摘要目的 从肝癌病程发展的视角,量化我国现患肝癌患者不同就诊年份的例均医疗费用,为基于肝癌疾病自然史的癌症负担及防控策略评价提供基线信息.方法 基于城市癌症早诊早治项目的13个省市项目点,对2012—2014年就诊的肝癌现患患者进行面对面调查,收集人和社会学信息和临床诊治信息、直接医疗费用和直接非医疗费用等信息.将肝癌患者首次就诊至调查终点的全部费用及就诊次数信息,以12个月为单位分割为逐年诊治费用和逐年就诊次数,观察两者的变化趋势,同时进行性别、年龄等亚组分析.费用数据贴现到2014年,统计分析采用SAS 9.4软件.结果 共纳入肝癌患者2 222例,确诊年龄(55.7±11.2)岁,男性79.2%(1 759例),女性20.8%(463例).75.6% (1 679例)来自肿瘤专科医院,Ⅰ期占14.1%(299例),62.6%(1 325例)为Ⅲ～Ⅳ期病例.64.4%(1 430例)的患者有病理信息,其中83.6%(1 195例)为肝细胞癌.首次就诊后前3个病程年样本量分别为2 222例、149例和57例,对应年例均总医疗费用分别为49 091(95% CI:47 376～50 806)元、30 506 (95% CI:26 462～34 549)元和32 100(95% CI:25 917～38 283)元(P<0.001),对应年均就诊次数依次为1.9次、1.6次和1.5次(P<0.001).各省份总体趋势与全国一致,但前2年费用下降幅度从1.4倍(浙江)到5.6倍(河南)不等.亚组分析显示,前3年的费用变化趋势在不同地区(P<0.001)及不同治疗方案(P<0.05)间存在不同.结论 我国肝癌患者就诊后第1年的费用为第2年的1.6倍且省间存在差异,但之后更长期病程的费用模式信息依然有限.

abstractsObjective To estimate the mean annual expenditure of patients with prevalent liver cancer in China on the perspective of the natural progression of the disease and to provide baseline information for liver cancer?related disease burden estimation and evaluation of prevention strategies. Methods A multicenter survey on liver cancer was conducted between 2012 and 2014 in 13 sites where the cancer screening program was conducted in Urban China, by face?to?face interviews with hospitalized patients. Data on basic information, clinical diagnosis and treatment, direct medical expenditure, and direct non?medical expenditure were collected. By?year expenditure and number of visits from the first visit to the end of the survey were analyzed. The trend for the two indicators in each year was analyzed. The subgroup analysis of factors such as sex and age was conducted. All the expenditure data were discounted to the year 2014 and presented in Chinese yuan. The statistical analysis was performed using the SAS 9.4 software. Results A total of 2 222 patients with liver cancer, with a mean age of 55.7±11.2 years, were included. Men accounted for 79.2% (1 759 cases) of the patients, women accounted for 20.8% (463 cases) of the patients, and 75.6% (1 679 cases) of the cases were from cancer hospitals. Stage Ⅰ cases only accounted for 14.1% (299 cases) of all the cases, and most cases were stageⅢorⅣ(62.6%, 1 325 cases). Of the cases, 64.4% (1 430 cases) had pathological information, and 83.6%(1 195 cases) were pathologically hepatocellular carcinoma. The sample sizes for the first 3 years from the first visit were 2 222, 149, and 57, respectively (by?year sample sizes thereafter were<50). The annual total medical expenditures for the first 3 years were 49 091 yuan (95% confidence interval [CI]: 47 376-50 806), 30 506 yuan (95% CI: 26 462-34 549), and 32 100 yuan (95% CI: 25 917-38 283) (P<0.001). The corresponding number of visits were 1.9, 1.6, and 1.5 (P<0.001). The trend for each province was consistent with the overall trend, while the down trend from years 1 to 2 varied among provinces, ranging from 1.4 (Zhejiang province) to 5.6 times (Henan province). For the trend in the first 3 years, differences were found in subgroups such as region (P<0.001) and treatment (P<0.05), instead of sex, age, stage, and other subgroups. Conclusions For liver cancer patients in China, the annual expenditure for the first year in the whole disease course was 1.6 times higher than that for the second year, which varied among provinces. However, information on annual expenditure for the later course of liver cancer is still limited.