RESUMO
OBJECTIVE： To study direct medical expense and its influential factors， and to provide empirical reference for medical expenses control of pulmonary embolism and the adjustment of anticoagulant drug reimbursement strategy. METHODS： Based on the national urban basic medical insurance data in 2014， the data of patients with pulmonary embolism were extracted by equidistant sampling method to form a sample database. According to related therapy information and expense information of pulmonary embolism patients in sample database， descriptive analysis was performed for demographic characteristics of patients （including gender， age， type of medical insurance， region， type of medical institution， etc.）， direct medical expenses and direct medical expenses of patients with different anticoagulants， etc. Multiple linear regression analysis was used to analyze potential influential factors for the medical expenses of patients. RESULTS： A total of 475 pulmonary embolism patients were included， a total of 1 090 visits were recorded， and the average length of stay was 12.37 days. The annual medical expense per capita of patients was 10 847.42 yuan （median was 4 113.00 yuan）， hospitalization expense per capita was 19 056.30 yuan （median was 13 042.86 yuan）， and outpatient expense per capita was 1 049.61 yuan （median was 418.70 yuan）. Results of subgroup analysis showed that annual medical expense in eastern， central and western cities were 9 203.54， 16 931.99 and 15 891.21 yuan. Per capita annual medical expenses of patients in tertiary hospitals were the highest （11 733.40 yuan）， followed by secondary hospitals， and the lowest was other medical related institutions. Among different anticoagulants treatment groups， the annual medical expense per capita （24 553.80 yuan） and annual drug expense per capita （12 088.96 yuan） were the highest in anticoagulant regimen of combined use of LMWH and UFH， while patients treated with warfarin alone had the lowest annual medical expense per capia （2 350.24 yuan） and annual drug expense per capita （1 163.67 yuan）. The multiple linear regression showed that the factors affecting medical expense per visit were type of patient （inpatient or outpatient），type of medical institution and type of complications. CONCLUSIONS： Direct medical expense per capita of patients with pulmonary embolism is still high， and the economic burden of disease is still heavy. Patients with pulmonary embolism treated with combination of LMWH and UFH had the highest medical expense per capita. The types of visit， types of medical institutions and complications can influence medical expense of patients significantly.
RESUMO
OBJECTIVE： To evaluate the effects of Pharmacy Benefit Management （PBM） model on drug compliance， health outcomes， economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS： In cross-sectional study， the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling， the questionnaire survey （including subjective evaluation） was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching （PSM） was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance，QALY， hospitalization probability，monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases， etc. RESULTS： A total of 755 valid questionnaires were collected， including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender， age， education degree， nature of household registration， type of medical insurance or usual visited medical institutions （P＜0.05）. About 95％ patients （405 cases） satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group； the hospitalization probability in PBM group was 0.56 times as that in the non-participating group （P＜0.05）. There was no statistical significance of difference in control of blood pressure QALY， monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups （P＞0.05）. CONCLUSIONS： The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However， the effects of PBM on patients’ control of blood pressure， QALY and medical expense are not obvious， and its long-term effect needs more follow-up studies to verify.