摘要目的 对因COPD急性加重(AECOPD)和肺癌入院并死亡病例的住院期间医疗费用进行调在,了解两种疾病终未期住院费用的状况.方法 采用回顾性研究方法 调查北京协和医院2003年至2007年因AECOPD或肺癌住院并死亡病例的住院费用.两组间总费用及不同费用间比较采用Wilcoxon秩和枪验,对不同费用所占比例采用独立样本t检验.结果 共416例入组,其中肺癌330例,AECOPD 86例.AECOPD病例并发肺部感染、呼吸衰竭和肺心病以及冠心病、高血压和脑血管疾病的比例明显高于肺癌病例,211例(63.94%)肺癌病例出现重要脏器转移.AECOPD和肺癌病例住院费用总构成无明显差别,其中药费所占比例最高,分别为(37.2±12.6)%和(53.8±17.6)%,其次为治疗费[分别为(30.7±13.8)%和(17.9±11.5)%]及辅助检查费用[分别为(20.8±11.4)%和(16.5±8.6)%].AECOPD病例人均总费用的中位数(四分位间距)为74 143(102608)元,明显高于肺癌病例的37810(51 374)元(z=2.48,P＜0.05),其中AECOPD病例的治疗费为19324(61843)元,明显高于肺癌病例的5876(9764元).AECOPD病例药费占总费用比例[(37.2±12.6)%]明显低于肺癌病例[(53.8±17.6)%],治疗费占总费用比例[(30.7±13.8)%]明显高于肺癌病例[(17.9±11.5)%],筹异均有统计学意义(t值分别为7.34和8.00,均P＜0.01).结论 因AECOPD死亡的病例在末次住院期间的医疗费用明显高于肺癌病例,这与生命支持等诊治措施的费用明显增高有关.

abstractsObjective To examine the cost for patients who died in hospital with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)compared with those died with lung cancer,and to examine their variations.Methods A retrospective cohort study was performed.The patients who died in hospital between January in 2003 and December in 2007 were enrolled.Statistical analysis was performed using the SPSS 13.0.Results Totally 416 patients were enrolled,with 86 COPD patients and 330 lung cancer patients.Patients with COPD were older than those with lung cancer.The incidences of comorbidities such as coronary artery disease,hypertension,cerebrovascular disease,respiratory failure and lung infection in AECOPI)patients were higher than those in lung cancer patients.Second malignant neoplasm of important organs was found in 211 patients(63.94%)with lung cancer.In the last hospitalization,the total amount of direct medical costs was higher for patients with AECOPD than for patients with lung cancer[74143(102608)RMB vs 37 810(51374)RMB],z=2.48,P＜0.05,especially for the treatment cost[(19324(61843)vs 5876(9764),z=4.55,P＜0.01]and the laboratory cost[7976(18 397)vs 3397(4096),z=5.97,P＜0.01].There was no significant difference in the constituents of the cost between COPD and lung cancer patients(X2=8.23,P＞0.05).The percentage of the drug cost to the total cost was the highest,followed by the treatment cost and the auxiliary examination cost.The ratio of the drug cost to the total cost was lower in COPD patients(37.2±12.6)% vs(53.8±17.6)%,t=7.34,P＜0.01.while the constituent ratio of treatment cost was higher in COPD than in lung cancer patients (30.7±13.8)%,(17.9±11.5)%,t=8.00,P＜0.01.Conclusions There was significant variability in healtheare resource utilization between COPD and lung cancer patients in their last hospitalization of life,the main reason of which was the increased costa of maintenance of life.