中国四川儿童造血干细胞移植的成本分析。
Cost analysis of childhood hematopoietic stem cell transplantation in Sichuan, China.
机构信息
Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.
出版信息
Front Public Health. 2023 Mar 23;11:990181. doi: 10.3389/fpubh.2023.990181. eCollection 2023.
OBJECTIVE
To analyze the inpatient cost of hematopoietic stem cell transplantation (HSCT) in children, so as to support clinical decision-making.
METHODS
Study population were children who received HSCT in a tertiary children's hospital (Sichuan, China) between 1st January 2020 and 31st December 2021. The median and interquartile range (IQR) of total cost at 100 days post transplantation were calculated. Subgroup analyses were conducted based on age, gender, transplantation types, and post-transplant complications. The cost differences between subgroups were analyzed to determine whether it had an impact on the total costs.
RESULTS
A total of 142 pediatric patients were included in the study with a total cost of 250721.78 yuan (197019.16-315740.52, 1 yuan equals to around 0.15 US dollars). Drug costs accounted for 51.85% of the total cost, followed by medical service costs (12.57%) and treatment expenses (12.24%). In terms of transplantation types, the cost of autologous transplantation was lower than that of allogeneic transplantation (115722.98 yuan vs. 256043.99 yuan, < 0.05), and the cost of human leukocyte antigen (HLA) complete matched was lower compared with that of partial matched (213760.88 yuan vs. 294044.84 yuan, < 0.05). As for post-transplant complications, cases with <3 types of complications cost less than those with ≥3 types (212893.25 yuan vs. 286064.60 yuan, < 0.05), and those with severity ≤ grade 2 cost less than those > grade 2 (235569.37 yuan vs. 280061.58 yuan, < 0.05). Age and gender of patients did not lead to statistical differences in the total cost, while the transplantation types and post-transplant complications influenced the total cost.
CONCLUSION
The total cost at 100 days post transplantation associated with HSCT treatment were substantial for pediatric patients. The HLA compatibility between donors and recipients, and post-transplant complications were important factors affecting the total cost.
目的
分析儿童造血干细胞移植（HSCT）的住院费用，为临床决策提供支持。
方法
研究对象为 2020 年 1 月 1 日至 2021 年 12 月 31 日期间在某三级儿童医院接受 HSCT 的儿童。计算移植后 100 天的总费用中位数和四分位距（IQR）。根据年龄、性别、移植类型和移植后并发症进行亚组分析。分析亚组之间的费用差异，以确定其是否对总费用有影响。
结果
本研究共纳入 142 例儿科患者，总费用为 250721.78 元（197019.16-315740.52，1 元约合 0.15 美元）。药物费用占总费用的 51.85%，其次是医疗服务费用（12.57%）和治疗费（12.24%）。就移植类型而言，自体移植的费用低于异体移植（115722.98 元比 256043.99 元， < 0.05），HLA 完全匹配的费用低于部分匹配（213760.88 元比 294044.84 元， < 0.05）。对于移植后并发症，并发症种类<3 种的费用低于≥3 种（212893.25 元比 286064.60 元， < 0.05），严重程度≤2 级的费用低于>2 级（235569.37 元比 280061.58 元， < 0.05）。患者的年龄和性别对总费用没有统计学差异，但移植类型和移植后并发症影响总费用。
结论
HSCT 治疗后 100 天的总费用对儿科患者来说是巨大的。供受者 HLA 相容性和移植后并发症是影响总费用的重要因素。
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