TCNCYH Phy trUOng 80 (3B) - 2012
Trichuris tnchiura is 100%, and the rate of eggs elimination of Ancylostoma duodenale/Necator amencanus Is 83.19%. No detection of the unwanted effects of the drug has been found.
Keyvirords: soil transmitted helminthiasis, infection prevalence
CHI PHi CUA BENH NHAN SUY THAN MAN GIAI DOAN CUbl
ei^u TRj B A N G Lgc M A N G B U N G T A I N H A V A B A N G LOC
THAN NHAN TAO TAI CO Sd Y Jt
Phan Van Bau^ Pham Huy Tuan Kigt^
III S#n/i vi$n Nhin din 115- TPH6 Chl Ivlinh, W Dai hgc YHa Npi
Nghien euu duoc tiin hanh so sanh chi phi tir phia b$nh nhin suy thin man giai doan cuoi choice ming bung tai nhi vi cho ipc than nhin tao tai Tnjng tam Lgc than - Benh viin Nhan dan 115-TP Ho Chl Minh Ting so b$nh nhin suy th$n man glal doan euil tham gia ng/iien cdv /a 595, tmng dd. 235 loc ming blinj va 360 Ipc than nhan tao. Banh nhan duvc IQC mang bung co chi phi (don vi nghin ddng) true tiip ngoaiyti la 1402,36 ± 76,63, tn/e flip cho y ti li 2460,60 ± 326,23 vi giin tiip la 1120,34 ± 385,92, diu thip hdn so vdi chi phi tuang duong la 1733,47 ± 2,32, 4438,07 ±416,aSvi 2997,18 ± 559,74 eiia nhdm benh nhin IQC than nhin tao Kit gui nghien cuv cho thay phuong phap IQC mang bung glim dang ke ehi phi diiu tri suy than man, can duQic md rpng vi ed co ehe Idiuyen l<hleh
Tip khoa: Chl phi loc mdng byng, chi phi Igc than nhan tgo
I. DAT V A N D 6 '"Jng oho phep thyc hien tai nha trong khi Igc thdn nhan tgo yeu clu bgnh nhan den co sd y Tir nam 2008, Tmng tdm Lgc thgn - Bgnh
vign Nhdn dan 115 - TP Ho Chi Minh trd thanh mgt trong nhyng ca sd y t l dau tidn trong cd nude triln khai va qudn ly Igc mdng byng cho bgnh nhdn suy thgn man giai dogn cuoi. Ap dgng phuong phap mdi md ra triln vgng them nhieu bgnh nhdn ed thl duy tri cugc song khi 90% bjnh nhdn suy thgn man d Vigt Nam phdi tir vgng do khong dugc dieu tri vl h$ thong y t l con hgn chl kha nang ddp u'ng nhu cau. Ngay Trang tdm Lgc thgn - Bgnh vign Nhdn ddn 115, mgc du la mpt trcng nhu'ng tnjng tam Idn nhat trgng ea nude, "vdi gan 50 mdy chgy th^n nhdn tgc, phai chay hit ccng suat 4-5 ca/ngay, nhyng vin chya ddp irng hit yeu cau dilu trj"
[6]. Mgt khde, ban chat vd quy trinh Igc mdng
t l tilp cgn mdy chgy thgn nhdn tgo ddn den gia thuylt phuang phap mdi giup gidm mgt sg chi phi tir phia b$nh nhan nhu di Igi, dn d, mat thu nhgp khi dieu tn tgi bgnh vign...
Myc tieu: Sg sdnh ehi phf tryc tiep ngoai y t l , cho y t l va chi phi gidn tilp cua bgnh nhdn dilu trj lgc mang byng vdi lgc thgn nhdn tgg tgi Trung tdm Lgc thgn - Bgnh vign Nhdn dan 115-TP Ho Chi Minh
II. Do! tifiyng va phifcng phap T h i l l k l nghien ciru: Nghien cO'U md td cat ngang
Dja dilm nghien ciru: Taing tam Lgc thgn - Bgnh vi#n Nhdn ddn 115 - TP Ho Chl Minh
TCNCYH Phu trUdng 80 (3B) - 2012 Doi tuyng nghidn edu: B0nh nhdn dilu trj lgc mdng bpng vd dilu trj Ipc thdn nhdn tgo duyc quan ly bdi Trung tdm Igc th0n - Bpnh vipn Nhdn ddn 115.
