Research On Economic Burden Of Disease And Its Determinants Of Hand,Foot And Mouth Disease Patient In Shandong Province

BackgroundHand, foot and mouth disease is a frequent acute infectious disease in under the age of four of children caused by enterovirus. The patient is characterized by fever and hand, foot, mouth and other parts of herpes or herpes. A small number of patients with serious complications and death can occur. HFMD not only affects the patients’ health, and can even lead to death, but also spreads to the surrounding children, leading to serious social and public health problem. Over the past decade, the hand, foot and mouth disease occurred in numerous large-scale outbreak or epidemic in many countries and regions, especially in the Asia-Pacific region, caused the death of a certain number of children, more and more national attention. The outbreak or epidemic of hand, foot and mouth disease also occurred in Shandong, Anhui and other parts of China in recent years. The Ministry of Health announced the Class C notifiable infectious disease including the hand, foot and mouth disease on May2,2008. The number of reported cases is increasing year by year, and the increase trend of severe from deaths is clear. There is no specific treatment or the disease vaccine on HFMD and mainly supportive therapy. It is difficult to control the outbreak situation and takes a huge burden to the many families, state and society. Few studies involved in the economic burden or influencing factors of the hand, foot and mouth disease at home and abroad. Only Ningbo City, Zhejiang Province had sporadic report. Therefore, the aim to carry out the economic burden of HFMD is to understand the direct medical costs, direct nonmedical costs and indirect costs of different types(normal, heavy and critical type)cases, to provide for the EV71vaccine cost-effectiveness evaluation of local information,to analyze the influencing factors of the economic burden of the children, and to provide for the data base for the further protection of health policy and strategy.Objectives1. To investigate the hand, foot and mouth disease patients of sociodemographic characteristics of the seven areas in Shandong Province.2. To investigate the hand, foot and mouth disease related costs and loss of time during treatment process.3. To calculate the different economic levels of different types (normal, heavy and critical type) the economic burden of the patient’s, and to project the toal ecomonic burden of Shandong Province.4. To explore the influencing factors of the economic burden of HFMD cases, and provide for the data base for the further protection of health policy and strategy.Methods1. Literature Review:Consult Shandong statistical yearbook in2010and understand the city in2010per capita GDP, per capita disposable income of urban residents and per capita net income of rural residents.Collect the incidence, severe and deaths data of HFMD of Shandong province in2011through the National Disease Surveillance Report Management System.2. Cross-sectional study:According to the2010municipalities per capita GDP of Shandong Province, the cities will be divided into three economic level of high, medium and low. Each layer1-2randomly selected cities and counties, municipal, county medical institutions1-2randomly selected in each city. The select patients were visited between May1,2011-August31,2011in the project hospital. Get the information of the economic burden of patients with hand, foot and mouth through questionnaire and telephone.3. Data analyze:Use descriptive analysis to analyze of the HFMD patients’ demographic characteristics such as gender, age, family economic status. Analyze direct economic burden and indirect economic burden patients using univariate non-parametric tests. Use binary logistic regression model for multivariate analysis of the HFMD economic burden (direct and indirect).Results1. The total economic burden of Hand, foot and mouth disease in Shandong Province in2011was2.23billion yuan.2. The direct economic burden of per HFMD outpatients family cases was717.70yuan in2011. The indirect economic burden of per HFMD outpatients family cases was52.08yuan in2011. The direct economic burden of per HFMD ordinary inpatient family cases was4067.29yuan in2011. The indirect economic burden of per HFMD ordinary inpatient family cases was288.44yuan in2011. The direct economic burden of per HFMD severe inpatient family cases was12626.18yuan in2011. The indirect economic burden of per HFMD severe inpatient family cases was309.78yuan in2011.3. The influencing factors of HFMD outpatients direct economic burden were region, age, number of visits, medical insurance and per capita GDP.The ordinary inpatients influencing factors include the regional hospital grade. The severe inpatient influencing factors was region.4. The influencing factors of HFMD outpatients indirect economic burden were outpatient visits, area. The ordinary inpatients influencing factors included area. The severe inpatients influencing factors were region and gender.Conclusions1. Strengthen the hand, foot and mouth disease prevention and control system and improve the quality of medical services.2. Establish the health promotion model which involved in the various departments and put the government at the center. 3. Increase the intensity of the coverage of the social security, the diagnosis and treatment of Hand, foot and mouth disease in the new type of rural cooperative medical care and urban medical insurance.4. Standardize the diagnosis and treatment of medical institutions behavior and draw up the roadmap to develop hand, foot and mouth disease diagnosis and treatment.