Analysis on influencing factors of hospitalization costs of echinococcosis surgery patients in designated echinococcosis hospital in Gansu Province

doi:10.12140/j.issn.1000-7423.2024.04.006

Abstract

Abstract:

Objective To analyze the hospitalization cost of echinococcosis surgery patients and its influencing factors in Gansu provincial designated echinococcosis hospital, and to provide basis for effieicent management of the medical cost for echinococcosis. Methods Data of echinococcosis patients who underwent surgery at provincial designated hospital in Gansu Province from January 2014 to December 2023 were collected. The data included patients’ basic information (hospitalization year, gender, occupation, age, medical insurance type, ethnicity), clinical information (admission pathway, whether transferred from another department, length of hospital stay, type of echinococcosis, disease outcome, presence of complications, location of cyst, type of surgery), and hospitalization cost data (total hospitalization cost, surgery cost, western medicine cost, consumables cost, diagnostic cost, other costs). Data analysis was conducted using the SPSS 29.0 statistical software. Median was used to represent the hospitalization cost. In single factor analysis, Mann-Whitney U test was used for comparison between two groups, and Kruskal-Wallis H test for comparison among multiple groups for non normal distribution data. Multivariate analysis was performed using multiple linear regression. Results A total of 540 echinococcosis surgery patients’ data were collected, including 504 patients with cystic echinococcosis and 36 patients with alveolar echinococcosis; 280 females and 260 males, with a total combined hospitalization cost of 20 809 800 yuan, a per capita hospitalization cost of 38 528.41 yuan, and median hospitalization cost of 33 732.87 yuan. In 2014 versus 2023, the hospitalization costs for patients with echinococcosis per capita increased from 31 276.59 yuan to 45 902.34 yuan. The median hospitalization costs for male and female cases were 35 232.35 and 31 891.16 yuan, respectively, and the difference was statistically significant (Z = -2.343, P < 0.05); the median hospitalization cost for patients ≥ 61 years old was the highest, 35 233.75 yuan, and the cost difference between different ages was statistically significant (P < 0.05); the median hospitalization cost for individual patients was the highest, 39 843.04 yuan, and the difference in hospitalization costs between different occupations was statistically significant (P < 0.05); the median hospitalization cost for Dongxiang patients was the highest at 65 401.29 yuan, and the difference in hospitalization costs between different ethnic groups was statistically significant (P < 0.05); the median hospitalization cost for patients transferred to ICU was 62 720.04 yuan, higher than the 32 526.89 yuan for patients who were not transferred to the department, and the difference was statistically significant (Z = -7.440, P < 0.05); the median hospitalization cost of patients with hospitalization time ≥ 21 d was the highest at 54 433.71 yuan, and the difference in hospitalization cost between different hospitalization times was statistically significant (P < 0.05); the median hospitalization cost of patients with multilocular echinococcosis was 43 949.85 yuan, higher than that of patients with fine-grained echinococcosis at 33 555.82 yuan (Z = -3.317, P < 0.05); the median hospitalization cost of transferred patients was the highest at 104 536.50 yuan, and the difference in hospitalization costs for different types of disease transfer was statistically significant (P < 0.05); the median hospitalization cost among patients with complications was 46 855.89 yuan, higher than that of 32 476.43 yuan for patients without complications (Z = -6.060, P < 0.05); the median hospitalization cost of patients with hepatic echinococcosis was 32 433.02 yuan, which was lower than that of patients with multi-organ echinococcosis, which was 43 550.83 yuan (Z = -4.933, P < 0.05); the median hospitalization cost of patients who underwent liver transplantation was the highest, which was 170 030.84 yuan, and the difference in hospitalization costs between different surgical procedures was statistically significant (P < 0.05). The results of multivariate linear regression analysis showed that the main factors influencing the cost of hospitalization for patients undergoing surgery for echinococcosis were year of hospitalization (t = 5.937, P < 0.01), age (t = 3.349, P < 0.01), occupation (t = 2.238, P < 0.05), whether or not to transfer to a different department (t = 8.778, P < 0.01), length of hospitalization (t = 7.346, P < 0.01), type of echinococcosis (t = 6.049, P < 0.01), the presence or absence of complications (t = 5.967, P < 0.01), location of cyst (t = 3.767, P < 0.01). Conclusion The per capita hospitalization cost of echinococcosis surgery patients in provincial designated hospital increased year by year from 2014 to 2023, The main factors influencing of hospitalization costs include year, age, occupation, whether or not to transfer to a different department, length of hospitalization, type of echinococcosis, the presence or absence of complications and location of cyst.

