Chi Phí Điều Trị Trên Trẻ Sơ Sinh Bệnh Tim Bẩm Sinh Nặng Được Can Thiệp Tim Mạch Tại Bệnh Viện Nhi Đồng Thành Phố Từ 08/2018 Đến 08/2020

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Tác giả: Ngọc Vân Phương Nguyễn, Thị Kim Yến Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.211

Bộ sưu tập: Metadata

ID: 339162

Thêm vào giỏ Liên kết toàn văn

- Mục tiêu: Xác định chi phí y tế trực tiếp và các yếu tố ảnh hưởng đến chi phí y tế trực tiếp của trẻ sơ sinh mắc bệnh tim bẩm sinh nặng được can thiệp tim mạch.- Phương pháp nghiên cứu: Nghiên cứu cắt ngang, hồi cứu 162 hồ sơ bệnh án trẻ sơ sinh bệnh tim bẩm sinh nặng được thông tim, mổ tim tại bệnh viện Nhi Đồng Thành Phố từ tháng 08/2018 đến tháng 08/2020.- Kết quả: Tổng chi phí y tế trực tiếp của trẻ sơ sinh bệnh tim bẩm sinh nặng có trung vị 104,0 triệu đồng, bảo hiểm y tế thanh toán trung vị 83,3 triệu đồng. Trong nhóm thông tim, trung vị tổng chi phí điều trị là 86,6 triệu đồng bao gồm chi phí về lâm sàng trung vị 55,3 triệu đồng, chi phí về cận lâm sàng trung vị 16,1 triệu đồng và chi phí điều trị khác trung vị 8,3 triệu đồng. Trong chi phí lâm sàng, vật tư y tế chiếm nhiều nhất (47,8 triệu đồng). Chi phí cao nhất thuộc nhóm tứ chứng Fallot (112,1 triệu đồng) và phương pháp đặt stent đường thoát thất phải (116,8 triệu đồng). Trong nhóm mổ tim, trung vị tổng chi phí điều trị là 120,3 triệu đồng gồm chi phí về lâm sàng trung vị 82,4 triệu đồng, chi phí về cận lâm sàng trung vị 18,1 triệu đồng và chi phí điều trị khác trung vị 15,3 triệu đồng. Chi phí cho vật tư y tế và thủ thuật chiếm nhiều nhất, lần lượt là 31,6 triệu đồng và 31,3 triệu đồng. Chi phí cao nhất thuộc nhóm thiểu sản tim trái được phẫu thuật Norwood (RACHS-1 nhóm 6) 226,1 triệu đồng. Thời điểm chẩn đoán sau 3 ngày tuổi, truyền PGE1, thời gian chờ can thiệp trên 3 ngày, biến chứng và nhiễm trùng bệnh viện là các yếu tố có thể làm tăng chi phí điều trị ở cả hai nhóm thông tim và mổ tim (p <
0,05).- Kết luận: Tổng chi phí y tế trực tiếp của trẻ sơ sinh bệnh tim bẩm sinh nặng có trung vị 104,0 triệu đồng (trong đó, trung vị chi phí của nhóm thông tim là 86,6 triệu đồng và nhóm mổ tim là 120,3 triệu đồng). Chi phí lâm sàng chiếm 70% với hạng mục vật tư y tế chiếm tỷ trọng cao nhất. Nhóm bệnh thiểu sản tim trái có chi phí điều trị nhiều nhất 226,1 triệu đồng. Để giảm bớt gánh nặng chi phí bệnh tật này, cần lưu ý thêm các yếu tố có thể làm tăng chi phí điều trị như thời điểm chẩn đoán, thời gian chờ can thiệp, biến chứng và nhiễm trùng bệnh viện.Abstract- Objective: This study aims to estimate the direct medical expenditure and related factors of critical neonatal congenital heart disease at City Children Hospital.- Method: A cross sectional study of 162 medical records of neonates with critical congenital heart disease treated by catheter or surgical intervention at City Children hospital from 08/2018 to 08/2020.- Results: Median total direct medical expenditure of neonates with critical congenital heart disease was 104.0 million VND, in which median health insurance covered 83.3 million VND. For the catheter intervention group, median treatment expenditure was 86.6 million VND, including clinical cost, subclinical costand other treatment cost at 55.3 million, 16.1 million and 8.3 million VND respectively. Most of the clinical cost was for medical instruments (47.8 million VND). Largest expenditure was for the Fallot group (112.1 million VND) and for the RVOT stenting group (116.8 million VND). For the surgical intervention group, median treatment expenditure was 120.3 million VND, including clinical cost, subclinical cost and other treatment cost at 82.4 million, 18.1 million and 15.3 million VND respectively. Most of the clinical cost was for medical instruments (31.6 million VND) and procedures (31.3 million VND). Largest expeniture was for hypoplastic left heart syndrome with Norwood operation (RACHS-1 group 6) 226.1 million VND.Diagnosis point after 3 days old, PGE1 infusion, intervention waiting time more than 3 days, complications and nosocomial infection were possible related factors of treatment expenditure increment in both catheter and surgical intervention group (p <
0,05).- Conclusion: Median total direct medical expenditure was 104.0 million VND (whereas, median treatment cost of catheter and surgical intervention groups were 86.6 million VND and 120.3 million VND respectively). Clinical expenditure occupied 70%, mostly for medical instruments. Hypoplastic left heart syndrome had highest treatment cost at 226.1 million VND. To lessen treatment expenditure, diagnosis point, intervention waiting time, complications and nosocomial infection should be taken into account. DOI: 10.59715/pntjmp.1.1.27

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