Measurement And Analysis For Related Cost Of Drug-induced Liver Injury And Establish Of A Risk Assessment Index System With Delphi Method

ObjectivesOur research focus on DILI.firstly,we measured and analysed the related cost of drug-induced liver injury from different decision makers.And in the following we tried to establish a risk assessment index system of DILI.The project aims to strengthen the alertness of patients,medical and the whole society to DILI,also provide reference for developing scientific DILI prevention measures to early and effectively identify DILI risk factors.Methods1.Measurement and analysis for related cost of drug-induced liver injury from different decision marks.In retrospective study,60 cured or recovered DILI inpatients were randomly selected as subjects from medical record management system of 4 hospitals in Henan province during Jun.2014-Jun.2015.Demographic characteristic clinical characteristic and related cost of DILI were analyzed retrospectively and the cost structure was also analyzed from different decision makers(patient,society,medical insurance payer).2.Establish of a risk assessment index system for drug-induce liver injury with Delphi method.Based on a wide collection of DILI factors,DILI prevention,care and so on literature,a item pool about DILI was formed.By Delphi approach,the risk assessment indexes were made into table questionnaire,and 15 expert involved in the two rounds of questionnaire and scored the importance and authority of items.Through analysis the mean,rate of full marks,and coefficient of variation,weight coefficient of experts questionnaire and items selection by research group,ultimately determined the risk assessment system items.Results1.Among the 60 cases,twenty-two patients were male and thirty-eight patients were female.The average age was 45.8±12.24 and average extended time of hospital was 18.62±8.67 d.The top 3 drugs which caused liver injury were Chinese Herbal medicine and Chinese patent medicine(28.33%),anti-tubercular agent(18.33%),acetaminophen(10.00%).The total direct cost of 60 cases was 615 206.20 yuan,and total indirect cost was 169 379.95 yuan;The total cost of DILI offered by medical patients was 616 289.38 yuan;the total cost of DILI offered by society was 784586.15 yuan;the total cost of DILI offered by medical insurance was 168 296.77 yuan.2.The expert's positivity was high and the response rates of the two-round consultation were 100.00%.The coefficient of the expert's authorities Cr was 0.82;The expert's Kendall's W of the two-round questionnaire were 0.40 and 0.63.The risk assessment index system of DILI included five part(medicine factor,host factor,environmental factor,behavial factor and cognitive factors)and twenty three items were formulated.Conclusion1.Serious economic losses caused by DILI for patients,country and society can not be ignored,which remind medical works of considering hepatotoxicity of drug toearly diagnosis and treat DILI when develop a treatment plan.2.The Chinese hepatitis and Chinese Patent medicine were the main cause of DILI,so it is very important to give more attention on the use of Chinese traditional medicine.At the same time we should organise more DILI education and promotion activities.3.Sensitivity analysis revealed that simply raised the rate of reimbursement can seemingly reduce the patient's medical burden,but the burden on the state and society can't be improved.4.Response rates,the coefficient of experts authorities and consistency of the risk assessment system for DILI with Delphi method met the requirement.The items are simple and easy to understand and convenient for clinical use,which can provide reference for the screening of high-risk population with DILI in clinically.But,the risk assessment system for DILI has yet to be further prove.5.Several limitations of this study need to be noted.Firstly,the risk assessment index system of DILI didn't cover race and genetic factor.Second this study's indexes were collected from past literature and expert's comment.So it is needed to employ more objective and more accurate validity criteria to establish the risk assessment index system for DILI in the future.