| Objectives We aim to analyze Hepatitis B virus(HBV)infection related to the current state of the antiviral treatment and to evaluate the medical expenditures,and to provide reference data for enhancing antiviral treatment usage and promoting health condition,and improve the related health policies for Guangzhou to provide health economics basis.Methods Demographic characteristics(including gender,age and paymode type),cost information(including the total cost,examination cost,antiviral medicines cost,other expenses for medicine,bed care fees and other expenses,prescription information(including antiviral drug names,for example Interferon(IFN),Entecavir(ETV),Tenofovir Disoproxil Fumarate(TDF),Adefovir dipivoxil(ADV),Lamivudine(LAM),Telbivudine(Ld T);specifications,dosage,usage,and prescription date)of HBV related patients(including chronic hepatitis B(CHB),Cirrhosis of the liver(Cirrhosis)and hepatocellular carcinoma(HCC))who visited to the hospital during January 1,2008 and December 31,2015 were collected from hospitals’ electronic medical record database.The contents of the study were as follows:1.To calculate the annual direct medical expenses for outpatient and inpatient patients,the proportion of each cost component and the total expenses annually;2.Using Generalized estimating equations(Generalized estimating equations,GEE)adjusted for the individual effect,with logarithm functionand binomial distribution to explore the factors affecting antiviral therapy in patients,then using the quantile regression model with logarithm function and the gamma distribution to explore the influence factors of patients’ direct medical costs;All costs were calculated in RMB 2015 at a discount rate of 5% per year;Statistical analysis were carried out under SAS 9.4 software.Results 1.Both outpatients and inpatients have a trend of increasing in antiviral utilization rate year by year,outpatients increased from 30% to 56%,however,inpatients from 46% to 63%.2.Among outpatients,female and antiviral utilization rate was lower than that of men(PR=0.36,95% CI=(0.35~0.37);P<0.001)With the increase of age,the utilization rate of antivirals were higher;The utilization rate of antivirals in patients with medical insurance was higher than who paid out-of pocket(PR =1.38,95% CI=(1.35~1.40);P<0.001).The utilization rate of antivirals in Cirrhosis patients were higher than CHB and HCC patients.Among hospitalized patients,the utilization rate of antivirals of women was lower than that of men(PR =0.87,95% CI =(0.84~0.91);P<0.001);With the increase of age,the use of antiviral drugs increased.Patients with medical insurance(PR=1.07,95% CI =(1.03~1.11);P<0.001)and patients with free insurance(PR=1.10,95% CI =(1.03~1.18);P=0.005)had higher antiviral utilization rate than those who paid out-of pocket;Patients with Cirrhosis(PR=1.29,95% CI(1.26~1.32);P<0.01)had higher rates of antiviral utilization than patients with CHB.3.The use rate of IFN decreases year by year,whether in outpatient or inpatient;The utilization rate of ETV and TDF is increasing year by year;The use of LAM and ADV was first increased and then decreased;The use of Ld T was first reduced and then increased.4.The annual direct medical costs of patients in outpatients and inpatients are increasing.In 2015,the direct medical expenses of outpatient patients with CHB,cirrhosis and HCC were 1570.04,3823.50 and 1676.06 RMB respectively.The direct medical expenses of hospitalized patients with CHB,cirrhosis and HCC in 2015 were 5304.68,10574.83 and 23685.30 RMB respectively.In outpatients,the annual direct medical costs of the female and out-of pocket patients were lower than that of the male and the insuranced;The use of antiviral drugs,liver protection and traditional Chinese medicine will increase the annual direct medical costs of patients.As the disease progresses,the patient’s annual direct medical costs increase(all P<0.001).Among inpatients,the annual direct medical costs of the female and insuranced patients was lower than that of the male and who paid out-of pocket;As the disease progresses,the patient’s annual direct medical costs increase;The annual direct medical costs of the patients increased with age;The use of antiviral drugs,liver protection and traditional Chinese medicine will increase the annual direct medical expenses of patients;With the progress of the disease and the increase of hospital stay,the annual direct medical expenses of patients increased(all P<0.001).5.The results of the quantile regression showed that the use of antiviral drugs,liver protection and traditional Chinese medicine will increase the annual direct medical costs,and its impact on costs will more significant in higher quantile.6.Among outpatients,the cost of antiviral drugs accounted for 54.61% of the total direct medical expenses,followed by the cost of other drugs(excluding the cost of antiviral treatment,accounting for 28.76%);In hospitalized patients,other drug fees(not including antiviral treatment fees)have the highest percentage of total medical costs(accounting for 46.06%),followed by inspection examination(accounting for 23.63%),antiviral drugs cost accounts for about 6.17% of the total direct medical costs;As the disease progresses,the proportion of the cost of antiviral drugs decreases.Conclusion: 1.In the year of 2008-2015,utilization rate of antiviral drugs in patients with CHB related disease increased year by year,but there are still 43% of 2015 patients with chronic hepatitis b related diseases without using antiviral drugs;Male,older patients,with medical insurance,disease progression can increase the utilization rate of antiviral drugs.2.The annual direct medical expenses of patients with CHB-related diseases increased year by year from 2008 to 2015.Men,older patients,disease progression,increased length of stay,use of antiviral drugs,liver protection drugs,and traditional Chinese medicine all can increase patients’ annual direct medical expenses. |
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