儿童急性白血病移植期间医院感染经济负担

Economic burden due to hospital-associated infections in children with acute leukemia during transplantation

  • 摘要:
    目的 分析儿童急性白血病移植期间医院感染发生率及经济负担,为制定医院感染管理策略提供科学依据。
    方法 选取2018年1月1日-2024年6月30日山东第一医科大学第一附属医院儿童血液科住院的急性白血病且行造血干细胞移植的患儿140例为研究对象,收集患儿临床资料、感染情况和费用资料,采用倾向指数匹配法将医院感染组与非感染组按照1∶1匹配,比较感染组和非感染组住院天数和各项医疗费用,估算医院感染造成的经济负担。
    结果 140例患儿发生医院感染59例,感染发生率为42.14%。纳入符合纳排标准的患儿125例,倾向性评分匹配成功53对。感染组患儿匹配后的住院费用中位数为230 125.79元,非感染组为189 880.90元,两组比较差异有统计学意义(Z=-2.038, P=0.042),急性白血病患儿医院感染的直接经济负担为40 244.89元。在各项费用中,西药费、自付费用和抗菌药物费的中位数上升最为明显(均P<0.05)。
    结论 实施医院感染目标性监测并对疑似病例及时预警,以降低医院感染发生率,是减轻患儿及家庭经济负担的重要策略。

     

    Abstract:
    OBJECTIVE To investigate the incidence of hospital-associated infections among the children with acute leukemia and analyze the economic burden so as to provide scientific bases for formulating the hospital infection management strategies.
    METHODS A total of 140 children with acute leukemia who were hospitalized in pediatric hematology department of the First Affiliated Hospital of Shandong First Medical University and underwent hematopoietic stem cell transplantation from Jan. 1, 2018 to Jun. 30, 2024 were recruited as the research subjects. The clinical data, incidence of infections and cost data were collected. The infection group and the non-infection group were matched in a 1∶1 ratio by propensity score matching method. The length of hospital stay and costs of medical items were compared between the infection group and the non-infection group. The economic burden due to the hospital-associated infections was estimated.
    RESULTS Of the 140 children, 59 had hospital-associated infections, with the incidence of infections 42.14%. A total of 125 children who conformed to the inclusion and exclusion criteria were included in the study, among whom 53 pairs were matched successfully by propensity score matching method. The median hospitalization cost was 230, 125.79 yuan in the infection group after the matching, 189, 880.90 yuan in the non-infection group, and there was significant difference between the two groups(Z=-2.038, P=0.042). The direct economic burden due to the hospital-associated infections in the children with acute leukemia was 40, 244.89 yuan. The median costs of western medicine, self-pay and antibiotics were increased most remarkably among all the costs of medical items (all P < 0.05).
    CONCLUSION The targeted surveillance of hospital-associated infections and early warning of suspected cases are the major strategies to reduce the incidence of infections and relieve the economic burden.

     

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