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背景:尽管治疗结核病不一定都需要住院,但在澳大利亚,90％结核病病人在医院启动治疗。 目标:计算和比较结核病住院与门诊治疗的费用,以衡量转变住院治疗为不住院治疗的影响。方法:在澳大利亚维多利亚州进行一项费用的研究,通过1994-1995会计年维多利亚州报告的疾病资料库与医院患者资料配对核实,计算所有登记报告的结核病病人中住院者的比例。以多种来源获得的数据计算住院与不住院的费用。采用Excel软件计算不同比例的住院与不住院治疗对卫生保健费用的影响。 结果:1994-1995年登记报告的结核病病人近90％(239/269)为住院治疗。住院治疗的费用(平均长达2周)每人约5447澳元,总费用为1301833澳元。住院费用占费用总数的60％。而门诊治疗费用则为每人2260澳元。如90％病人均门诊治疗,总费用则可降至693670澳元。作者估计至少55％结核病病人门诊治疗将是可行的,这样可减少近30％的费用。 结论:病情不复杂的结核病病人事实上可不必常规住院治疗,但工业化国家则常如此。如果更多结核病病人在门诊治疗,可在资源利用上更符合费用一效益原则。
Background: Although treating tuberculosis does not necessarily require hospitalization, in Australia, 90% of TB patients start treatment at the hospital. Objectives: To calculate and compare the costs of inpatient and outpatient tuberculosis treatment in order to measure the impact of changing hospitalization for out-of-hospital treatment. METHODS: A cost study was conducted in Victoria, Australia using a matched database of disease databases and hospital patient data from the Victorian state report for the 1994-1995 fiscal year to calculate the proportion of in-patients who reported all TB cases. Data from a variety of sources are used to calculate the cost of hospitalization and non-hospitalization. Using Excel software to calculate the different proportions of hospital and non-hospital treatment on health care costs. Results: Nearly 90% (239/269) of the reported tuberculosis patients in 1994-1995 were hospitalized. Hospitalization costs (up to an average of 2 weeks) are about $ 5447 per person for a total cost of $ 1,301,833. Hospitalization costs account for 60% of the total costs. Outpatient treatment costs $ 2,260 per person. If 90% of patients are outpatient treatment, the total cost can be reduced to 693670 Australian dollars. The authors estimate that an out-patient treatment of at least 55% of tuberculosis patients will be feasible, reducing the cost by nearly 30%. CONCLUSIONS: Tuberculosis patients with uncomplicated disease may in fact not need to be routinely hospitalized, but this is often the case in industrialized countries. If more tuberculosis patients are treated in outpatient settings, it is more cost-effective to utilize resources.