中国哮喘的医疗资源利用与相关费用：一项为期 1 年的回顾性研究。
Medical resource utilization and the associated costs of asthma in China: a 1-year retrospective study.
机构信息
College of Pharmacy, Jinan University, Guangzhou, 510632, China.
International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, 510632, China.
出版信息
BMC Pulm Med. 2023 Nov 22;23(1):463. doi: 10.1186/s12890-023-02685-0.
BACKGROUND
Despite evidence that severe and poorly controlled asthma are associated with more clinical unmet needs and intensive utilization of healthcare resources, limited data is available on severe asthma expenditure in China. The study aimed to assess Medical Resource Utilization (MRU) costs of asthma and explore the cost drivers in order to better understand the economic burden of the Chinese population suffered from asthma.
METHODS
A retrospective analysis was conducted using Chinese sampled national claim database. Patients aged 6 years and above with primary diagnosis of asthma and asthma-related medical visit/hospitalization during 2015 were included. Medication was used as a proxy per the GINA and China guideline to identify asthma severity (i.e. mild, moderate, and severe). multiple linear regression model was conducted to identify MRU costs drivers.
RESULTS
7,254 patients diagnosed with asthma were included: 4,529 (62.4%), 2,200 (30.3%), and 525 (7.2%) had mild, moderate, and severe asthma, respectively. On average, each severe patient spent 6,782 Chinese Yuan (CNY) on asthma treatment and had 57.0% hospitalization rate during the year, 3.9- and 4.4-fold of the average of overall population (P < 0.001 for both). The proportion of patients experiencing exacerbation significantly higher in the severe asthma population (66.5%; P < 0.001) compared to mild (30.0%) and moderate (16.8%) groups. In subgroup with 1,660 samples had annual consecutive data, severe patients had annual cost of CNY 8,314 and 52.2% hospitalization rate. 13% of severe patients who had frequent severe exacerbation (≥ 2 events) experienced the highest annual average cost CNY 23,037, P < 0.001) whereas children aged from 6 to 14 with a lower annual cost of CNY 1,094.2, 1,660.2 and 3,020.2 for mild, moderate, and severe patients respectively. The multiple model identified degree of severity, control status, complications, age, and live region as independent drivers of MRU costs.
CONCLUSIONS
Chinese asthma patients bear heavy economic burden. Severe asthma associated with higher MRU (mainly from hospitalization) and costs compared with mild to moderate asthma in China. More efforts should be devoted to the control of the disease severity and complication as the main drivers of asthma cost.
背景
尽管有证据表明严重和控制不佳的哮喘与更多的临床未满足需求和医疗资源的密集利用有关，但在中国，关于严重哮喘支出的数据有限。本研究旨在评估哮喘的医疗资源利用（MRU）成本，并探讨成本驱动因素，以便更好地了解中国哮喘患者的经济负担。
方法
使用中国抽样国家索赔数据库进行回顾性分析。纳入 2015 年有哮喘主要诊断和哮喘相关医疗就诊/住院的年龄在 6 岁及以上的患者。根据 GINA 和中国指南，药物使用被用作识别哮喘严重程度（即轻度、中度和重度）的替代指标。采用多元线性回归模型确定 MRU 成本驱动因素。
结果
共纳入 7254 例哮喘患者：4529 例（62.4%）、2200 例（30.3%）和 525 例（7.2%）分别为轻度、中度和重度哮喘。平均而言，每个重度患者在哮喘治疗上花费 6782 元人民币（CNY），当年住院率为 57.0%，是总体人群的 3.9-4.4 倍（均 P < 0.001）。重度哮喘患者的哮喘恶化比例明显高于轻度（66.5%；P < 0.001）和中度（30.0%和 16.8%）组。在具有 1660 个样本的亚组中，重度患者的年费用为 8314 元人民币，住院率为 52.2%。13%的重度患者频繁发生严重恶化（≥2 次），年平均费用最高，为 23037 元人民币（P < 0.001），而年龄在 6 至 14 岁的儿童年费用分别为轻度、中度和重度患者的 1094.2、1660.2 和 3020.2 元人民币。多元模型确定了严重程度、控制状况、并发症、年龄和居住地区是 MRU 成本的独立驱动因素。
结论
中国哮喘患者负担沉重的经济负担。与轻度至中度哮喘相比，严重哮喘与更高的 MRU（主要来自住院）和成本相关。应更加努力控制疾病严重程度和并发症，作为哮喘成本的主要驱动因素。
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