Investigation On Economic Burden Of Patients Of Hand,Foot And Mouth Disease In Hebei Province

Objectives To estimate direct economic burden(direct medical cost,direct non-medical cost)and indirect economic burden of different types of HFMD,by investigating economic burden of HFMD patients in Hebei province.To understand the specific economic effects of HFMD on patients and their families,and then estimate the total economic burden of HFMD in Hebei province,and explore the influence factors that may affect the economic burden of HFMD,and provide the basis for further development of related disease control strategy and health economic policy.Methods By applying stratified random sampling method and according to the 2016 municipalities per capita GDP of Hebei Province,the cities was divided into two economic level of high and low.Each layer randomly selected a city and these select patients were diagnosed by Real-time RT-PCR from May 1,2017 to August 31,2017 at HFMD network laboratory in the two cities.Get the information of the economic burden of patients with HFMD through questionnaire and telephone.Descriptive analysis was carried out on the basic situation and economic burden of HFMD patients collected in various cities.The single factor analysis of direct medical cost,direct non-medical cost,indirect economic burden and total cost of HFMD patients were carried out with rank sum test.The economic burden of HFMD patients was analyzed by using binary logistic regression model.Results 1 Patients with younger,scattered,rural and household with lower per capita yearly income were mostly hospitalized and severe form of HFMD.2 The median direct medical cost of outpatients,ordinary and severe inpatients was 300.00,1100.00 and 6000.00 yuan,which accounted for 37.40%,51.07% and 84.10% of median total cost of the corresponding case type respectively.The median total cost of severe inpatients was 7134.50 yuan and 7864.99 yuan in urban and rural areas,which accounted for 25.26% and 65.99% of per capita disposable income of urban and rural residents respectively.The overall economic burden attributable to HFMD was over 60 million yuan in Hebei in 2017,among which due to other enterovirus infections was up to 35.6768 million(55.89%)yuan.3 The influencing factors of HFMD outpatients direct medical cost were medical insurance(OR=7.038,P=0.001),household per capita yearly income(P<0.001),pathogenic types(P<0.001),course of disease(P=0.013).The ordinary inpatients influencing factors included the medical insurance(OR=9.020,P<0.001),economic level(OR=0.499,P=0.005),household per capita yearly income(P=0.002),pathogenic types(P<0.001),time interval which from onset to diagnosis(P=0.003),grade of the highest medical institution that visited(P<0.001),course of disease(P=0.002).4 The influencing factors of HFMD outpatients direct non-medical cost were medical insurance(OR=6.762,P<0.001),residence(OR=1.971,P=0.015),economic level(OR=6.605,P<0.001).The ordinary inpatients influencing factors included the medical insurance(OR=0.291,P=0.041),household per capita yearly income(P<0.001),pathogenic types(P<0.001),residence(OR=1.854,P=0.030).The severe inpatient influencing factors was the course of disease(P=0.032).5 The influencing factors of HFMD outpatients indirect economic burden were residence(OR=0.330,P<0.001),course of disease(P<0.001).The ordinary inpatients influencing factors included the residence(OR=0.015,P<0.001),economic level(OR=0.194,P<0.001),household per capita yearly income(P<0.001),course of disease(P<0.001).The severe inpatient influencing factors was the course of disease(P=0.008).6 The influencing factors of HFMD outpatients total cost were medical insurance(OR=3.878,P=0.009),household per capita yearly income(P<0.001),pathogenic types(P=0.013),time interval which from onset to diagnosis(P=0.016),course of disease(P<0.001).The ordinary inpatients influencing factors included the household per capita yearly income(P=0.014),pathogenic types(P<0.001),grade of the highest medical institution that visited(P<0.001),course of disease(P<0.001).Conclusions 1 Patients with younger,scattered,rural and household with lower per capita yearly income were mostly hospitalized and severe form of HFMD,and the family of severe inpatients with relatively heavy economic burden in rural areas.2 The overall economic burden attributable to HFMD was over 60 million yuan in Hebei in 2017,which accounted for 0.02‰ of the province's GDP,and the direct medical cost was an integral part of the economic burden of HFMD patients.3 The total economic burden of HFMD caused by other enteroviruses was relatively high,and it is of great significance and function to reduce the economic burden of HFMD by strengthening the prevention and control of HFMD caused by other enteroviruses.4 The main influencing factors of HFMD patients economic burden were medical insurance,household per capita yearly income,pathogenic types,course of disease.