Analysis Of Ecnomic Burden And Its Influencing Factors Among Muti-Drug Resistant Tuberculosis In Guangzhou

Objective:Tuberculosis is an infectious disease that seriously endangers human health.Muti-drug resistant tuberculosis（MDR-TB）is the focus of tuberculosis prevention and treatment.Because MDR-TB not only brings a heavy economic burden to the patient’s family and society,it also reduces the patient’s treatment compliance,which leads to a longer treatment time for the patient,which further increases the economic burden and creates a vicious circle.There are many influencing factors of the economic burden of MDR-TB.Previous studies have only analyzed the economic burden of MDR-TB from the direct economic burden of the family,and the influencing factors of the direct economic burden of MDR-TB families lack the influence of psychology and living habits on the direct economic burden of MDR-TB families.The purpose of this study is to understand the economic burden of MDR-TB from the direct and indirect economic burdens of MDR-TB patients.In addition,through the basic conditions of patients,diagnosis and treatment conditions,living habits and psychological conditions to explore the influencing factors that affect the direct economic burden and catastrophic expenditure of MDR-TB families.The analysis of comprehensive economic burden and influencing factors provides a scientific basis for the formulation of MDR-TB subsidy policies in Guangzhou,improving the quality of health services,and promoting the reform of the medical and health system.Methods:From September to December 2020,patients who were diagnosed with MDR-TB and were diagnosed with MDR-TB after standard treatment in the Multidrug Resistance Department of Guangzhou Chest Hospital were collected.Using a combination of face-to-face surveys and telephone surveys,the research subjects were surveyed through self-made questionnaires.The content of the questionnaire includes:the basic information of the patient（such as gender,age,household registration,etc.）,treatment status（such as comorbidities,drug withdrawal,etc.）,life and behavior habits（such as smoking and drinking before and after drug resistance）,psychological status and the patient Direct non-medical expenses（such as transportation expenses,boarding and lodging expenses,etc.）.By querying the hospital information system,the direct medical expenditures of the research subjects（such as anti-tuberculosis drug fees,laboratory examination fees,etc.）are collected.Qualitative data is described by frequency and percentage,and quantitative data is described by median and interquartile range.The quantitative data of non-normal distribution were compared with the rank sum test to compare the differences between groups,and the qualitative data was compared with the 2 test to compare the differences between groups.A stepwise multiple linear regression model was used to analyze the influencing factors of the family’s direct economic burden.Two-category stepwise logistic regression was used to analyze the influencing factors of catastrophic expenditure.Inspection level=0.05.Results:1.Basic information:（1）Demographic characteristics:A total of284 MDR-TB patients were included.There were 161 male patients（45.69%）and 123 female patients（43.31%）;the 25-45 age group had the most patients,120（42.25%）;there were 175 patients（61.62%）with registered permanent residence in Guangzhou.There were 109 patients（38.38%）with an annual family income of less than RMB 150,000;161patients（56.69%）had the most education level of secondary school or technical secondary school;210 patients（73.94%）were married patients;in the occupation,patients who were unemployed by housekeeping The number and proportion are the largest,152 cases（53.52%）;in the medical insurance,136 cases（47.89%）of the urban employee medical insurance.（2）Diagnosis and treatment:161 cases（56.69%）were newly treated patients;126 cases（44.37%）had other diseases;170 cases（59.86%）were treated with linezolid;203 cases（71.48%）Patients used self-administered medication to manage their medication;153 patients（53.87%）had side effects during medication;84 patients（29.58%）had drug withdrawal due to various reasons;during outpatient follow-up or hospitalization,there were accompanying persons There were 249patients（87.68%）who accompanied MDR-TB patients to the hospital;the proportions of patients who were resistant to two drugs,three drugs and more than three drugs were 40.14%,37.68%and 22.18%,respectively.（3）Life and behavior habits:51 patients（17.96%）smoked after drug resistance,which was 53 cases less than before drug resistance.There were 66 patients（23.24%）who drank alcohol after drug resistance,which was 44 cases less than before drug resistance.After the resistance of MDR patients,the number of participants in sports increased from 52（18.31%）to 171（60.21%）.（4）Psychological condition:The median Kessler score of MDR-TB patients is 20 points（18,24）.There were 190 MDR-TB patients（66.90%）with healthy mental health and 97（33.10%）unhealthy patients.2.Analysis of direct family economic burden and influencing factors:（1）Composition of family direct economic burden:The average family direct economic burden of MDR-TB patients who completed the entire treatment process was 132,677.30 yuan,with a median of108,760.81 yuan（47390.11,208523.38）.The direct medical expenses of patients accounted for the highest proportion of the direct economic burden of the family,at 93.67%.Anti-tuberculosis drugs accounted for the highest proportion of patients’direct medical expenses,accounting for 71.75%.Transport expenses account for the highest proportion of patients’direct non-medical expenses.Accounted for 42.97%.