Cbng cu, ehi s6 vd biln s6 nghidn edu:
Phbng vdn b0nh nhdn v l cdc chi phi tryc tilp:
chl phi y t l , ehi phi ngodi y t l nhu di Igl, dn d eua ban thdn vd ngudi dl cung (nlu cb) vd cdc chi phi gidn tilp do mit thu nh0p, eho lao dbng thay thl, cho chdm sbc vd trd ldi do vay muyn [3].
Phuang phdp thu thdp dd Ii0u: Tiln hanh phbng vin doi tuyng nghien cuu trong ndm 2011, dya trdn bbeSu hbicbsSnsau khi duyc ldp huln.
Nhdp va xu ly s l Ii0u; S6 Ii0u dinh luyng duyc nhdp bdng phin mlm Epi Data 6 vd xu ly bdng phin mem SPSS 18.0 Thong ke mb ta tinh gid tri trung binh cdc logi chi phi ± khodng tin cgy 95%. Kilm dinh t-student va test)( duyc su dyng trong thing ke phan tieh. Sy khdc bipt cb y nghTa thong ke khi gia tq p < 0.05. Sy khae bi0t rat cb y nghTa thong ke khi p < 0,001.
Dgo ddc nghien cdu: Nghien cuu duyc liln hdnh trong khuon kho hoat dpng hyp tde
nghibn euu ciia B0nh vi0n Nhdn ddn 115-TP HCM vdi Trung tdm Ddnh gid Kinh te Y t l - Dgi hpe Y Hd Npi. Nghien euu nhgn duyc sy h i try phuang phdp eOa cdc chuydn gia tu vin QuIe l l Idm vl0c vdi Dgi hpe Y Hd NOi.
Mpl thbng Im cd nhdn v l dii tuyng nghidn cifu • duye gid bl m0t.
III. K ^ T QUA
1. Thbng tin chung ve doi tuyng nghien ciru
Ting s6 b0nh nhdn tham gia nghien ciru Id 595, trong db, Ipe mdng byng la 235 vd Ipc th0n nhdn igo Id 360. Sy khde bi0l ve ty 10 gidi tinh giua hai nhbm b0nh nhan khbng co y nghTa thing kb (p=0,267). Tuli trung binh vai khoang lin c0y 95% d nhbm lgc mdng byng Id 49,18 ± 2,05 khde bipt sc vdi 51,76 ± 1,62 b nhbm Igc thdn nhdn tgo (p=0,052). 40% b0nh nhdn Igc mdng byng Idm vl0c tgi nhd so vbi 23,9% d nhbm Igc thdn nhdn tgo.
2. Chi phi dl Igi va an d
Bang 1 so sdnh chi phi di Igi vd dn d gija hai nhbm b0nh nhdn suy thgn mgn Ipc mdng bung tgi nhd vd Ipe thdn nhdn tgo tgi b0nh vipn:
Bang 1. Chi phi di Igl va an d ciia hai nhbm bpnh nhan stt.