Key words: Echinococcosis, Hospitalization expenses, Influencing factors, Gansu Province

CLC Number:

R532.3

XU Dan, YAN Jun, YAN Huan, HE Hongfeng, LIANG Tianhu, ZHAO Junxian, CHEN Yaolong, LI Xun. Analysis on influencing factors of hospitalization costs of echinococcosis surgery patients in designated echinococcosis hospital in Gansu Province[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2024, 42(4): 461-468.

Figures/Tables 4

Table 1

Composition of hospitalization costs for echinococcosis patients in provincial designated hospital in Gansu, 2014-2023

年份 Year	手术费用 Surgical costs		西药费用 Western medicine costs		耗材费用 Cost of consumables		诊断费用 Diagnostic costs		其他费用 Other expenses		总费用 Total costs
年份 Year	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%	中位数/元（四分位间距/元） Median/Yuan (Interquartile/Yuan)	构成比/% Composition/%
2014	4 504.50 （1 594.45）	15.6	12 109.51 （6 669.20）	47.1	1 910.82（2 311.86）	11.1	3 850.00 （1 573.78）	14.2	2 660.90（1 929.94）	12.0	27 054.33（12 268.00）	100
2015	5 020.90 （2 594.40）	17.5	12 699.87 （8 096.34）	44.8	2 624.06（2 544.13）	12.1	4 374.25 （2 322.95）	15.4	2 593.60（1 917.70）	10.2	28 950.78（13 956.28）	100
2016	5 208.30（2 993.45）	15.4	12 518.51（12 303.15）	45.6	2 970.96（2 631.16）	11.8	4 975.55 （1 970.00）	15.2	2 592.05（2 719.00）	12.1	31 844.02 （13 963.15）	100
2017	7 364.00（2 634.65）	22.3	9 905.59 （8 727.04）	36.7	2 823.48（2 627.20）	11.6	5 617.80 （2 083.30）	16.9	3 442.69（2 512.04）	12.5	31 398.14 （16 918.51）	100
2018	10 160.50 （4 386.88）	30.0	7 744.07 （4 666.37）	25.5	2 289.20（2 325.00）	10.4	5 935.75 （4 209.88）	18.3	4 332.19（3 710.06）	15.8	30 850.39 （13 546.43）	100
2019	10 580.50 （4 486.00）	28.7	8 541.66 （5 517.14）	24.7	4 014.54（5 032.30）	17.2	5 846.00 （2 918.00）	17.7	3 605.23（2 213.23）	11.6	34 385.75 （15 454.93）	100
2020	10 807.50 （4 923.00）	27.1	8 785.47 （7 558.26）	26.6	3 911.18（3 870.38）	14.1	6 827.50 （4 668.75）	20.9	3 692.50（2 476.54）	11.4	36 577.94 （17 561.82）	100
2021	9 759.50 （4 169.00）	26.6	8 014.12 （3 463.83）	22.1	5 318.90（4 833.24）	19.8	7 439.00 （4 248.50）	20.1	3 918.50（2 516.00）	11.4	35 687.65（17 990.87）	100
2022	11 749.25 （3 834.63）	30.2	7 549.39 （5 349.57）	19.4	5 464.98（5 001.73）	17.8	7 524.50 （4 515.88）	20.2	3 887.50（2 771.75）	12.4	39 421.68（16 299.23）	100
2023	11 038.00 （5 285.00）	25.9	8 511.17 （6 057.80）	22.3	7 794.05（7 523.30）	21.9	7 280.00 （3 869.50）	17.5	4 870.60（2 675.50）	12.5	40 291.50（23 121.97）	100

