Health Economics Research On TCM Advantage Diseases From The Perspective Of "evidence-based + Value-based Medicine

Objective:1.Taking patients as the center,this study attempted to introduce the concept of dominant diseases of TCM,and selected two dominant diseases of ORTHOPedics and surgery of TCM with clear clinical pathway,few complications and complications,mature diagnosis and treatment technology,controllable quality,prominent characteristics of TCM treatment,and little difference in treatment.Systematic evaluation and meta-analysis were conducted to verify the clinical efficacy of TCM treatment schemes compared with western medicine treatment for the same diseases,providing a certain reference for evidence-based medical evidence of TCM superior diseases.2.This study the advantages of traditional Chinese medicine disease to historical cost and the cost of a clinical pathway for empirical research,using the method of health economics evaluation,the cost-effectiveness evaluation of input-output analysis,to test and verify the economic effect of treatment of traditional Chinese medicine to provide certain reference,so as to fully reflect the fair value of TCM medical services and use of traditional Chinese medicine diagnosis and treatment of technical labor value of medical personnel,We will promote traditional Chinese medicine and make policy suggestions on the current payment methods for medical insurance,especially the payment standards for TCM medical services.3.Taking the equivalent study of different diagnosis and treatment methods of the same disease as an example,the economic evaluation model based on value is explored to provide evidence support for health evidence-based decision-making,expand the specific practice of value medicine in China and make theoretical summaries,so as to better improve the governance capacity and level of medical and health care and health field.Method:1.The dominant diseases of TCM were selected by statistical analysis and expert questionnaire.First,the medical record data of Hunan provincial TCM hospitals from January 1,2017 to December 31,2021 were cleaned,desensitized and corrected,and the top ten dominant TCM diseases in the number of discharged patients in Hunan provincial TCM hospitals were counted from the management level.Secondly,based on the national policy,combined with the actual situation of Hunan Province,from the policy level,summarized the current hunan Province is implementing TCM by disease collection and payment of 10advantages of TCM diseases.Finally,the 20 dominant diseases of TCM were selected by expert questionnaire.2.Rev Man 5.3 and Stata 12.0 were used for meta-analysis on the clinical efficacy of TCM dominant diseases.Among them,dichotomous variables are calculated by odds ratio(OR),and mean difference(MD)OR standardized mean difference(SMD)is calculated for continuous variables.Both are expressed as values with 95%confidence intervals(CI).The heterogeneity was evaluated by I~2and Chi-square test.When I~2≦50%,the fixed-effect model was used for analysis.When I~2>50%,the random effects model was used.The results are presented by forest map.For all outcomes,publication bias was assessed by Egger and Begg tests or funnel plots.The level of meta-analysis was P=0.05.3.In the empirical study of the dominant diseases of TCM,the analytical methods used for the analysis of the historical cost of the dominant diseases of TCM include historical cost deduction method,structural change analysis method and grey correlation analysis method,and the cost-effectiveness analysis method is used for the analysis of the clinical path cost of the dominant diseases of TCM.SPSS 22.0 software was used for statistical analysis.Descriptive statistical analysis,mean test,logistic regression,correlation test,one-way analysis of variance,partial correlation analysis,multiple linear regression analysis and other methods were used for statistical analysis.Result:1.Selection of dominant diseases of TCM.(1)Results of TCM dominant diseases of"management":vertigo,bi syndrome,apoplexy,cough,lumbago,thirst,upper limb fracture,snake string sore,lung cancer,asthma syndrome;(2)Results of dominant diseases of TCM in"clinical scientific Research"category:clavicular fracture,mixed hemorrhoids(main operation mode:upper hemorrhoids annular resection and anastomosis of rectal mucosa),mixed hemorrhoids(main operation mode:Ligation of internal hemorrhoids),herpes zoster,distal radius fracture,superior 1/3 fracture of ulna with dislocation of radial head,pulmonary heart disease(chronic pulmonary heart disease),apoplexy(acute phase of ischemic stroke),anal fistula(high anal fistula),disintegration(dysfunctional uterine bleeding).2.Systematic evaluation and meta-analysis of clinical efficacy and related factors of TCM bone-setting for distal radius.A total of 19 articles