| Background:Advanced schistosomiasis is caused due to untreated or incomplete treatment after the infection of Schistosoma japonicum It is a chronic disabling condition associated with portal hypertension,splenomegaly,ascites,and gastro-oesophageal variceal bleeding,or with severe growth retardation or granulomatous disease of the large intestine.At present,the World Health Organization(WHO)and the World Bank's Global Burden of Disease(GBD)project only treats ascites,bladder pathology,dysuria,hepatomegaly,hydronephrosis,anemia,mild schistosomiasis and diarrhea as the health outcomes of schistosomiasis when measuring the disease burden.Different species of the genus Schistosoma and clinical stages of the disease have not been distinguished,and not all symptoms of schistosomiasis japonica are covered,leading to an underestimation of the disease burden.Accurate measurement of the burden of advanced schistosomiasis japonica is therefore of great significance for optimizing the allocation of health resources.Objectives:To compare and optimize the methods used for assessing the burden of advanced schistosomiasis japonica and measure the disease burden(DALYs)and economic burden of patients with advanced schistosomiasis in China,so as to provide decision-making basis for improving the strategies and approaches for the rescue of advance cases.Methods:The patients with advanced schistosomiasis japonica receiving cure and assistance in Hunan Province in 2017 were recruited and the epidemiological characteristics of the cases were described firstly.The GBD estimation method,modified GBD metihod and quality of life evaluation method were applied to compare the accuracy of different measurements.The direct economic burden of advanced schistosomiasis cases was calculated,and indirect economic burden was estimated by the combination of disability-adjusted life year(DALY)with the hunan capital method.Multiple linear regression analysis was used to analyze the influencing factors of the economic burden.Based on the parameters obtained from the sample analysis of Hunan Province,the disease burden and economic burden of advanced schistosomiasis were calculated from 2011 to 2017,and the trend and distribution characteristics were analyzed to evaluate the effect of the treatment and cure project for advanced schistosomiasis japonica in China.Results:1)The mean age of patients with advanced schistosomiasis in Hunan Province was 63.63 ± 10.86 years old,and the ratio of male to female patients was= 2.08:1.The major clinical types included ascites(56.09%)and splenomegaly(43,64%).88.12%of the patients had medical insurance,and the New Cooperative Medical System(NCMS)was the predominant type of medical insurance types(94.48%)Among the clinical symptoms,the prevalence of ascites was the highest.Most patients underwent medical therapy(99.38%),and only 0.62%received surgical treatment2)The GBD method showed that the YLD of advanced cases was 673.94 YLDs,the per capita loss was 0.181 YLDs,and the YLD rate was 10.61 YLDs per 100,000.The modified GBD method showed that the patient's YLDs were 728.77 YLDs,the per capita loss was 0.196 YLDs,the YLD rate was 11.48 YLDs per 100,000,and the YLDs were 8.1%higher than the GBD method.According to the self-evaluation method,the patient's YLDs were 1761.99 YLDs,the per capita loss was 0.474 YLDs,the YLD rate was 27.75 YLDs per 100,000,and the YLDs were 2.6 times than that of the GBD method.The main symptoms contributing to the burden of advanced schistosomiasis included ascites,moderate anemia,severe anemia,diarrhea and hematochezia.3)The mean annual direct medical economic burden,direct non-medical economic burden,indirect economic burden,indirect economic burden of relatives and annual total economic burden of advanced schistosomiasis were 5454.21 CNY,366.00 CNY,25787.13 CNY,2077.93 CNY and 31564.85 CNY,respectively.The top five disease burdens of direct medical economic burden included medicine costs,laboratory tests,treatment costs,bed costs and inspection.The multiple linear regression analysis showed that five factors influencing economic burden of schistosomiasis included age,duration of hospital stay,conditions of hospitalization,medical treatment and frequancy of praziquantel therapy.Among these factors,the duration of hospital stay and the condition of hospitalization were the common factors affecting direct economic burden,indirect economic burden and total economic burden.4)The DALYs of advanced schistosomiasiswas 15679.02 DALYs and the rate of DALY was 31.11 DALYs per 100,000 and the male to female ratio was 1.14:1 in 2017.The burden of advanced schistosomiasis was mainly caused by YLD,accounting for 73.24%of the total disease burden,and the ratio of YLD to YLL was 2.74:1.The highest DALY rate was found in lake and marshland endemic areas(4.028 DALYs per 100,000),followed by in plain regions with waterway networks(2.115 DALYs per 100,000),and hilly and mountainous areas(DALYs per 100,000).In 2017,the total economic burden of advanced schistosomiasis was 823 million CNY in China,and the indirect economic burden was 4.79 times more than the direct economic burden.5)From 2011 to 2017,the DALYs,the rate of DALY and per capita loss DALYs for patients increased by 19.50%,15.61%and 12.63%,respectively.Of all DALYs,the YLDs were higher than YLLs,and the male DALYs were higher than female DALYs.The increase in the burden of advanced schistosomiasis was greater in females than in males,with a reduction from 1.38:1 male to female ratio in 2011 to 1.14:1 in 2017,and the gender difference in the burden of advanced schistosomiasis also showed a gradual decrease.The mean DALYs increased by 10.43%and 14.30%in males and females from 2011 to 2017,respectively,and the mean DALYs and increase were both greater in females than in males.6)The DALY and DALY rates showed an upward trend from 2011 to 2017 in schistosomiasis-endemicareas,with a minimum increase of 12.66%in the lake and marshland endemic areas and a maximum of 83.77%in the hilly and mountainous endemic areas.From 2011 to 2017,the DALY rate increased by 9.28%and 55.38%in the lake and marshland and hilly and mountainous endemic areas,while the DALY rate decreased by 2.54%in the plain regions with waterway networks.A downward trend of disease burden was seen in Hunan and Jiangxi provinces while an upward trend was found in Jiangsu,Hubei,Yunnan,Zhejiang,Anhui and Sichuan provinces.Conclusions:1)The burden of advanced schistosomiasis japonica is greatly underestimated by the measurement of GBD and the measurement of burden of advanced schistosomiasis based on the self-evaluation method can more comprehensively assess the impact of patients with advanced schistosomiasis.2)The burden of advanced schistosomiasis is heavy in China,similar to that of liver cancer secondary to alcohol consumption.The government should pay more attention to the advanced schistosomiasis and invest more funds for prevention,so as to prevent the poverty caused by returning to poverty due to the illness.3)The duration of hospital stay and the severity of advanced schistosomiasis are risk factors for the burden of advanced schistosomiasis,while the frequency of praziquantel therapy and medical insurance are protective factors.Shortening the duration of hospital stay and increasing the popularity of medical insurance may reduce the economic burden of advanced schistosomiasis.4)The indirect economic burden of advanced schistosomiasis is much higher than the direct economic burden.It is suggested that medical insiurance is the first choice for the advanced schistosomiasis cases followed by the cure and assistance project,so as to minimize the economic burden of advanced schistosomiasis.5)The cure and assistance policy for advanced schistosomiasis has reduced the disease burden caused by early death(YLL),and the proportion of advanced schistosomiasis YLL has been decreas:ing year by year since 2012.Improving the intervention of chronic schistosomiasis which hepatic fibrosis above grade 2 is an important way to reduce the occurrence of advanced schistosomiasis.6)From 2011 to 2017,the cost-effectiveness of medical rescue was the best in lake and marshland areas endemic for schistosomiasis.In the future,the lake and marshland endemic ares should be the strategic focus of advanced schistosomiasis rescue,so as to maximize the benefits of policy. |
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