Table 1

Table 2

Basic information and hospitalization costs of echinococcosis surgery patients at designated provincial hospital in Gansu from 2014 to 2023

分类 Categorization	病例数/例 No. cases/case	占比/％ Percentage/%	住院总费用中位数/元 Median total hospitalization costs/Yuan
性别 Gender
女 Female	280	51.9	31 891.16
男 Male	260	48.1	35 232.35
年龄组/岁 Age group/Year
≤ 20	16	2.9	23 094.78
21~40	97	18.0	31 547.76
41~60	323	59.8	33 694.61
≥ 61	104	19.3	35 233.75
职业 Occupation
农牧民 Farmers and herdsmen	447	82.8	33 694.61
工人 Workers	35	6.5	32 086.24
干部 Functionary	17	3.1	32 238.67
退（离）休人员 Retiree	14	2.6	36 899.60
学生 Schoolchildren	12	2.2	23 094.78
个体 Self-employed	15	2.8	39 843.04
民族 Ethnic group
汉族 Han	454	84.1	33 870.42
藏族 Zang	35	6.5	29 578.24
回族 Hui	37	6.9	33 905.31
东乡族 Dongxiang	8	1.5	65 401.29
其他 Other	6	1.0	21 121.83
医保类型 Type of medical insurance
城镇职工基本医保 Basic medical insurance for urban workers	40	7.4	33 483.69
城镇居民基本医保 Basic medical insurance for urban residents	222	41.1	34 298.88
新型农村合作医保 New rural cooperative medical insurance	202	37.4	32 496.88
全自费 Fully self-financed	19	3.5	28 895.83
其他 Other	57	10.6	34 646.25
入院途径 Pathway to hospitalization
急诊 Emergency call	21	3.9	32 120.25
门诊 Outpatient service	501	92.8	33 694.61
转诊 Referral	18	3.3	36 976.76
是否转科 Whether or not to transfer
无 No	505	93.5	32 526.89
转ICU ICU transfer	35	6.5	62 720.04
住院时间/d Length of hospitalization/d
0~10	92	17.0	27 515.59
11~20	371	68.7	33 348.51
≥ 21	77	14.3	54 433.71
棘球蚴病类型 Types of echinococcosis
细粒棘球蚴病 Cystic echinococcosis	504	93.3	33 555.82
多房棘球蚴病 Alveolar echinococcosis	36	6.7	43 949.85
疾病转归 Disease regression
痊愈 Heal	304	56.3	32 250.26
好转 Improve	235	43.5	35 232.35
转院 Transfer to hospital	1	0.2	104 536.50
有无并发症 Any complications
无 No	493	91.3	32 476.43
有 Yes	47	8.7	46 855.89
棘球蚴寄生部位 Location of cyst
肝脏 Liver	451	83.5	32 433.02
多脏器 Multi-organ	89	16.5	43 550.83
手术方式 Type of surgery
外囊完整剥除术 Complete cystectomy	198	36.7	32 355.63
内囊摘除术 Endocystectomy	130	24.1	29 545.46
内囊 + 外囊摘除术 Endocystectomy + cystectomy	104	19.2	33 743.71
肝部分切除术 Partial hepatectomy	69	12.8	41 713.35
腹腔镜下包虫切除术 Laparoscopic hidatid-ectomy	37	6.8	36 937.62
肝移植 Liver transplant	2	0.4	170 030.84

Table 2

Table 3

Univariate analysis of total hospitalization costs for echinococcosis patients in designated provincial hospital in Gansu from 2014 to 2023