1,1
1.2
1.3
1.4
S6 lln trung binh din bgnh vign hdng thdng Thai gian trung binh di tir nhd din bgnh vign (phiit) Chi phi trung binh mli lln dl lai ciia b§nh nhdn (Nghin dong) Chi phi trung binh cho dn uong moi lln cua b^nh nhdn (Nghin ding)
Lgc mang byng 2,65 ± 0,36
124,72± 20,70
341,31 ± 109,31
34,23 ± 6,80
Lgc thgn nhan t^o 11,77 ±0,13
48,79 ± 4,76
74,67 ±10,63
39,33 ± 2,29 P
< 0,001
< 0,001
< 0,001
0,107
1.5 Ty Ig % bgnh nhan co ngydi nhd di ciing
63,3% 0,819
TCNCYH Phy trUOng 80 (38) - 2012
Loc mang bung Loc than nhan tgo 1.6 Chi phi trjjng binh moi lln di Igi 187,89 ± 140,23 25,20 ± 4,09
ciia ngudi di eung (Nghin dong)
1.7 Chi phi trung binh eho dn uong moi lan 31,07 ± 7,96 eiia ngudi dl cung (Nghin dong)
1.8
1.9
1.10
Ty Ig % bgnh nhdn phai ngii nghi Igi d thdnh phi khi din bgnh vi^n Chi phi trung binh cho ngii, nghi khi din vign (Nghin ddng) Tgng chi phi tryc tilp ngodi y t l hdng thang
4,3%
350,00 ± 68,52 1402,36 ±76,63
1,4%
76,00 ± 48,65
1733,47 ±2,32 0,029
< 0,001
< 0,001
Mdc du b0nh nhdn Ipe mdng byng tgi nhd d xa bpnh vi0n han, nhung do so lan din bpnh vien it han nen eb tong chi phi tryc tiep ngoai yte cho di Igi, dndciiab0nh nhan va ngudi di eiing (nlu cb) thap han so vdi b0nh nhdn Ipe than nhdn tgo tai benh vi0n.
3.3. Chi tra cho y te
99,6 % b0nh nhan Igc mdng byng tgi nhd va 98,9% benh nhan Ipe than nhan tgo tgi b0nh vien cb the bao hiem y t l va duye bao hiem y t l ehi tra theo quy djnh. 8en canh db, cac chl tra them hang thang (tinh bdng nghin dong) cho y te eiia nhbm bpnh nhan Ipe mang byng la 2460,60 ± 326,23 thap han 4438,07 ± 416,89 (p < 0,001) cua nhbm b0nh nhan Ipc than nhdn tgo.
3.4. Cac chl phi gian tiep
Bang 2 so sdnh cae logi ehi phi gidn tilp giua hai nhbm bpnh nhan lgc mdng byng tai nha vd Ipc than nhan tgo tgi bpnh vi0n:
Bang 2. Cac logi chi phi gian tilp giira hai nhbm benh nhan
Stt. Lpe mang bgng Lpc than nhan tgo p 2.1 Thu nhgp mat di hdng thang do 959,08 ± 302,35 2451,79 ± 388,64 < 0,001
phai den b0nh vien cua nhbm b0nh nhan eb ebng viec tgo thu nhdp
2.2 Ty [0 % bpnh nhdn cb ngudi lam 10,6% 12,6% 0,477 hb cbng viec tgo thu nhgp khi hp
den bpnh vi0n
2.3 Ty 10 % nhung ngudi ndy la thdnh 92,0%
vien hp gia dinh .
309
TCNCYH Phy trUdng 80 (3B) - 2012
Stt.
2.4
2,5
2.6
Ty Ig % nhOng ngydi thyc hl$n hO cdng vi$c dugc trd cdng S l tien trung binh hg dugc trd edng hdng thdng
Ty Ig % nhu'ng ngydi ndy m i l thu nh^p do phdi ngyng cdng vi$c ciia
Lgc mang bgng 12,0%
976,47 ± 680,94
33,8%
Lgc thgn nhan tgo 16,3%
2538,1 ±675,79
33,3%
P 0,621
0,057
0,965
minh Igi
2.7 S6 tiln hg m i l hdng thdng 333,0 ±261,33 1900,0 ± 830,73 0,057 2.8 Ty 10 % b$nh nhan 42,3% 68,1% < 0,001
cin ngudi chdm sdc 2.9
2.10
2.11
-2.12 2.13 2.14 2.15 2.16 2.17 2.18
Ty Ig % ngydi chdm soc Id thdnh vidn hg gia dinh
Ty Ig % ngydi eham sdc dyge trd edng S l tiln trung binh hg nhgn hang thdng Ty le % bgnh nhdn vay mygn Vay tu' gia dinh
Vay tir ban be Vay ngdn hdng
Ty Ig % bgnh nhdn phdi trd lai So tiln lai hg phai trd hdng thdng Tong ehi phi gidn tilp hang thdng
93,1%
7,0%
1875,00 ±1137,90
35,2%
56,1%
22,0%
26,8%
48,7%
474,81 ±185,81 1120,34 ±385,92
90,9%
8,6%
1954,35 ± 513,60
53,5%
56,6%
21,2%
18%
47,6%
1174,45 ±362,41 2997,18 ±559,74
0,504
0,614
0,888
< 0,001 0,937 0,885 0,099 0,879 0,002
< 0,001 Tong chi phi gidn tilp hdng thdng eua bgnh nhdn Igc mdng byng Id 1120,34 ± 385,92, thip han 2997,18 ± 559,74 ciia nhdm b^nh nhdn Igc thjn nhan tgo. Sy khdc bigt cd y nghTa thong k6.
