[Survey of economic burden of hepatitis B-related diseases in 12 areas in China].

Objective: Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China, so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking. This study aimed to analyze the direct, indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China. Methods: The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study. All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases. The direct expenditure included direct medical cost and direct non-medical cost. The indirect expenditure, including work loss of patients and caregivers, were calculated by using human capital method for urban and rural populations in 12 areas. The intangible expenditure were reflected by willing to pay and stochastic tournament. The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis. Results: A total of 27 hospitals in 12 areas were included in the survey. A total of 4 718 cases were surveyed, the overall response rate was 77.7%. The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case, in which the highest proportion (61.2%) was medicine fees [10 365.10 yuan (RMB)]. The average direct expenditure and indirect expenditure were consistent with the severity of illness, which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively, with the ratio of 3.85 ∶ 1. The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)]. It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures. Among the average indirect expenditure, the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)]. The total direct and indirect expenditure was highest for liver transplantation, followed by severe hepatitis, hepatocellular carcinoma and decompensated cirrhosis, acute hepatitis B, compensated cirrhosis and chronic hepatitis B. The influencing factors for both direct and indirect expenditure were high hospital level, severity of hepatitis B, living in urban area, antiviral therapy, long hospitalization and monthly income of family. For average 3.74 outpatient visits and 1.51 hospitalization, the average annual direct, indirect and intangible expenditure for HB-related diseases were 30 135.30, 6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)], accounting for 37.3%, 7.7% and 55.0%, respectively. Of the annual direct medical expenditure [28 402.80 yuan (RMB)], which were much higher than non-medical expenditure [1 732.50 yuan (RMB)], hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)]. The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB), respectively. Of the annual intangible expenditure, the highest was that for primary hepatocellular carcinoma, followed by cirrhosis, chronic hepatitis B, severe hepatitis B, liver transplantation and acute hepatitis B. Conclusions: A heavy economic burden has been caused by HB-related diseases in China, and patients are more likely to rely on medical service rather than non-medical service. It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits. The influence of HB related diseases on mental health of the people can be reflected by an economics term, intangible expenditure.目的： 中国缺少全国性乙型肝炎（乙肝）相关疾病经济负担研究，本病的社会经济危害未能阐明，乙肝防治经济学评价缺乏关键参数；本研究旨在获得我国不同地区乙肝相关疾病患者住院期间及年均直接、间接和无形费用。 方法： 选取中国12个地区的传染病专科医院和综合性医院，采用时间阶段连续病例整群抽样法，对住院治疗的乙肝相关疾病患者进行调查。直接费用包括直接医疗和直接非医疗费用；间接费用采用人力资本法，分地区按城镇和农村人口计算患者和陪护人误工费；无形费用采用支付意愿法。多元线性逐步回归分析直接和间接费用的影响因素。 结果： 全国12个地区共调查医院27所，有效调查样本4 718例，总应答率为77.7%。按住院期间计算，平均住院29.2（27~34）d，例均费用16 832.80元，药费（10 365.10元）占比（61.2%）最高；直接和间接费用分别为18 336.10元和4 759.60元，二者之比3.85∶1，直接和间接费用高低与乙肝严重程度相一致。直接医疗费用为17 434.70元，高于直接非医疗费用（901.40元）；直接医疗费用中，住院费高于门诊费和自购药费；直接非医疗费用中，旅费最高。间接费用中，患者误工费（3 832.50元）高于陪护人误工费（927.20元）。直接和间接费用合计高低依次为肝移植、重型乙肝、原发性肝癌和失代偿期肝硬化，而急性乙肝、代偿期肝硬化和慢性乙肝（CHB）较低。直接和间接费用共同影响因素为医院级别高、乙肝相关疾病严重、城市户籍、使用抗病毒治疗、住院天数多、家庭收入高。按1年计算，年均门诊和住院3.74次和1.51次，年均直接、间接和无形费用分别为30 135.30元、6 253.80元和44 729.90元，合计总费用为81 119.00元；直接、间接和无形费用的构成比分别为37.3%、7.7%和55.0%。年均直接费用中，住院直接费用（26 074.20元）高于年均门诊费（4 061.10元），年均直接医疗费用（28 402.80元）远高于年均直接非医疗费用（1 732.50元）。年均间接费用中，门诊和住院间接费用分别为763.60元和5 490.10元。年均无形费用以肝癌最高，肝硬化和CHB次之，重型乙肝和肝移植均较低，急性乙肝最低。 结论： 乙肝相关疾病给中国带来了沉重经济负担，患者更多的依赖医疗服务，非医疗服务费用较少；采取有效治疗策略，遏制乙肝相关疾病的恶化，将会收到显著的经济效益；乙肝相关疾病对人群心理健康的影响，可用无形费用给出经济学表述。.