研究变量 Research variables	检验值 Test value	P值 P value
手术年份 Operation year		< 0.05^b
性别 Gender（0 = 女 Female，1 = 男 Male）	Z = -2.343	< 0.05^a
年龄 Age（1 = ≤ 20岁 ≤ 20 years，2 = 21~40岁 21-40 years，3 = 41~60岁 41-60 years，4 = ≥ 61岁 ≥ 61 years）		< 0.05^b
职业 Occupation（1 = 农牧民 Farmers and herdsmen，2 = 工人 Workers，3 = 干部 Functionary，4 = 退（离）休人员 Retiree，5 = 学生 Schoolchildren，6 = 个体 Self-employed）		< 0.05^b
民族 Ethnic group（1 = 汉 Han，2 = 藏 Tibetan，3 = 回 Hui ethnic group，4 = 东乡 Dongxiang ethnic group，5 = 其他 Other）		< 0.05^b
医保类型 Type of medical insurance（1 = 城镇职工基本医保 Basic medical insurance for urban workers，2 = 城镇居民基本医保 Basic medical insurance for urban residents，3 = 新型农村合作医保 New rural cooperative medical insurance，4 = 全自费 Fully self-financed，5 = 其他 Other）		> 0.05^b
入院途径 Pathway to hospitalization（1 = 急诊 Emergency call，2 = 门诊 Outpatient service，3 = 转诊 Referral）		> 0.05^b
是否转科ICU Whether or not to transfer ICU（0 = 否 No，1 = 是 Yes）	Z = -7.440	< 0.05^a
住院时间 Length of hospitalization（1 = 0~10 d，2 = 11~20 d，3 = ≥ 21 d）		< 0.05^b
棘球蚴病类型 Types of echinococcosis（1 = 细粒棘球蚴病 Cystic echinococcosis，2 = 多房棘球蚴病 Alveolar echinococcosis	Z = -3.317	< 0.05^a
疾病转归 Disease regression（1 = 痊愈 Heal，2 = 好转 Improve，3 = 转院 Transfer to hospital）		< 0.05^b
有无并发症 Any complications（0 = 无 No，1 = 有 Yes）	Z = -6.060	< 0.05^a
棘球蚴寄生部位 Location of cyst（1 = 肝脏 Liver，2 = 多脏器 Multi-organ）	Z = -4.933	< 0.05^a
手术方式 Type of surgery（1 = 外囊完整剥除术 Complete debridement of the external capsule，2 = 内囊摘除术 Endocystectomy，3 = 内囊 + 外囊摘除术 Internal + external capsule removal，4 = 肝部分切除术 Partial hepatectomy，5 = 腹腔镜下包虫切除术 Laparoscopic peritonectomy，6 = 肝移植 Liver transplant）		< 0.05^b

Table 3

Table 4

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变量 Variant	偏回归系数 Biased regression coefficient	标准偏回归系数 Standardized partial regression coefficient	t值 t value	P值 P value	F值 F value	调整后R² Adjusted R²
常数项 Constant term	-3 257 800.579		-5.994	< 0.01	35.906	0.437
手术年份 Operation year	1 600.561	0.207	5.937	< 0.01
性别 Gender	-134.061	-0.003	-0.094	> 0.05
年龄 Age	3 618.456	0.116	3.349	< 0.01
职业 Occupation	1 451.051	0.075	2.238	< 0.05
民族 Ethnic group	597.174	0.021	0.606	> 0.05
是否转科ICU Whether or not to transfer ICU	27 263.505	0.303	8.778	< 0.01
住院时间 Length of hospitalization	10 104.449	0.258	7.346	< 0.01
棘球蚴病类型 Types of echinococcosis	17 756.202	0.203	6.049	< 0.01
疾病转归 Disease regression	-331.173	-0.008	-0.225	> 0.05
有无并发症 Any complications	15 938.668	0.207	5.967	< 0.01
棘球蚴寄生部位 Location of cyst	7 372.307	0.125	3.767	< 0.01
手术方式 Type of surgery	769.385	0.045	1.320	> 0.05