5. Can doi thu nhgp vdi chi phi
Bang 3 can doi thu nhgp (tinh cd vay) so vdi chl phi ciia hai nhdm bdnh nhdn Igc mdng byng tgi nha vd lgc thgn nhdn tgg tgi bgnh vign:
TCNCYH Phy trUOng 80 (3B) - 2012 Bang 3. Thu nhgp va chl phi
Lgc mdng byng Lgc than nhan tgo p 3.1 Ty Id % bgnh nhdn cd cdng vide
tgo thu nhgp
30,6% 14,4% = 0,001
3.2 Thu nhgp trung binh/thdng ciia 10269,17 ± 7679,90 6175,96 ± 3276,31 0,398 nhom bgnh nhan cd cdng vigc
tgo thu nhgp (Nghin dong) 3.3
3.4 3.5
3.6
3.>
3.8
Ty Ig % bgnh nhan phai bdn d l d l Igc thgn S l tiln bdri dyge lan cuoi So thang dii tu tiln bdn d l lln cuoi Chi phi tryc tilp ngoai y t l (tir ddng 1.10 bang 1) Chi phi tryc tilp eho y t l (tir mue 3.3) Chi phi gidn tilp
16,6%
21700,00 ±21167,70 4,97 ±4,11
1402,36 ±76,63
2460,60 ± 326,23
1120,34 ±385,92
26,1%
74601,06 ±85905,00 2,54 ± 0,75
1733,47 ±2,32
4438,07 ±416,89 2997,18 ±559,74
0,006
0,402 0,100
< 0,001
p< 0,001
< 0,001 (tir ddng 2.18 bang 2)
3.9 3.10
Tong thu nhdp ( k l cd vay) Tong ehi tir phia bgnh nhdn cho Igc mau ngodi thgn
3867,15 ±3205,00 4933,3 ± 788,78
8555,03 ± 30366,72 9168,72 ±978,95
< 0,656
< 0,001
B0nh nhdn Ipe mang bgng eb thu nh$p trung binh/ thang cao han nhbm bpnh nhan Ipe thgn nhdn tgo. Tuy nhien su khae bi0t khbng cbi/nghTathongke. Doehiphieaohan, nhbm bpnh nhdn lpe than nhan tgo vay nhilu han nhom b0nh nhdn lpc mdng byng. Hl0u sb giua gid tri trung binh eua thu va ehl d ca hai nhbm bpnh nhan deu dm.
jv. BAN LUAN
Nhieu nghien cdu phdn tich ehi phi Ipe mdu ngodi than duye thyc hl0n tai My, Phdp, Canada vd Y vdo gida nhung ndm 90 eOa t h l k^ tardc cung cho thay dilu trj bpnh nhan suy thgn man giai dogn culi bdng Igc mang byng
tgi nhd eb chi phi thap han so vdi dilu trj bdng lgc thgn nhdn tgc tgi b0nh vipn [1,2,4,5].
Theo so Ii0u thong ke nam 2011 thi thu nhgp tnjng binh eua ngudi Vi0t Nam vdo khodng 1300 USD/ngudl/ nam (tuang duang 27.105.OOOVND tgi thai diem nghien edu) [7].
Tu nghien edu tgi benh vipn Nhan dan 115-TP Ho Chl Minh, eb the nhgn thdy chl phi tu phfa b0nh nhan eho dieu tri lgc mang byng bdng 221
% va eho dieu tn Ipc than nhdn tgo bdng 406%
thu nhgp binh quan tren dau ngudi mpt nam.
