| Objective: For Wilson's disease inpatients embodiment TCM clinical path management, comparison of TCM clinical pathway group and TCM non-clinical pathway group dominant western medicine group in medical expenses, medical efficiency of medical quality and characteristics of Chinese medicine terms for further Wilson degeneration TCM treatment specification provides practicable basis, through cost- utility analysis, evaluate the intervention Wilson's disease clinical medicine path, provide a reference for further study.Methods: Controlled trial using the same period, met the inclusion criteria of Wilson's disease patients 120 people(were hospitalized patients) were randomly divided into TCM clinical pathway group, Chinese non-clinical pathway group and western medicine group. TCM clinical path of patients according to TCM diagnosis and treatment path, the path of non-Chinese medicine patients in routine clinical practice of traditional Chinese medicine treatment, treatment group received only western medicine treatment. Collect 3 groups of patients hospitalized fees constitute hospitalized content and efficacy data and its statistical analysis, as well as more cost-utility analysis to evaluate the significance of its health economics.Results:Medical efficiency and economic indicators:(1)The average hospital stay Compare: TCM clinical pathway group and TCM non-path group, Western medicine group were significant difference(P<0.05), TCM non-path group treatment group compared with no significant difference between the two(P>0.05).(2)total hospital cost comparison: TCM clinical pathway group and TCM non-path group having a significant difference(P<0.05), compared with the treatment group with a very significant difference(P<0.01), TCM non-path group and Western medicine group there was no significant difference(P>0.05).(3)daily hospitalization cost comparison: Chinese medicine group and TCM path other than a path group, Western medicine group, statistical analysis showed no significant difference(P>0.05). Chinese medicine and Western medicine group of non-path group the average daily cost of hospitalization was no significant difference(P>0.05).(4) total drug cost comparison: Chinese medicine group and TCM path other than a path group, Western medicine group were extremely significant difference(P<0.01). Chinese medicine and Western medicine non-path group was no significant difference(P>0.05) compare the total cost of the drug.(5)medicine cost comparison: TCM path group and TCM non-path group, Western medicine group were extremely significant difference(P<0.01), TCM non-path group and Western medicine group with a very significant difference(P<0.01).(6)Chinese medicine treatment cost comparison: Chinese medicine group and TCM path other than a path group, Western medicine group were extremely significant difference(P<0.01). Chinese medicine and Western medicine group of non-path group with a very significant difference(P<0.01).(7) Check the cost comparison: TCM path group, treatment group compared with the traditional Chinese medicine non-path group, have significant difference(P<0.01), TCM non-path group treatment group compared there was no significant difference(P>0.05). Clinical outcome measures:(1)The total clinical efficacy comparison: clinical pathway group, 10 cases markedly effective in 25 cases, the total efficiency of 92.1%; Chinese medicine non-path group markedly effective in 6 cases, effective in 28 cases, the total efficiency of 85.0%; treatment group markedly 3 cases, effective in 25 cases, the total efficiency of 71.2%; TCM path group and TCM non-path group having a significant difference(P<0.05), and Western medicine group, the total comparison there was a significant difference(P<0.01) efficiency. Chinese medicine and Western medicine group of non-path group, the total effective rate was significant difference(P<0.05).(2)UWDRS scores: TCM group path, the path of non-Chinese medicine group, western medicine group UWDRS total score compared with before treatment have a very significant difference(P<0.01).Chinese medicine group and TCM path other than a path group, Western medicine group after treatment between the two groups were highly significant difference(P<0.01),Chinese medicine and Western medicine non-path group therapy group had no significant difference(P>0.05) among the latter group.(3) symptom score comparison: TCM path group, Chinese non-path group, have a very significant(P<0.01) as compared to pre-treatment group treatment group within the group. Comparison after treatment has significant difference(P<0.05) between the group and the Chinese medicine TCM path other than a path group group, there was a significant difference(P<0.01) between the treatment group compared with the group. There was no significant difference(P>0.05) between non-traditional Chinese medicine and Western medicine group group group path.(4)24h urinary copper: Compared with before treatment, the treatment before the end of the last 24 h urinary copper: 3 urinary copper values have risen, in the group were very significant differences(P<0.01); Chinese medicine group and TCM path non-path group group there was significant difference(P<0.05), Chinese medicine path group and Western medicine group group there was a significant difference(P<0.01), there was no significant difference between Chinese medicine non-path group and the treatment group group(P>0.05). Cost utility analysis:(1)cost comparison: TCM path consisting of the costs associated with TCM non-path group, the treatment group compared were significant differences(P<0.05), TCM non-path group treatment group compared with no significant difference between the two(P>0.05).(2)utility value comparison: at the end of treatment group 3 utility value of patients have a very significant difference(P<0.01) compared with the previous improvements, TCM path group and TCM non-path group utility comparison with a very significant difference between value groups(P<0.01), and treatment group utility value among groups showed significant differences(P<0.05), no significant difference(P>0.05) TCM non-path group and treatment group. QALY value(3)obtained by comparison: at the end of therapy, Chinese path group and TCM non-path group, the treatment group showed significant differences(P<0.05) as compared to non-Chinese medicine non-path group and the treatment group compared to the significant difference(P>0.05).(4)CUR and sensitivity analysis: each get a quality adjusted life years, hospitalized path group takes 350,307.24 / person, Chinese non-path group spent 433,114.23 / person, the treatment group spent 427,205.00 / person. Sensitivity analysis of the three groups, with the results, even in the case of small variable for reasonable mobility, CUR value obtained is still consistent with the original results, cost effectiveness evaluation findings of this study will not be affected, indicating that the cost- utility analysis results are reliable better implementation of clinical pathways Chinese medicine is still the economy, cost-effective solution.Conclusion:(1) Wilson's disease clinical pathway of Chinese medicine in the hospital efficiency and operations management have obvious advantages, the patient length of stay decreased, total cost of hospitalization, drugs total cost medicine costs, inspection costs are significantly reduced, TCM treatment costs increased significantly, clinical significantly improved efficacy, indicating that the implementation of Wilson's disease clinical pathway in Chinese medicine to improve the quality of medical services, give full play to the characteristics and advantages of Chinese medicine case, greatly reducing the cost of hospitalization, the hospital as much as possible to avoid the waste of resources;(2)When TCM clinical path as a medical management model used in Wilson's disease, and its cost- effectiveness ratio was better than not using TCM clinical path of case group(TCM group and the path of non-Western group), the implementation of TCM clinical path It is more economical and cost-effective solution. |
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