| 文晓娟,束仁佳,李彤,凌永睿,曹素梅.鼻咽癌病例住院费用及影响因素分析[J].中华流行病学杂志,2026,47(3):549-554 |
| 鼻咽癌病例住院费用及影响因素分析 |
| Analysis on hospitalization expenditures and influencing factors in nasopharyngeal cancer patients |
| 收稿日期:2025-07-21 出版日期:2026-03-19 |
| DOI：10.3760/cma.j.cn112338-20250721-00509 |
| 中文关键词: 鼻咽癌|经济负担|住院费用|影响因素 |
| 英文关键词: Nasopharyngeal carcinoma|Economic burden|Hospitalization expenditures|Influencing factor |
| 基金项目:广东省医学科学技术研究基金（C2023054）；广东省卫生经济学会2025年度科研课题（2025-WJMZ-74） |
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| 中文摘要: |
| 目的 分析鼻咽癌病例的住院费用及变化趋势，评估其造成的经济负担及相关影响因素。方法 按年份随机抽取2019年1月至2023年12月在华南地区某三甲专科医院进行根治性治疗的初诊鼻咽癌病例（排除复发、转移、合并严重并发症及非根治性治疗病例），收集其住院费用及相关信息，包括基本信息、肿瘤特征、治疗方式、付费方式、住院总费用及其构成等。主要分析指标为每例病例的住院费用M（经居民消费价格指数调整至2023年值），采用单因素及多因素广义线性模型分析其影响因素。按年份分层分析费用的构成及其变化趋势。结果 最终共纳入788例鼻咽癌病例，确诊年龄为（47.0±11.7）岁，598例（75.9%）病例来自华南地区。男性584例（74.1%），716例（90.9%）病例为晚期。鼻咽癌病例住院费用M（Q1，Q3）为146 289（125 083，178 056）元。2019-2021年鼻咽癌病例住院费用M分别为150 718、151 811、157 463元，2022、2023年分别降至139 696元和134 621元。费用构成方面，住院费用以放疗费为主（83 430元，59.7%），其次是药物治疗费（26 580元，19.0%）。多因素广义线性模型分析结果显示，商业保险/公费付费方式病例的住院费用M（150 045元）高于城镇居民保险病例（144 524元）［aOR=1.11（95%CI：1.06~1.16），P<0.001］。鼻咽癌晚期病例的住院费用M（149 342元）高于早期病例（114 476元）［aOR=1.11（95%CI：1.03~1.19），P=0.002］；综合治疗病例的住院费用M（148 573元）高于单纯放疗组（99 727元）［aOR=1.33（95%CI：1.21~1.47），P<0.001］。2022年（139 696元）和2023年病例的住院费用M（134 621元）低于2019年（150 718元）［aOR=0.93（95%CI：0.88~0.99），aOR=0.87（95%CI：0.82~0.93），均P<0.05］。结论 鼻咽癌病例住院费用M较高，近年平稳中略有下降；付费方式、临床分期、治疗方式、住院年份是影响住院费用的主要因素。 |
| 英文摘要: |
| Objective To analyze the hospitalization expenditures and their temporal trends in patients with nasopharyngeal carcinoma (NPC), and evaluate the associated economic burden and influencing factors. Methods A random sampling survey was conducted in newly diagnosed NPC patients undergoing curative therapy in a grade Ⅲ cancer hospital in Southern China from January 2019 to December 2023 to obtain their hospitalization cost data, the patients with recurrence, metastasis, severe complications or receiving no radical therapy were excluded. The collected data included basic demographics, tumor characteristic, treatment way, payment method, total hospitalization expenditure, and their composition. The primary outcome was the median hospitalization expenditure per case (adjusted to 2023 values using the Consumer Price Index). Univariate and multivariate generalized linear models were used to identify factors associated with hospitalization expenditures. The annual cost composition and temporal trends were analyzed. Results A total of 788 NPC patients were finally included with an age of diagnosis of (47.0±11.7) years, in whom 598 (75.9%) were from Southern China, 584 (74.1%) were men, and 716 (90.9%) were at advanced stage. The M(Q1, Q3) hospitalization expenditure per case was 146 289 (125 083, 178 056) yuan. The median expenditures in 2019, 2020 and 2021 were 150 718, 151 811 and 157 463 yuan, respectively, and the median expenditures decreased to 139 696 yuan in 2022 and 134 621 yuan in 2023. Regarding cost composition, the expenditure for radiotherapy was highest (83 430 yuan, 59.7%), followed by the expenditure for medication (26 580 yuan, 19.0%). Multivariable generalized linear model analysis showed that the median hospitalization expenditure (150 045 yuan) was higher in patients with commercial insurance or public funding than in those with urban resident basic medical insurance (144 524 yuan) (aOR=1.11, 95%CI: 1.06-1.16, P<0.001). Patients in advanced stage had higher expenditures (149 342 yuan) compared with those in early stage (114 476 yuan) (aOR=1.11, 95%CI: 1.03-1.19, P=0.002). Patients receiving comprehensive treatment incurred higher expenditures (148 573 yuan) compared with those receiving radiotherapy alone (99 727 yuan) (aOR=1.33, 95%CI: 1.21-1.47, P<0.001). The median hospitalization expenditures of patients in 2022 (139 696 yuan) and 2023 (134 621 yuan) were lower than those in 2019 (150 718 yuan) (aOR=0.93, 95%CI: 0.88-0.99; aOR=0.87, 95%CI: 0.82-0.93, both P<0.05). Conclusions The median hospitalization expenditure per case in NPC patients was high with a slight decreasing trend in recent years. Payment method, clinical stage, treatment way, year of hospitalization were the main factors influencing the hospitalization expenditure. |
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