were contained.TCM bonesetting remarkably improved the patients’excellent and good rate[OR=7.77,P<0.00001],pain scores[MD=-0.95,P<0.00001],length of stay[MD=-3.19,P<0.00001],hospitalization expenses[SMD=-2.42,P<0.00001],complications[OR=0.28,P=0.009].3.Systematic evaluation and Meta analysis of clinical efficacy and related factors of acupuncture in the treatment of herpes zoster.A total of 45 literatures were included,involving 3550 patients,including 1832 patients in the treatment group and 1718 patients in the control group.Meta-analysis showed that acupuncture significantly improved the total effective rate compared with conventional treatment of western medicine such as antiviral therapy[OR=4.37,P<0.00001].Pain relief,such as decreased pain score[MD=-1.43,P<0.00001],reduced pain intensity[MD=1.42,P<0.00001];The herpes situation was improved,such as shortening the time of stopping the blister[MD=-1.17,P<0.00001],the time of forming scab[MD=-2.14,P<0.00001],the time of removing scab[MD=-4.66,P<0.00001].Adverse events were decreased[OR=0.16,P<0.00001].The complication rate was decreased,for example,the incidence of neuralgia after 30d[OR=0.21,P=0.17],60d[OR=0.27,P=0.99],90d[OR=0.28,P=0.98].4.An empirical study on dominant diseases of TCM.(1)Payment standard of medical insurance quota:11,048 yuan for distal radius fracture,covering 80%of patients in 2021;Herpes zoster was7454 yuan,covering 58.46%of patients in 2021.(2)Cost-effectiveness analysis:the cost of herpes zoster in the TCM group(9311.9 yuan)was lower than that in the Western medicine group(11976.4 yuan),and the effect of TCM was better than that of western medicine,so TCM was more economical.The cost of fracture of distal radius in TCM group(9476.62yuan)was much lower than that in WESTERN medicine group(14844.75 yuan),and the effect of TCM was better than that of western medicine,so TCM was more economical.(3)The main factors affecting the hospitalization expenses of the two diseases:length of stay.Conclusions:1.Compared with operation and other western medicine treatment,TCM bone-setting treatment can significantly improve the good rate of distal radius fracture,reduce the pain score,reduce the incidence of complications,suggesting that TCM bone-setting treatment of distal radius fracture clinical efficacy is superior to western medicine.Length of stay and cost of hospitalization are important factors that reflect the unique advantages of TCM bonesetting.Compared with western medicine treatment such as antiviral therapy,acupuncture and moxibustion of Traditional Chinese medicine significantly increased the total effective rate of herpes zoster and reduced the pain score,indicating that acupuncture and moxibustion has more significant clinical efficacy in the treatment of herpes zoster than western medicine treatment.Acupuncture treatment greatly reduced the occurrence of adverse events and improved the complications such as neuralgia.Therefore,acupuncture and moxibustion has its unique advantages in disease treatment,disease control and safety,and is affordable and easy to be accepted by patients.In general,TCM treatment that embodies the characteristics and advantages of TCM can not only effectively improve the clinical efficacy of the disease,but also significantly reduce the pain of patients,reduce the economic burden of the disease and improve the quality of life of patients;2.From the cost-effectiveness analysis,the economic effect of the TRADITIONAL Chinese medicine group was better than that of the Western medicine group,which showed that the implementation of the traditional Chinese medicine clinical pathway had obvious advantages in economic effect compared with the non-traditional Chinese medicine clinical pathway;3.There is room for further optimization of medical cost structure;4.There is room for adjusting the payment quota standard of medical insurance.The evaluation system of TCM evidence-based medicine should be established to increase the research on clinical efficacy of TCM dominant diseases.Continue to implement TCM clinical pathway management and give full play to TCM characteristics and advantages;We will promote the simultaneous adjustment of medical service prices and the reform of payment methods,give full play to the role of TCM medical insurance payment,and implement the"same effect at the same price"or"high quality at a superior price"in the payment of TCM superior diseases by referring to the pricing mechanism of Western medicine.Continuously improve the information disclosure mechanism and supervision mechanism,explore the construction of credit evaluation system for medical institutions and medical insurance doctors of different levels in different regions,promote the change of medical behavior of medical institutions and medical insurance doctors,and ensure the smooth implementation of policies.