Analysis of Direct Medical Expense of Patients with Pulmonary Embolism and Its Influential Factors in China ：Based on 2014 National Urban Basic Medical Insurance Data / 中国药房

ABSTRACT

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.