims as farmers, domestic workers and the unemployed.

Key words: Drug-resistant pulmonary tuberculosis, Rifampicin, Medical treatment expenses, Economic burden

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