Nghien cuu ehi phi eho dieu tri b0nh tdt nbi chung va bpnh than nbi rieng ebn rat mdi d Vipt Nam. Nghien euu ndy mang tinh tien 311
T C N C Y H Phy t r u o n g 80 ( 3 8 ) - 2 0 1 2
phong. Y vdn trong n u d e khdng cd cdc nghidn ciru t y a n g t y d l cd t h l bdn ludn vdi k i t qua nghien ciru ndy.
V. K t T L U A N V A K I ^ N N G H j Mdc dii bdo h i l m y t l dd chl trd p h i n Idn cde ehi phi y t l cho lgc mdu ngodi thdn n h u n g chi phi t u phIa bdnh nhdn v i n t u 221 - 4 0 6 % thu nhgp binh qudn trdn d l u n g u d i m^t ndm.
D i l u ndy cho t h i y . suy thdn mgn gtai dogn c u l l Id mgi gdnh ndng b$nh tdt ddng k l , Mgi ehi phi tryc tiep vd gidn t i l p cho Igc mdng byng tgi nhd d l u t h i p h a n cho Igc thdn nhdn Igo tgi c a s d y t l . Bg Y t l c i n cd ehlnh sdch k h u y i n khich vd quy djnh lgc mdng byng Id d i l u trj ban d l u bdt huge cho bdnh nhdn suy thdt mgn giai dogn cuoi.
T A I L I E U T H A M K H A O
2. J a c o b s C (1997). T h e costs of dialysis treatments for patients with end-stage renal disease in France, Nephrol Dial Transplant, 12(Suppl 1 ) : 2 9 - 3 2 .
3. N g u y i n T h | K i m C h u c (2007). Kinh le Y t l vdo Bao h i l m Y t l , Sach ddo tgo Bdc sf da khoa, Vy Khoa hgc vd D d o tgo, Bg Y t l .
4. P r i c h a r d S (1997). The costs nf dialysis in Canada, Nephrol Dial Transplant, 12(Suppl 1 ) : 2 2 - 2 4 .
5. P i c c o l i G, F o r m i c a M, Mangiarotti A , PacittI A , P i c c o l i G B (1997). The costs of dialysis in Italy, Nephrol Dial Transplant, 1 2 ( S u p p l 1 ) : 3 3 - 4 4 .
1 . Garella S (1997). The costs of dialysis in the USA, Nephrol Dial Transplant, 12(Suppl 1): 1 0 - 2 1 .
6. S a i g o n Giai p h o n g (2010). Ganh ndng suy t h ^ n m g n , http://www.sggp.org.vn/
ytesuckhoe/2010/7/231685/.
7. T o n g e y e t h o n g ke (2011). So li?u thong ke Kinh te - Xd hgi 2 0 1 1 , Nha xuat ban T h i n g ke.
S u m m a r y
COSTS OF END STAGE R E N A L FAILURE PATIENTS T R E A T E D BY HOME P E R I T O N E A L DIALYSIS A N D H O S P I T A L H A E M O D I A L Y S I S Objective of the research was to compare costs of end stage renal failure patients far home pentoneal dialysis and haemddialysis at Dialysis Center, People's Hospital 115 - Ho Chi Ivlinh City Total of patients with end-stage renal failure participating in the research was 595, of which, 235 ware treated by pentoneal dialysis and 360 were treated by haemodialysis Home peritoneal dialysis patients had non-medial dired cost of 1402.36 ± 76.63, medical direct cost of 2460.60 ± 326,23 and indirect cost of 1120.34 ± 365.92.
They were lower than the equivalent costs of 1733.47 ± 2.32.4438.07 ± 416.89 and 2997.18 ± 559.74 by the hospital-based haemodialysis patients. In Cdnclusldn, research results provided evidence of signlUcant cost reduction by peritoneal dialysis for treatment ol end stage renal failure. The method needs to be expanded and on incentive mechanism.
K e y w o r d s : C o s t f o r p e r i t o n e a l d i a l y s i s , c o s t f o r h a e m o d i a l y s i s