（2）The direct economic burden of the families of MDR-TB patients under different circumstances:the direct economic burden of the families of the floating population is greater than that of the registered population（Z=1.66,P=0.048）.The direct economic burden of the family of self-administered patients is greater than that of patients who have been supervised during the whole course of taking the drug（Z=10.48,P<0.001）;the direct economic burden of patients with drug withdrawal is greater than that of patients without drug withdrawal（Z=4.77,P<0.001）;The direct family economic burden of patients with drug side effects is greater than that of patients without side effects（Z=5.27,P<0.001）;the direct family economic burden of patients using linezolid is greater than that of patients not using linezolid（Z=12.42,P<0.001）;the direct economic burden of the family of patients with accompanying persons is greater than that of patients without accompanying persons（Z=4.75,P<0.001）.The direct economic burden of mentally healthy patients’families is less than that of mentally unhealthy patients（Z=9.11,P<0.001）.（3）Factors affecting the direct economic burden of the family:After the natural logarithm conversion of the direct economic burden of the family,a stepwise multiple linear regression model was used to indicate that the floating population（β=0.226,P<0.001）,self-administration（β=0.497,P<0.001）),drug side effects（β=0.189,P=0.001）,use of linezolid（β=0.722,P<0.001）,accompanied by an accompanying person（β=0.359,P<0.001）and no exercise after drug resistance（β=0.180,P=0.002）is a risk factor for the direct economic burden of the patient’s family.The direct economic burden of the family of patients with Guangzhou city registration is 1.25(e^0.226)times that of the floating population;the direct economic burden of the families of patients who supervise the medication throughout the entire process is1.64(e^0.497)times that of self-administered medications;do not exercise after drug resistance The direct economic burden of the family of patients is 1.19(e^0.18)times that of traveling after drug resistance.The direct family economic burden of patients with drug side effects is 1.21(e^0.189)times that of those without side effects;the direct family economic burden of patients taking linezolid is 2.01(e^0.722)times that of non-use linezolid;The direct economic burden of the family of a patient who is accompanied by an escort is 1.43(e^0.359)times that of a patient who is not accompanied by an escort.3.Analysis of catastrophic expenditures of MDR-TB patients and influencing factors:（1）Catastrophic expenditures of MDR-TB patients under different circumstances:The catastrophic expenditure rate of patients with floating population is higher than that of patients with household registration in Guangzhou（71.56%VS.18.86%,X²=78.36,P<0.001）.The catastrophic burden rate of patients with drug withdrawal is higher than that of patients without drug withdrawal（71.43%VS.25.50%,X²=52.41,P<0.001）;the catastrophic burden rate of patients with comorbidities is higher than that of patients without comorbidities（49.21%VS.31.01%,X²=13.67,P=0.002）;the catastrophic burden rate of patients with drug side effects is higher than that of patients without drug side effects（50.33%VS.25.95%,X²=17.61,P<0.001）.The catastrophic burden rate of patients who used linezolid was higher than that of patients who did not use linezolid（44.71%VS.30.70%,X²=5.62,P=0.018）.The catastrophic burden rate of patients who did not exercise after drug resistance was higher than that of patients who exercised after drug resistance（64.60%VS.22.22%,X²=51.33,P<0.001）.The catastrophic burden rate of mentally healthy patients was lower than that of mentally unhealthy patients（18.69%VS.86.05%,X²=114.26,P<0.001）.（2）Multi-factor analysis of catastrophic expenditure:Taking catastrophic expenditure as the dependent variable,the general demographic characteristics,diagnosis and treatment conditions,living habits and mental health conditions are incorporated into the two-category stepwise logistic regression model.The results showed that floating population,no exercise after drug resistance,drug withdrawal,comorbidities,use of linezolid,and mental health are risk factors for catastrophic expenditure.The risk of catastrophic expenditures for patients with registered permanent residence in Guangzhou is 0.12 times that of the floating population（adjusted OR=0.12,95%CI=0.05～0.26）;the risk of catastrophic expenditures for patients who have not exercised after drug resistance is due to exercise after drug resistance 0.26 times（adjusted OR=0.26,95%CI=0.15～0.44）;the risk of catastrophic expenditure in patients with drug withdrawal is 4.62 times that of patients without drug withdrawal（adjusted OR=4.62,95%CI=1.57～13.58）The risk of catastrophic expenditures in patients with comorbidities is 4.73 times that of patients without comorbidities（adjusted OR=4.73,95%CI=2.73～8.20）;the risk of catastrophic expenditures in patients using linezolid is not The use of linezolid was2.44 times（adjusted OR=2.44,95%CI=1.24～4.81）;the risk of catastrophic expenditures in patients with mental health was 9.54 times that of mental health（adjusted OR=9.54,95%CI=2.71～33.59）.4.The total social economic burden of patients with MDR-TB:（1）The human capital method estimates that the total cost of the family’s indirect economic burden is 2,289,655.69 yuan.（2）The DALY method estimates that the social indirect economic burden is 18,220,441.11 yuan,and the average social indirect economic burden is 64,156.48 yuan.（3）Total social economic burden:The total social economic burden of 284MDR-TB patients is 74,645,344.70 yuan,of which the direct economic burden is 54,135,247.90 yuan,accounting for 75.52%;the indirect economic burden is 20,510,096.80 yuan,accounting for 27.48%.The economic burden of every completion of a course of treatment of per MDR-TB patient to the society is about 262,835.72 yuan,and the direct economic burden to a family is 132,677.30 yuan.Conclusions:The direct economic burden of families of MDR-TB patients in Guangzhou is heavy,and the direct economic costs of patients are the main factor causing the direct economic burden of families.Government should intensify drug screening and health education to these high-risk patients who are floating population,who do not exercise after drug resistance,who use linezolid,whose medicine manage way is self-administration,who have drug side effects,who have drug withdrawal,who have comorbidities,who are mentally unhealthy,and who are accompanied by an accompanying,and make sure have patients early detected,early diagnosed,early treated,and less burden.While reducing the economic burden of patients and society,it also controlled the prevalence of MDR-TB.